Cardiac Exam lecture 3

Question 1

Where do we cyanosis? _______, tip of nose, tip of the ears

Answer 1

lips

Question 2

If we have cyanosis acutely we see the _______, the gray, the discoloration

Answer 2

blue

Question 3

If we have someone who has chronic loss oxygen or oxygenation then you see __________

Answer 3

clubbing

Question 4

Tangential lighting is a pen light or light from your phone looking for pulsations on the neck like carotid or jugular veins you can see those pulsating

Question 5

We are only palpating one carotid at a time

Question 6

Diameter is about the size of a nickel

Question 7

Only use ______fingers to find PMI but you have to move around intercostal space a bit to really feel it and it helps if you lean forward on the left hand side so the heart is now against the chest wall…those ribs and those intercostal spaces so that you can palpate it

Answer 7

two fingers

Question 8

If someone has cardiovascular disease and they have plaques in that carotid artery and carotid artery becomes more narrow do you think its going to be peaceful flow or turbulent flow so what do you think that’s going to sound like? Really loud so think about everytime that heart contracts and pushing that blood through that much thinner artery than what its use to or a thinner space your going to hear it so a carotid bruit is when you have your bell over the carotid artery and you ask the pt to hold their breath for a second or two and that’s what your listening for is that swishing sound so if pt has heart disease or heart failure your probably going to hear bruits it may be on the right or left one or the other

Question 9

Tomorrow when you hear your classmates for a bruit you will NOT hear anything the blood is just flowing there is no resistance in there…its NOT narrow

Question 10

Cardiac Exam: Auscultation

Listen in order over all valve areas with
diaphragm

Go back over all areas with bell

Concentrate on each part of cardiac cycle
in isolation

“RRR, no M/R/G”

Question 11

Cardiac Exam: Palpation of carotids

One carotid at a time

Question 12

RRR=____________________

Answer 12

Regular rate rhythm

Question 13

M/R/G=

Answer 13

no murmurs, rubs, or gallops

Question 14

Regular rate rhythm is normal…we want a regular consistent rate and we want rhythm to be a normal sinus rhythm

Question 15

(murmurs, rubs, or gallops)= Extra sounds you might hear depending on how much fluid is on board or they have heart failure like S3 or S4

Question 16

S1= _________

Answer 16

love,dub

Question 17

Where can we hear the aortic and pulmonic valves the loudest?

Answer 17

Second intercostal space left and right

Question 18

When you put the diaphragm on your chest tomorrow and your listening whats going to sound louder up here love or dub?

Answer 18

Dub because its S2

Question 19

S1 is mitral

Answer 19

Tricuspid is S1

Question 20

S1 is going to sound louder at the _______of the heart

Answer 20

apex

Question 21

S2 is louder up here