Cardio - Precordium

Question 1

What do we look for on inspection?

Answer 1

Deformities - Pectus Excavatum/caritanatum or kyphoscoliosis

Scars

Symmetry (from bed end)

Visible pulsations

Question 2

What do we palpate for?

Answer 2

• Tracheal Deviation
• Pacemaker in left infraclavicular area
• Apex Beat
• Right Ventricular Heave
• Thrills

Question 3

Where do feel for a RV heave?

Answer 3

Hand flat vertically on left parasternal edge

Question 4

Where do you feel for thrills?

Answer 4

Thrills are palpable murmers so feel each valve:

• Mitral and tricuspid at once
• Aortic
• Pulmonary

Question 5

What must you do to be able to properly assess the heart sounds?

Answer 5

Palpate the carotid so you can time S1 and S2

Question 6

Which is S1 and which S2?

Answer 6

S1 is the Atrio-ventricular valves shutting and will be just prior or in line with pulse

S2 is semilunar valves closing and counter timed to the pulse

Question 7

What added heart sounds could be heard?

Answer 7

S3 - heard in diastole
S4 - before S1

Snaps/clicks - Mechanical valves
Coarse scratching - Pericardial rub
Murmurs

Question 8

In what order do you listen to the heart valves?

Answer 8

All 4 with diaphragm and bell

Find S1 & 2, check for added sounds (S3/4, rubs and mechanical valves)

Question 9

What 4 murmurs do we listen for?

Answer 9

Aortic Stenosis
Aortic Regurg
Mitral Stenosis
Mitral Regurg

Question 10

Describe how you listen for Aortic Stenosis?

Answer 10

Listen over aortic valve for High pitched ejection systolic murmur.

Then listen over both carotids for radiation

Question 11

Describe how you listen for Mitral Regurgitation?

Answer 11

Listen over apex then L axilla with diaphragm

High pitched Pansystolic murmur

Question 12

Describe how you listen for Mitral Stenosis?

Answer 12

Roll onto left side
Hold breath in expiration
Listen at apex with bell for Low pitched rumbling mid-diastolic murmur

Question 13

Describe how you listen for Aortic Regurgitation?

Answer 13

Sit up lean forward and hold breath in expiration

DIaphragm at lower left sternal edge (Tricuspid region)

High pitched early diastolic murmur

Question 14

Location of each valve?

Answer 14

Aortic- Right 2nd intercostal space
Pulmonary - Left 2nd intercostal space
Tricuspid - 4th intercostal space at left sternal edge
Mitral - 5th intercostal space in mid-clavicular line

Question 15

Sound of each murmur?

Answer 15

Aortic Stenosis - High pitched ejection systolic

Mitral Regurg - High pitched pan-systolic

Mitral Stenosis - Low pitched rumbling mid-diastolic

Aortic Regurg - High pitched early diastolic