Cardiovascular Flashcards
What is the 5 finger method of the heart?
history, physical, ECG, imaging, and labs
What are the 4 parts of cardiovascular exam?
inspection, palpation, percussion, and auscultation
What is the PMI? Where is it normally palpated?
Point of maximal impulse/apex beat -> lower border of heart at LV
- if pt is upright, 5th left ICS, slightly medial to midclavicular line
- if pt is supine at 45 degrees, 4-5th ICS at midclavicular line
When is percussion done?
When PMI not detectable -> start far left (resonance) and move medially to find cardiac “dullness”
What are the 4 listening posts for the heart? Where are they located?
Aortic - 2nd ICS at RSB
Pulmonic - 2nd ICS at LSB
Tricuspid - 4th ICS at LSB
Mitral - 5th ICS at left mid central lobe
What causes S1?
mitral and tricuspid closure; beginning of ventricular systole
What causes S2?
aortic and pulmonic closure; marks end of ventricular systole and beginning of diastole
What is physiologic splitting of S2?
occurs during inspiration b/c of increased venous return during inspiration and more time for RV to deliver blood to lung (delayed P2)
What causes S3?
due to high pressures and abrupt deceleration of inflow across mitral valve at end of rapid filling phase; heard just after S2; normal in children and young adults
What causes S4?
atrial gallop from forceful contraction of atria against a stiffened ventricle; heard just before S1; can be normal in trained athletes
What is the grading system (I-VI) for murmurs?
I - barely audible
II - soft but easily heard
III - loud w/o thrill
IV - loud w/ thrill
V - loud w/ minimal contact between stethoscope and chest (thrill)
VI - loud and can be heard w/o stethoscope (thrill)
What do the jugular veins reflect?
reflect activity of right side of heart
What is normal value for JVP? What is most common cause of elevated JVP?
Normal = 0-9 Elevated = elevated RB diastolic pressure; SVC obstruction; severe heart failure; RV infarction; cardiac tamponade
What is HJR? What can cause it?
RV failure; constrictive pericarditis; obstructive RV filling by RA tumor
How do you document pulses?
0/4 = absent 1/4 = barely palpable 2/4 = normal 3/4 = stronger than average 4/4 = bounding
What side of the stethoscope do you use to auscultate carotid arteries, S3, and S4?
Bell
What is normal capillary refill time?
< 2 seconds
Where do you check for edema (3)?
dorsal of foot; behind medial malleolus; anterior tibia (shin)
Define regurgitation
turbulent flow sound when blood is moving in opposite direction from what it should
Define stenosis
turbulent flow when blood is moving through a stiff, damaged valve
What valves are opened/closed during ventricular systole?
Aortic and pulmonic open
Tricuspid and mitral closed
What valves are opened/closed during ventricular diastole?
Aortic and pulmonic are closed
Tricuspid and mitral open
What makes right heart murmurs (tricuspid and pulmonic) louder?
inspiration
What makes left heart murmurs (aortic and mitral) louder?
expiration
How does preload affect murmur sounds?
increased preload = louder murmur
decreased preload = softer murmur
What occurs to murmur sounds in pts w/ hypertrophic cardiomyopathy (HOCM)?
increased preload improves aortic murmur by pushing septum away from aortic outflow and allowing blood to be ejected more easily; decreased preload worsens murmur
What occurs to murmur sounds in pts w/ mitral valve prolapse (MVP)?
leaflets of mitral valve prolapse into LA under normal pressure; increasing preload improves mid-systolic click by allowing prolapsed leaflets to return to normal orientation
How does afterload affect murmurs? What are the exceptions?
Increased afterload = louder murmur
Decreased afterload = softer murmur
Exceptions = HOCM and MVP (increased afterload = softer murmur)
What type of murmur is caused by aortic stenosis? Most likely presentation?
crescendo-decrescendo murmur; calcified aortic valve; radiates up to the carotids
What type of murmur is caused by mitral regurgitation? Most likely presentation?
holosystolic murmur -> plateau shaped loud blowing murmur; decreased S1; best heard at apex; radiates to axilla; usually caused by rheumatic fever
What type of murmur is caused by tricuspid regurgitation? Most likely presentation?
holosystolic murmur; history of IVDA (IV drug abuse)
What type of murmur is caused by aortic regurgitation? Most likely presentation?
early blowing diastolic murmur; found in pts w/ connective tissue disorders, marfan’s syndrome, “head-bobbing”, water hammer pulse and femoral bruits
What type of murmur is caused by mitral stenosis? Most likely presentation?
opening “snap” murmur; found in pt’s w/ history of rheumatic fever
What is seen in FHx for hypertrophic cardiomyopathy (HOCM)?
FHx of sudden cardiac death at young age
What is heard in pt’s w/ MVP? What is a common clinical presentation?
midsystolic “click”
commonly seen in young women w/ psychiatric history
What is another name for MVP?
myxomatous valvular disease
What does the Allen test evaluate?
function of radial and ulnar arteries
