Cardiovascular exam

Question 1

Cardiovascular Exam (Five Finger Method)

Answer 1

Lab Tests
X-Ray
ECG
Physical
History

Question 2

Documenting History

Answer 2

Look for signs of noticable dysfuction

Fatigue, dyspnea (breathlessness), pain, palpation, syncope

All non-specific descriptors

Question 3

Family History

Answer 3

Heart conditions in family

High LDL? Marfan’s Syndrome? Long QT?

Question 4

Physical Exam

Answer 4

Inspection
Palpation
Percussion
Auscultation

Make sure the room is quiet & direct contact with skin

Question 5

Inspection

Answer 5

Look along the precordium

ID scars, skeletal abnormalities (TART)

Question 6

Palpation

Answer 6

Feel for the Point of Maximum Intensity: near the mid-clavicular line on the left side at 4th-5th ICS

Locate the Apex beat of the heart @ 5th ICS

Feel for turbulent blood flow causing palpable murmors (thrills)

Question 7

Percussion

Answer 7

Identify the borders to the heart (cardiac border)

Hollow sounds indicate spaces

Dull sounds should indicate location of the heart

Question 8

Auscultation

Answer 8

S1: Mitral and Tricupsid closure; Start of systole

S2: Aortic and pulmonic closure; Start of diastole

Question 9

ID of Heart Sounds

Answer 9

Aortic V: 2nd ICS to R of sternum

Pulmonic V: 2nd ICS on L of sternum

Tricuspid V: 4th ICS at Left Sternal Border

Mitral V: Apex of the heart; 5th ICS in mid-clavicular line

Question 10

Murmur Grading System

Answer 10

1 - barely audible
2 - soft, but heard
3 - loud with no thrill
4 - loud with thrill
5 - loud with small contact of stethoscope
6 - thrills heard without stethoscope

Question 11

Midsystolic Murmor

Answer 11

Murmor that is between S1 and S2
Increases then decreaes in sound
Mitral or Tricupsid Failure or Regurg

Question 12

Pansystolic (holosystolic) Murmor

Answer 12

Heard at equal intensity throughout S1 to S2

Mitral and Tricupsid Issues

Question 13

Late Systolic Murmor

Answer 13

Late in S1 to S2

Usually mitral valve issues

Question 14

Early Diastolic Murmor

Answer 14

Always indicated heart disease

Starts immediately after S2

Pulmonic or Aortic Issues

Question 15

Middiastolic Mumor

Answer 15

Starts halfway after S2 and next S1

Pulmonic or Aortic issues

Question 16

Kussmauls Sign

Answer 16

Venous column (JVP) rises during inspiration

Right Heart failure or RV infarction

Question 17

Pulse Locations

Answer 17

• Radial Pulse (most common)
• Brachial Pulse
• Carotid Pulse
• Popliteal Pulse
• Posterior Tibial Pulse
• Dorsalis Pedis Pulse (common in kids)

Question 18

Capillary Refill Time

Answer 18

Pinch the tips of fingernail beds
Normal refill is less than 2 seconds
Test Distal Perfusion of Blood

Question 19

Pulse Documentation

Answer 19

Location of Pulse Site

Rate

Rhythm: Regular vs Irregular

Strength: Absent (0), barely palpable (1), Normal intensity (2), Strong (3), bounding (4)

Question 20

Edema

Answer 20

Swelling due to inadequate blood return or excess blood in interstitial spaces
Grading Scale (0-4) 

0: absent
1: 2 mm
2: 4 mm; 10-15 seconds
3: 6 mm; less than a minute
4: 8 mm; 2-5 minutes

Question 21

S1

Answer 21

Closure of the mitral and tricupsid valves

On EKG its usually at the QRS complex

Question 22

S2

Answer 22

Closing of the aortic and pulmonic valve

Seen on EKG following the T-Wave

Question 23

S3

Answer 23

High pressures and abrupt deceleration of blood across mitral valve

Normal is Kids
Heard after S2

Question 24

S4

Answer 24

Atrial gallop due to hard contraction of Atria
Heard before S1; following P-Wave

Normal in athletes

Question 25

Barrel Chest

Answer 25

COPD

Question 26

Pectus Carinatum

Answer 26

Pigeon Chested

Overgrowth of the sternum

Question 27

Pectus Excavatum

Answer 27

Funnel Chested

Depression of the sterum