Cardio Exam Flashcards

Question

Neck, Mouth, Chest, Extremities Inspection for Cardio

Answer 1

Neck: webbing (Turners Syndrome/Coarctation of the aorta & Noonan’s syndrome/pulmonic stenosis) Mouth: highly arched palate (congenital heart problems/MVP), palate petechiae (infective endocarditis) Chest: Pectus excavatum & caranutum (Marfan’s syndrome/MVP), visible movements of the chest Extremities: Extra phalanx, finger or toe (ASD), long slender fingers (Marfan’s syndrome/aortic regurgitation)

Answer 2

Elevate the head of the bed to 30-45 degrees Turn the patient’s head gently to the left Standing on the right side of the patient identify the topmost point of the venous pulsation using either the internal jugular vein (preferred) or external jugular vein Place a centimeter ruler upright at the sterno-manubrial angle Place a card or a tongue blade horizontally from the top of the JVP to the ruler making a right angle (90 degrees) Measure the distance above the sternal angle in centimeters at 45 degrees the upper limit of normal is 4-5 cm at 30 degrees the upper limit of normal is 6 cm

Answer 3

Jugular vein reflects the right atrial pressure

Answer 4

a wave (atria contract) Reflects slight rise in atrial pressure that accompanies atrial contraction Occurs before S1& the carotid pulse ``` x descent (atria relax) Atrial relaxation & ventricles contract ``` ``` v wave (venous filling) Atria begin to fill ``` ``` y descent (atria empties) Blood flows into right ventricle ```

Answer 5

Occurs because of the inability of the right side of the heart to accommodate increased venous return Assesses right ventricular function Performed with the patient lying flat in the bed, with their mouth open, & breathing normally Observe the jugular height, press firmly under the right costal margin for 10-15 seconds The jugular veins will remain distended during the entire period of compression in right ventricular failure or elevated pulmonary artery wedge pressure The normal response is for the jugular veins to show a transient increase during the first few cardiac cycles followed by a fall to baseline levels during the latter part of compression

Answer 6

1. Aortic – right 2nd ICS sternal border 2. Pulmonic – left 2nd ICS sternal border 3. Erb’s Point – left 3rd ICS sternal border 4. Tricuspid – left 4th ICS sternal border 5. Mitral – left 5th ICS mid-clavicular line

Answer 7

Aortic – right 2nd ICS sternal border Pulmonic – left 2nd ICS sternal border Tricuspid – left 4th ICS sternal border Mitral – left 5th ICS mid-clavicular line

Answer 8

Timing: systolic or diastolic If the murmur coincides with the carotid upstroke it is systolic Location: in which of the 5 areas is the murmur best heard Radiation: does the murmur radiate to the neck, back, or axilla Duration: how long does it occur for Mid/pan/or late systolic Early/mid/or late diastolic Intensity: graded I-VI based on increased sound ( grades 4-6 must have a thrill with them) Pitch: high, medium, or low Quality: harsh, musical, soft, blowing, or rumbling Relationship to Respiration Relationship to Position

Answer 9

``` Best heard in the aortic area mid to mid-late systolic Radiates to the neck Crescendo/decrescendo shape Medium pitch Harsh Decreased A2 Ejection click S4 Narrow pulse pressure Slow rising & delayed pulse ```

Answer 10

``` Best heard in the apex in early systole Radiates to the axilla Holosystolic/machinery type murmur High pitched Blowing type murmur PMI is laterally displaced & diffuse Decreased S1 S3 ```

Answer 11

``` Best heard in pulmonic area mid to mid-late systole Radiates to the neck Crescendo/decrescendo diamond shaped Medium pitched Harsh Similar to aortic stenosis ```

Answer 12

``` Best heard in tricuspid area in early systole Radiates to right of the sternum Holosystolic High pitched Blowing ```

Answer 13

``` Best heard in tricuspid area in early systole with muscular or non-restrictive pulmonary HTN & holosystolic with left to right shunt Radiates to right of sternum Holosystolic High pitch Harsh ```

Answer 14

``` Heard best above the clavicle Radiates to the right side of the neck Continuous High pitch Roaring/humming ```

Answer 15

``` Widespread Minimal radiation Diamond shaped Medium pitch Twanging/vibratory ```

Answer 16

``` Heard best at the apex in mid diastolic No radiation Decrescendo Low pitch Rumbling Increased S1 Opening snap RV rock (RV impulse at left lower sternal border) Presystolic accentuation ```

Answer 17

Best heard in aortic area in early diastole No radiation Decrescendo High pitch Blowing S3 Laterally displaced PMI Wide pulse pressure (Resting > 100 mmHg when normal isusually 30-40 mmHg) Bounding pulses Austin Flint Murmur – apical diastolic murmur in association with AR mimicking MS Systolic ejection murmur

Answer 18

Abnormal communication between the aorta & pulmonary artery Occurs during the end of systole into diastole Blowing High pitched Heard best at left upper sternal border near the left 2nd intercostal space Most pronounced at S2