Cardiovascular Exam Flashcards
Steps to Cardiovascular Exam
- Inspection
- Palpation
- Percussion
- Auscultation
(IPPA for everything except GI)
What to look for: Inspection
- Shape: Barrel chested (COPD), Pectus Carinatum, Pectus Excavatum
- Landmarks: Aortic, Pulmonic, Tricuspid, Mitral
- Scars/Signs of trauma
What to Feel for: Palpation
Make sure to check the Point of Maximal Impulse which is located ______________
Palpate for thrills (vibrations)
Check at Point of Maximal Impulse or Apical impulse which is located at the 4th-5th intercostal space at mid-clavicular line - this is where the apex of the heart is
What to listen for: Percusion
Start from left (resonance) move medially to find cardiac (dullness
Use to estimate size
Cardiac Cycle: Systole
Ventricular contraction/Ejection
Cardiac Cycle: Diastole
Ventricular relaxation/filling
Describe the S3 heart sound and when/why you would hear it.
S3 is dull, low pitched, and best heart with the bell. Sounds like “Ken-tuck-Y”. Typically caused by rapid filling of the atria into ventricle –> this is a diastolic murmur. Normal in children, pathologic in ppl > 40
Describe the S4 heart sound and when/why you would hear it.
S4 is dull, low pitch, best heard with bell. Sounds like “Ten-Nes-See”. Caused by atrial gallop from forceful contraction of atria against stiffened (low compliant) ventricle. Can be normal in trained athletes.
Name and describe the different types of murmurs?
Early diastolic: starts end of S2 and fades before S1
Mid-diastolic: starts short after S2 and fades or merges into late diastolic murmur
Mid-systolic: inbetween S1 and S2 with gap in sound
Pansystolic: all the way between S1 and S2 (no gap in sound)
Late systolic: starts mid-to-late systole and progresses until S2
How do you describe the following grades of murmurs? Grade 1: Grade 2: Grade 3: Grade 4: Grade 5: Grade 6:
Grade 1: very faint
Grade 2: quiet but heard easily with a stethoscope
Grade 3: moderately loud
Grade 4: loud with palpable thrill
Grade 5: very loud with thrill, can be heard with stethoscope partly off chest
Grade 6: Heard with stethoscope entirely off the chest
How do you grade a pulse:
0/4 = absent, not palpable 1/4 = diminished, barely palpable 2/4 = average intensity, expected, normal 3+ = strong, full, increased 4+ = bounding
Note: X/4 is equal notation as X+
Normal capillary refill time is what?
2 seconds or less
How do you examine for edema and what do these tests mean?
Press firmly for 5 sec over the area (typically dorsum of foot, anterior tibia, or behind medial malleolus)
0 = absent 1+ = barely detectable, slight pitting (2mm) and disappears years 2+ = slight indentation (4mm); 10-15 secs before it disappears 3+ = deeper indentation (6mm); may be > 1 min 4+ = very marked indentation (8mm); 2-5 min
What are the normal diagnostics (5 finger method)?
- History
- Physical
- ECG
- X-ray
- Lab tests
Where are the listening spaces of the following found? Aortic valve: Pulmonic valve: Tricuspid valve: Mitral valve:
Aortic: 2nd intercostal space just lateral to right sternal border
Pulmonic: 2nd intercostal space just lateral to left sternal border
Tricuspid: 4th intercostal space just lateral to left sternal border
Mitral: 5th intercostal space @ midaxillary line
What can finger clubbing suggest?
congenital heart disease, interstitial lung disease, lung cancer, cystic fibrosis, and possibly more related things
What do the “a wave” and “v wave” correspond to on the venous distention chart?
A wave = atrial contraction (big in right atrial obstruction or increased pressure in right ventricle)
V wave = semilunar valves (aortic and pulmonic) closing and atrial filling
