Cardiac Exam Competency Flashcards
Where is the listening post for the aortic valve?
Right 2nd ICS at sternal border (Right upper sternal border)
Where is the listening post for the pulmonary valve?
Left 2nd ICS at sternal border (left upper sternal border)
Where is the listening post for the tricuspid valve?
Left 4th ICS at sternal border (left lower sternal border)
Where is the listening post for the mitral valve?
Left 5th ICS at mid-clavicular line (at heart apex)
What are the 6 peripheral pulses?
RadialBrachialFemoralPoplitealDorsalis edisPosterior tibial
What can a slow capillary refill be indicative of?
Arterial occlusionHypovolemic shockHypothermia
What is a normal capillary refill time?
2 seconds or less
How is pitting edema graded?
0 = absent1 = barely detectable nonpitting (2mm)2 = slight indentation (4mm); 10-15 sec3 = Deeper indentation (6mm); can be >1min4 = very marked indentation (8mm); 2-5 min
How do you examine for pitting edema/in what 3 places do you assess?
By pressing firmly for 5 seconds over the dorsum of the foot, behind the medial malleolus, or over anterior tibia
What do you assess for at the carotid pulse?
Thrills and bruit -> can use stethoscope bell
How are heart murmurs graded?
1 = very faint2 = quiet, but heard easily with stethoscope3 = moderately loud, no thrill4 = loud with palpable thrill5 = very loud with stethoscope partially off chest6 = heard without stethoscope
During which heart sounds is a systolic murmur heard?
Between S1 and S2
During what heart sounds is a diastolic murmur heard?
Between S2 and S1
What high pitched sounds are listening for with the diaphragm of your stethoscope?
S1S2ARMRFriction rub
What low pitched sounds are you listening for with the bell of your stethoscope?
S3S4MSCarotid bruit
What are the landmarks used for inspecton during a normal cardiac exam?
Sternal notch and angleSternal borderMid clavicular lineAnterior axillary lineXiphoid processNipples
What is the point of maximal impulse (PMI) used to estimate?
The location of the apex/left border
What are characteristics of a normal point of maximal impulse (PMI)?
- Should be small, brisk beat and measure less than 2.5cm- Should last through the first 2/3 of the systolic period (or less) - SHouldnt be felt through the second heart sound
What is the proper way to percuss when performing a normal cardiac exam?
Start left where “resonant” (lung) and move medially to find cardiac “dulness”- Use percussion to estimate cardiac size when PMI not detectable
What should S3 and S4 dound like?
Dull and low pitched -> heard best with bell of stethoscope
What are systolic murmurs indicative of?
Aortic stenosisPulmonary stenosisMitral regurgitationTricuspid regurgitation
What are diastolic murmurs indicative of?
Aortic regurgitation Pulmonic regurgitation MItral stenosisTricuspid stenosis
Where is the carotid pulse felt?
Medial to the SCM
How are peripheral pulses graded?
4 = bounding 3 = strong, full, increased2 = normal, average intensity1 = diminished, barely palpable0 = absent
What is Erb’s point and where is it heard?
the point at which S1 and S2 are heard equally; heard at L 3rd ICS at SB
Pressure on the carotid baroreceptors when taking a carotid pulse may cause what?
A hypotensive reflex and possible fainting
What 3 things in particular can capillary refill test for?
Tests for digital perfusion so it can test for arterial occlusion, hypovolemic shock and hypothermia
