Cardiovascular Assessment

Question 1

Jugular Veins

1. Depression
2. Distended

Answer 1

1. fluid volume deficit

2. fluid volume overload (in heart or renal failure patients) or right ventricular dysfunction

Question 2

If you find a pulse irregularity…

Answer 2

auscultate apical pulse while simultaneously palpating the radial pulse (these should be identical)

Question 3

S1

Answer 3

• follows the longer pause
• loudest at the apex
  timed by simultaneously feeling the carotid pulse while listening to the heart
• sound heard when the carotid is felt is S1

Question 4

S2

Answer 4

• always loudest at the base

- splitting of S2 every 4th heartbeat

Question 5

S3

Answer 5

• extra dub
• ventricular gallop
• diastolic sound with a low-frequency heard just after
• left side- best heard at apex
• right side- best heard between 4th and 5th intercostal space, left sternal border

Question 6

S3 Causes

Answer 6

• increased ventricular diastolic volume

- decreased ventricular compliance

Question 7

When is S3 Normal

Answer 7

• children

- young adults

Question 8

S4

Answer 8

• extra lub
• atrial gallop
• just before S1
• during late diastolic filling stage
• auscultated like S3

Question 9

Causes of S4

Answer 9

• increased ventricular volume

- decreased ventricular compliance

Question 10

I S4 heard in atrial fibrillation? Why?

Answer 10

no, because S4 does not occur unless atrial contraction takes place

Question 11

Common Causes of Murmurs

Answer 11

• backward regurgitation of blood
• foreword flow of blood through a narrowed or deformed valve
• structural defects
• innocent or functional murmurs

Question 12

Grade I Murmur

Answer 12

barely audible, heard only in a quiet room and then with difficulty

Question 13

Grade II Murmurs

Answer 13

clear but faint

Question 14

Grade III Murmurs

Answer 14

moderately loud, easy to hear

Question 15

Grade IV Murmurs

Answer 15

loud, associated with palpable thrill on the chest wall

Question 16

Grade V Murmurs

Answer 16

very loud, hear with one corner of the stethoscope

Question 17

Grade VI

Answer 17

loudest, still heard with entire stethoscope lifted off the chest wall

Question 18

Mid Systolic Ejection Murmurs

Answer 18

• due to blood flow through the semilunar valves
• occur at the start of blood ejection, starts after S1
• ends with the cessation of the blood flow, is before S2
• crescendo-decrescendo

Question 19

Pan Systolic (Mitral) Regurgitation Murmurs

Answer 19

• heard best at the apex with the diaphragm of the stethoscope
• heard best when on left side

Question 20

Diastolic Rumbles of AV Valves

Answer 20

• mid-diastolic
• start at or after S2 and end before or at S1
• stenosis of the atrioventricular valves or regurgitation of the semilunar valves

Question 21

Early Diastolic Murmurs

Answer 21

• start at the same time as S2 with the close of the semilunar (aortic & pulmonary) valve and end before S1
• Common causes include aortic or pulmonary regurgitation and left anterior descending artery stenosis

Question 22

Infant’s Heart Apex

Answer 22

4th intercostal space

Question 23

Child’s Heart Apex

Answer 23

5th intercostal space

Question 24

Expected Finding in Infants

Answer 24

• sinus arrhythmias
• barrel shaped thorax
• visible apical pulse

Question 25

An increase in a neonate’s cardiac output depends on ___ because ______.

Answer 25

• heart rate

- unable to increase stroke volume

Question 26

Normal Findings in Pregnant Women

Answer 26

• increased blood volume and cardiac output
• horizontal shift in heart
• S1 and S2 split
• S3 loud and easily heard
• systolic murmurs
• edema

Question 27

Normal Findings in Older Adults

Answer 27

• systolic murmurs

- S4

Question 28

Cardiac Enzymes

Answer 28

• creatine kinase
• Troponin I or T
• HDL
• LDL
• triglycerides

Question 29

Stenosis

Answer 29

narrowing of a valve opening