Cardiovascular exam Flashcards
Cardiovascular Exam (Five Finger Method)
Lab Tests X-Ray ECG Physical History
Documenting History
Look for signs of noticable dysfuction
Fatigue, dyspnea (breathlessness), pain, palpation, syncope
All non-specific descriptors
Family History
Heart conditions in family
High LDL? Marfan’s Syndrome? Long QT?
Physical Exam
Inspection
Palpation
Percussion
Auscultation
Make sure the room is quiet & direct contact with skin
Inspection
Look along the precordium
ID scars, skeletal abnormalities (TART)
Palpation
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)
Percussion
Identify the borders to the heart (cardiac border)
Hollow sounds indicate spaces
Dull sounds should indicate location of the heart
Auscultation
S1: Mitral and Tricupsid closure; Start of systole
S2: Aortic and pulmonic closure; Start of diastole
ID of Heart Sounds
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
Murmur Grading System
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
Midsystolic Murmor
Murmor that is between S1 and S2
Increases then decreaes in sound
Mitral or Tricupsid Failure or Regurg
Pansystolic (holosystolic) Murmor
Heard at equal intensity throughout S1 to S2
Mitral and Tricupsid Issues
Late Systolic Murmor
Late in S1 to S2
Usually mitral valve issues
Early Diastolic Murmor
Always indicated heart disease
Starts immediately after S2
Pulmonic or Aortic Issues
Middiastolic Mumor
Starts halfway after S2 and next S1
Pulmonic or Aortic issues
Kussmauls Sign
Venous column (JVP) rises during inspiration
Right Heart failure or RV infarction
Pulse Locations
- Radial Pulse (most common)
- Brachial Pulse
- Carotid Pulse
- Popliteal Pulse
- Posterior Tibial Pulse
- Dorsalis Pedis Pulse (common in kids)
Capillary Refill Time
Pinch the tips of fingernail beds
Normal refill is less than 2 seconds
Test Distal Perfusion of Blood
Pulse Documentation
Location of Pulse Site
Rate
Rhythm: Regular vs Irregular
Strength: Absent (0), barely palpable (1), Normal intensity (2), Strong (3), bounding (4)
Edema
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
S1
Closure of the mitral and tricupsid valves
On EKG its usually at the QRS complex
S2
Closing of the aortic and pulmonic valve
Seen on EKG following the T-Wave
S3
High pressures and abrupt deceleration of blood across mitral valve
Normal is Kids
Heard after S2
S4
Atrial gallop due to hard contraction of Atria
Heard before S1; following P-Wave
Normal in athletes
