Cardio

Question 1

Demonstrate the surface marking of the upper border of the heart.

Answer 1

Superior border –( Right and left atrium and the great vessels)- 3rd CC, 1cm from sternal border on the right to 2nd ICS/CC, 2.5 cm from sternal border on the left

Question 2

Demonstrate where you would auscultate for the aortic valve using a stethoscope.

Answer 2

Aortic Valve- 2nd ICS on right sternal edge

Question 3

Examine the radial/ulnar/brachial (2 sites)/carotid pulse and describe them (rate and rhythm).

Answer 3

Carotid- Lateral to thyroid cartilage and medial to sternocleidomastoid

brachial- lateral to medial epicondyl or just under biceps

Question 4

Describe the surface marking of the apex beat of the heart and demonstrate palpation.

Answer 4

APEX BEAT: normally palpable just medial to the MCL in the 5th left ICS. This is also the position for auscultation of the mitral valve. May vary from 4th ICS (children) to 5th ICS (adults).

You start laterally (MAL towards MCL) because the apex beat will be felt prematurely in a patient with ventricular hypertrophy.

Can be facilitated by asking patient to jog on the spot

Question 5

Describe and demonstrate the surface marking of the arch of the aorta.

Answer 5

The aortic arch lies within the superior mediastinum behind the manubrium

The aortic arch begins and ends at the level of sternal angle:

• Beginning of the arch (from ascending aorta) at the level of right 2nd CC
• End of the arch (becomes thoracic aorta) at the level of left 2nd CC
• Top of the arch midway between jugular notch and sternal angle.

Question 6

Describe and demonstrate the surface markings of the common carotid artery

Answer 6

Right common carotid (RCC) artery:
The RCC artery ascends into the neck on the right side of trachea under the cover of right sternocleidomastoid (SCM) muscle. The carotid artery runs from the right sternoclavicular joint to the lobe of the right ear (splits to internal and external at upper border of thyroid cartilage)

Left common carotid (LCC) artery:
The artery runs from the aortic arch (representing the LCC artery) towards the left sternoclavicular joint. This line ascends into the neck along the left side of the trachea and continues upwards along the anterior border of left SCM muscle towards the left ear lobe.

Question 7

Describe and demonstrate the surface markings of the internal jugular vein

Answer 7

Right and left internal jugular veins: just lateral to the common carotid arteries to reach the sternoclavicluar joints. (ie: earlobe to sternoclavicular joint).

Question 8

Chest leads for ECG

Answer 8

V1- Right 4th ICS, next to sternum
V2-Left 4th ICS, next to sternum
V3-Left 5th ICS, between V2 & V4
V4-Left 5th ICS, at MCL
V5-Left 5th ICS, at AAL (anterior axillary) (between V4&6)
V6-Left 5th ICS, at MAL

Question 9

Demonstrate the surface marking of the right border of the heart

Answer 9

Right border –Right atrium- from 3rd CC, 1cm from sternal border on the right to 6th CC, 1cm from sternal border on right

Question 10

Demonstrate the surface marking of the left border of the heart

Answer 10

Left border – Left ventricle (and some of the left atrium)- 2nd ICS/CC, 2.5 cm from sternal border on the left to 5th ICS at MCL

Question 11

Demonstrate the surface marking of the inferior border of the heart

Answer 11

Inferior border – Left ventricle and right ventricle- 6th CC, 1cm from sternal border on right to 5th ICS at MCL

Question 12

Demonstrate where you would auscultate for the pulmonary valve using a stethoscope.

Answer 12

Pulmonary valve- 2nd ICS, left sternal edge

Question 13

Demonstrate where you would auscultate for the mitral valve using a stethoscope.

Answer 13

Tricuspid- 4th ICS, left sternal edge

Question 14

Demonstrate where you would auscultate for the tricuspid valve using a stethoscope.

Answer 14

Mitral- 5th ICS on MCL