Cardiovascular Exam

Question 1

Steps to Cardiovascular Exam

Answer 1

1. Inspection
2. Palpation
3. Percussion
4. Auscultation

(IPPA for everything except GI)

Question 2

What to look for: Inspection

Answer 2

1. Shape: Barrel chested (COPD), Pectus Carinatum, Pectus Excavatum
2. Landmarks: Aortic, Pulmonic, Tricuspid, Mitral
3. Scars/Signs of trauma

Question 3

What to Feel for: Palpation

Make sure to check the Point of Maximal Impulse which is located ______________

Answer 3

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

Question 4

What to listen for: Percusion

Answer 4

Start from left (resonance) move medially to find cardiac (dullness

Use to estimate size

Question 5

Cardiac Cycle: Systole

Answer 5

Ventricular contraction/Ejection

Question 6

Cardiac Cycle: Diastole

Answer 6

Ventricular relaxation/filling

Question 7

Describe the S3 heart sound and when/why you would hear it.

Answer 7

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

Question 8

Describe the S4 heart sound and when/why you would hear it.

Answer 8

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.

Question 9

Name and describe the different types of murmurs?

Answer 9

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

Question 10

How do you describe the following grades of murmurs?
Grade 1:
Grade 2:
Grade 3:
Grade 4:
Grade 5:
Grade 6:

Answer 10

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

Question 11

How do you grade a pulse:

Answer 11

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+

Question 12

Normal capillary refill time is what?

Answer 12

2 seconds or less

Question 13

How do you examine for edema and what do these tests mean?

Answer 13

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

Question 14

What are the normal diagnostics (5 finger method)?

Answer 14

1. History
2. Physical
3. ECG
4. X-ray
5. Lab tests

Question 15

Where are the listening spaces of the following found?
Aortic valve:
Pulmonic valve:
Tricuspid valve:
Mitral valve:

Answer 15

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

Question 16

What can finger clubbing suggest?

Answer 16

congenital heart disease, interstitial lung disease, lung cancer, cystic fibrosis, and possibly more related things

Question 17

What do the “a wave” and “v wave” correspond to on the venous distention chart?

Answer 17

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