Cardiac Exam Supplement II Flashcards
Where is PMI?
4th or 5th intercostal space at midclavicular line
What is the significance of JVP?
Level of JVP visibility gives indication of RAP
How do you look at JVP?
- Place patient supine allow veins to engorge
- Raise patient 30-45 degrees
- Most peoples hearts are 5 cm below the horizontal plane of the sternal notch
- Measure height of most distended part of vein to the sternal notch
- 0-9 is normal
S2?
Reflects diastole, closure of ASL and PSL valves
What is A wave?
- Right atrial contraction
- triscupid open coincides with S1
- Preceeds carotid pulsation
What can cause a giant A wave?
- obstruction between RA and RV
- Increasaed RV pressure
- Pulm Htn
- Recurrewnt pulmonary emboli
- AV dissociation
What is C wave?
- Backwards push by closure of the Tricuspid valve during isovolumetric systole and impact of carotid artery adj to JV
What is X wave
- Passive atrial filling and relaxation, blood flows into RA from vena cava and closure of tricuspid occurs
What could cause a steep X wave?
- Cardiac tamponade
- Constrictive pericarditis
What is V wave?
- Atrial filling
- Increasing volme and pressure in RA when tricupsid is closed
What causes prominent V wave?
- Triscupid regurgiation
- Pulmonary Htn
What is Y slope?
- Triscupid opens and rapid RV filling occurs
What causes steep Y descent?
- Severe triscupid regurgitation
What does a slow Y descent mean?
Obstruction for RV filling
what causes increased JVP?
- Sup vena cava obstruction
- Severe heart failure
- Constrictive pericarditis
- Cardiac tamponade
- RV infarction
- Restrictive cardiomyopathy
Positive HJR seen with?
- Poorly compliant RV, RV failure
- Constrictive pericarditis
- Obstructive RV filling
What is S3?
- Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase
- Ken- Tuck- Y
S4?
- Atrial gallop from forcefulcontraction of atria against stiffened ventricle
- Ten-Nes-See
When does physiologic splitting of S2 occur?
Inspiration
Where do you listen for the Mitral valve?
- 5th left ICS at midclavicular line
Where do you listen for Triscupid?
- 4th left ICS at LSB
Where do you listen for aortic valve ?
2nd ICS to the R of sternum
Where do you listen for pulmonic valve?
- 2nd ICS L of sternum
Murmur grading system?
- Barely audible
- Soft, but easily heard
- Loud, without a thrill
- Loud with a thrill
- Loud with minimal contact between stethoscope and chest –Thrill
- Loud, can be heard without a stethoscope -Thrill
