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Physical Exam (DL) > Cardio > Flashcards

Cardio Flashcards

1
Q

The inferior border of the RV lies _____________

A

below the junction of the sternum and xyphoid process.

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2
Q

RV narrows superiorly and joins the ____________ at the level of the __________

A

pulmonary artery at the level of the sternum or (BASE of the heart).

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3
Q

Where do you feel the apical impulse or PMI?

Diameter size?

A

PMI is normally found in the 5th ICS 7-9 cm lateral to the MSL.

Diameter of PMI >2.5 cm or displacement laterally is evidence of left ventricular hypertrophy
(LVH) or enlargement.

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4
Q

What is the S1 sound?

S2?

A

S1- “LUB” TV and MV close- Beginning of Systole

S2- “DUB” AV and PV close- End of Systole/Beginning of Diastole

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5
Q

What is cachexia?

A

Cachexia is loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite in someone who is not actively trying to lose weight.

Loses weight if if they try to increase calorie intake

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6
Q

Physical appearances- related cardiac abnormalities ?

  • Marfan’s
  • Down’s
  • Turner’s
  • Spondyloarthritides (ankylosing spondylitis)
A
  • Aortic regurgitation (dissection)
  • ASD, VSD
  • Coarctation of the aorta
  • Aortic regurgitation
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7
Q

Facial signs of cardiovascular disease

A
  • Malar flush- redness around cheeks- Mitral stenosis
  • Xanthomata- yellow lipid deposits around eyes/palms-Hyperlipdiemia
  • Corneal arcus- ring around the cornea - Age, hyperlipidemia
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8
Q

When would you check both radial pulses?

What other peripheral pulses can you check?

A

all cases of chest pain as a gross screening test for aortic dissection

Femoral, Popliteal, Posterior tibial, dorsal pedis

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9
Q

What are some visual signs of endocarditis ?

A

clubbing
splinter hemorrhages
Janeway lesions
Osler’s nodules

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10
Q

When is BP taken?

pump bladder up to..

A

after PT rest for 5 minutes

30mm Hg above radial pulse, release 2-3 mmHg per second

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11
Q

JNC 7 guidlines for BP

A

normal <120 / <80

Pre HTN 120-139 OR / 80-89

Stage 1 HTN 140-159 OR / 90-99

Stage 2 HTN > 160 OR / > 100

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12
Q

Orthostatics
Normal?
Orhtostatic HTN?

A

Normal- Sys drops or unchanged, while dia pressure rises slightly

Orhtostatic HTN- w/ in 2-5 minutes from supine to stand:
Drop sys of >20mmHg OR
Drop dia of > 10mmHg OR
Pulse rises by >20 beats
symptoms of cerebral HPTN
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13
Q

Orthostatic hypotension may be classified as:

A

neurogenic, non-neurogenic, or iatrogenic (e.g., caused by medication).

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14
Q

Why do we check orthostatic?

A

The lack of a pulse response increase when the blood pressure drops implies a neurological cause.

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15
Q

Where is the PMI?

How big?

A

Vertically: 4th or 5th ICS.

Horizontally: distance from midsternal line (MSL) or MCL.

Lateral displacement outside the MCL while supine increases likelihood of cardiac enlargement .

Diameter should be < 2.5 cm and occupy < 1 ICS

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16
Q

increased amplitude at the PMI could indicate:

A

hyperthyroidism, severe anemia, aortic stenosis (pressure overload), or mitral regurgitation (volume
overload

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17
Q

What part of the diaphragm picks up S3/S4 and murmur of mitral stenosis?

A

Bell

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18
Q

If you hear an abnormality over the aortic and pulmonary areas, listen over the ______

Abnormality at the apex, listen at the _______

A

Carotids

Axilla

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19
Q

Where is S1 sound loudest?

S2?

A

apex

base and often splits w/ respiration

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20
Q

What are the 4 valvular areas?

A

Aortic
Pulmonic
Tricuspid
Mitral

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21
Q

What Is splitting?

What causes it?

A

Aortic valve (A2) closure occurs earlier than pulmonary valve (P2)

Caused by increased venous return and negative intrathoracic pressure –>This delays RV emptying and pulmonary valve closure (P2), at the same time that pooling of blood in the pulmonary capillary
bed hastens LV emptying and aortic valve closure (A2).

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22
Q

What can cause a reversal/paradoxical S2 splitting?

A

(Reversal is when AV closure is delayed)

Bundle branch block- PV closes too early (Wolff- Parkinson’s- White syndrome)

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23
Q

When does a widened fixed splitting of S2 occur?

A

with an atrial septal defect (ASD)

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24
Q

Where is the best place to hear a splitting of the second heart sound?

A

Erb’s point- left upper sternal border

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25
Q

Why do we listen for bruits in carotid arteries?

How do you do it?

A

Older aged Pts that we suspect cerebral vascular disease.

Pt holds breath for a moment, then listen with bell

26
Q

How can we check for artherosclerosis and other arterial disorders?

A

palpate peripheral pulses- look for symmetry or absence of pulses

27
Q

Peripheral pulses:
-How will thyrotoxicosis and hypermetobolic states feel?
-Myxedema
*

A

rapid and bounding
slow and sluggish

*If pulses are asymmetrical- auscultate for bruits (due to stenosis)

28
Q

What are the peripheral pulses we can check?

A

carotid, radial, dorsalis pedis, posterior tibialis, femoral pulses bilaterally

29
Q

Grading pulses

A 
4+ Bounding
3+ Increased (stronger than expected)
2+ Brisk (expected)
1+ Diminished (weaker than expected)
0 Absent (unable to palpate)
30
Q

S3 Lub du bub sound?
AKA?
best heard?
Why might you find this?

A

AKA ventricular gallop (3 heart sounds) “I believe” “ken-ktuck-ey”

Heard best in apex in left decubitus position (LV), or along the LLSB or below the diploid w/ PT supine,
and louder in inspiration (RV)

LV failure, 3rd trimester preg, athletic heart

31
Q

An S3 in a person >40 is almost ______

A

Pathological

32
Q 
S4 Belub dup sound
When is it heard?
AKA?
How is it heard?
Whats it sound like?
Caused by?
A

Before S1
Atrial gallop
Bell side at apex in left decubitus position

“Believe me” or “ Teness-ee”

Hypertensive heart, CAD, diastolic heart failure, cardiomyopathy

33
Q

Why do we auscultate left lateral decubitus position?

A

To listen for gallops associated w/ S3 or S4

34
Q

The S2 split is best heard at the …..

A

left 2nd or 3rd ICS along the sternum

35
Q

S2

The aortic valve closes _______ the pulmonic valve and a split may be heard _________

A

slightly prior to

on inspiration

36
Q

S1 sound (start of systole) is best heard where?

S2 sound is best heard where?

A

at the apex

Right and left 2ICS

37
Q

Murmurs that coincide with the carotid upstroke are _________

A

Systolic

38
Q

What are the elements of a murmur description?

A

Timing (sys or dias)

Location (where on the precordium is it the loudest) Intensity (Grade 1-6)

Other features (maneuvers that accentuate- valsalva, squaring etc. Any associated sounds- snaps)

39
Q

What are the murmur grade intensities?

A

Grade I: Barely audible.
Grade II: Faint but heard immediately upon listening.
Grades III: Moderately loud without a thrill (purr).
Grade IV: Loud with a thrill.
Grade V: Loud enough to be heard with the stethoscope placed on its edge.
Grade VI: So loud it can be heard with the stethoscope off the chest.

40
Q

When does an opening snap occur?
What does this indicate?
Where is the best place to hear it?

A

after S2 (diastole)

diseased mitral valve opening to stenotic position

Heard with the DIAPHRAGM just medial to the apex and along the the LLSB- when loud, radiates to the apex and pulmonic area

41
Q

When does an ejection click and mild systolic click happen?

What does it indicate?

A

after S1 (systole)

EC-aortic stenosis and pulmonic stenosis

MSC- mitral valve prolapse, an abnormal systolic ballooning of part of the mitral valve into the left atrium (often followed by a late sys murmur or mitral regurgitation)

42
Q

What is a pansystolic murmur?
When is it heard?
Why is it heard

A
  • When BF moves from a high press chamber to lower press chamber, through valve that should be closed.
  • Begins w/ S1 and continues thru S2
  • Mitral regurgitation
43
Q

Pansystolic Murmur- Mitral regurgitation

How can you hear it?

A

Use the diaphragm at apex- radiation to left axilla

louder w/ valsalva and standing position

44
Q

Pansystolic Murmur- Tricuspid regurgitation

How can you hear it?

A

Tricuspid valve fails to close

Use the diaphragm at LLSB- radiation to right sternum/xiphoid, blowing

Louder at inspiration (increases preload)

45
Q

Pansystolic Murmur- Ventricular Septal Defect (VSD)

How can you hear it?

A

Hole in the septal wall

3-5 left ICS- very loud with a thrill

46
Q

What is the most common kind of heart murmur?
Why do they happen?
When do they happen?

A
  • Midsystolic murmurs
  • May be no issue

Physiologic- changes in metabolism

Pathologic- arising from structural abnormalities

-Tend to peak near midsystole and usually stop before S2

47
Q

Where can you hear mid systolic murmurs?

Who is it commonly seen in?

A

2-4 ICS between LLSB and apex (usually quiet and disappears when sitting)

-Children/young adults

48
Q

Midsystolic murmurs are usually innocent, but what could they be a physiological sign for?

A

anemia, pregnancy, fever, hyperthyroidism

49
Q

What and Where can you hear midsystolic murmurs that stem from pathological causes?

A

Aortic Steonis- R2ICS- radiates to carotids or down to apex w/ loud thrills, medium crescendodecrescendo
pitch
Decreased by handgrip (increases after load)

Pulmonic stenosis- 2nd and 3rd LICS- loud w/ a thrill, medium crescendo- decrescendo pitch

Hypertrophic Cardiomyopathy- 3rd and 4th LICS- may radiate down to LSB to apex- LV hypertrophy
Causes unusually rapid flow from LV- louder w/ valsalva and standing (decreases preload) just like MR

50
Q

Diastolic murmurs almost always indicate ______

A

Heart Disease

51
Q

What are the different types of diastolic murmurs?
Where can you hear them?
What are they caused by?

A

Aortic regurgitation- 2-4 LICS w/ DIAPHRAGM (high pitched)- radiation to apex/right sternal border, blowing decrescendo- heard best w/ sitting, lean fwd, breath out
-Leaflets of AV valve don’t close

Mitral Stenosis- rumbling murmur in mid or late diastole, decrescendo, low pitched (BELL)
opening snap (diaphragm) often follows S2 and initiates murmur
52
Q

What is a Quincke’s sign?

A

alternate reddening and blanching of the nailed w/ each heartbeat

Seen w/ aortic regurgitation (diastolic murmur)

53
Q

When would you hear a systolic click and why?

A

caused by mitral valve prolapse (MVP) abn systolic ballooning of metal valve into the left vent

  • mid to late systolic- followed by late systolic murmur of mitral regurg
  • heard medial to apex and LLSB, high pitched with the DIAPHRAGM
54
Q

What are the high freq murmurs you can hear w/ diaphragm?

What are the low pitch murmurs you can hear w/ the bell

A

High-
Systolic: MR and TR
Diastolic: AR

Low- Diastolic: MS, TS, and Gallops

55
Q

What are sounds you might hear w/ both systolic and diastolic components?

A

Venous Hum- turbulent flow in jugular vein (child)- heard medial 3rd of clavicles esp on right ,
humming heard w/ BELL

Pericardial Friction Rub- from pericardial sac inflammation (pericarditis) Heard best at L3ICS- louder
when PT leans fwd- Scratchy, scraping sound heard with Diaphragm

Patent Ductus Arterioles (PDA)- harsh machine like w/ thrill- heard in L2ICS- congenital abnormality

56
Q

What is the most common cause of sudden cardiac death in athletes?
Where can you hear it best?

A

HCM

3-4th ICS

57
Q

How can you get an HCM to increase intensity?

A

standing and valsalva maneuver

58
Q

What is the JVP exam for?

A

check volume status and cardiac function

Reflects pressure in the right atrium, or central venous pressure (CVP)

-Best assessed from the right IJV

59
Q

If you suspect your Pt is hypovolemic, what should you do to help measure the JVP?
What about hypervolemia or volume overload?

A

Lower the HOB to 0 degrees

Raise the HOB to 60-90 degrees

60
Q

What is considered a normal JVP w/ HOB at 30 degrees?

A

> 3 cm

>3-4 cm is abnormally high

Physical Exam (DL) (3 decks)

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