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Physical Diagnosis > Cardiovascular Exam > Flashcards

Cardiovascular Exam Flashcards

1
Q

most anterior cardiac surface

A

R ventricle (has thin walls, under lower pressure)

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2
Q

most prominent heart sounds

A

left ventricle

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3
Q

lateral margin of the heart

A

left ventricle

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4
Q

base of the heart

A

Superior aspect of the heart

Right and left 2nd ICS

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5
Q

Apex of the heart

A

Inferior aspect of the heart

Apex at 5th ICS, 7-9 cm from midsternal line

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6
Q

systole

A

ventricular contraction
in systole, aortic and pulmonic valves open while mitral and tricuspid close
begins after S1

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7
Q

diastole

A

ventricular relaxation

begins with S2

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8
Q

S1

A

mitral valve closing

systole begins after S1

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9
Q

S2

A

aortic valve closing

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10
Q

S3

A

rapid ventricular filling

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11
Q

S4

A

atrial contraction

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12
Q

heart sounds

A

closure of valves is responsible for heart sounds

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13
Q

cardiovascular exam

A 
Assess Jugular Venous Pressure (JVP)
Assess Carotid Pulse
Examine the Heart 
-Inspection
-Palpation
-Auscultation 
Peripheral vascular exam
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14
Q

jugular venous pressure

A
  • Position: patient comfortable, supine with head raised to 30˚, tilted slightly away from side you are inspecting
  • Use tangential lighting to identify landmarks
  • Identify amplitude and timing of venous pulsations, lateral to SCM
  • Arterial pulsations look and feel like single strong impulses
  • -Compare with apical or radial pulse
  • Venous pulses look like billowing sails with gentler wave forms
  • -Press on RUQ to accentuate hepato-jugular reflux if JVD is suspected
  • JV Distention indicates increased pressure in the Right heart (usually due to heart failure)
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15
Q

how to measure JVP

A
  • Identify highest point of venous pulsation of the internal jugular along SCM border
  • Measure vertical distance above sternal angle
  • Elevation is defined as JVD
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16
Q

carotid pulse

A
  • Inspect for carotid pulsations
  • -Patient supine with HOB elevated to 30˚
  • -Inspect medial to the sternocleidomastoid muscles
  • -Medial to IJ
  • -Matches radial pulse
17
Q

carotid pulse

A

Auscultate for bruits (before palpation)
-Have patient hold breath
-Use bell of stethoscope to listen for bruit
–rumbling sound of turbulent blood flow through artery
Palpate for amplitude, rate, contour, thrills

18
Q

cardiac exam

A
  • Starting patient position is supine with 30 degrees head elevation
  • Examiner stands on right side of patient
  • Other positions
  • -Left lateral decubitus (LLD)
  • -Sitting up and leaning forward
  • Inspection
  • -Heaves
  • -Point of maximum intensity (PMI) or apical impulse
  • Palpation
  • -Lifts and heaves, thrills, PMI
  • -Cardiac silhouette
  • Auscultation
  • -Heart sounds
  • -Murmurs
19
Q

apical impulse

A 
Location
-usually 4th or 5th intercostal space, 7-9cm from MSL
Diameter
-usually less than 2.5cm
Amplitude
-usually small, brisk, tapping
Duration
-listen, feel and estimate proportion
20
Q

cardiac auscultation

A
  • Start with patient supine, HOB at 30⁰
  • Listen to entire precordium
  • -Right 2nd intercostal space (ICS)
  • -Left 2nd through 5th ICS
  • -Apex
  • Use both diaphragm and bell
  • -Diaphragm for higher pitched sounds
  • -Bell for lower pitched sounds
  • Left lateral decubitus position (bell)
  • -Brings LV closer to chest wall
  • -Accentuates S3, S4 and mitral murmurs
  • Sitting up, leaning forward (diaphragm)
  • -Accentuates aortic murmurs
  • Squatting, Valsalva maneuvers: make different murmurs louder or softer
21
Q

heart sounds

A

-S1 usually loudest at apex (mitral valve closing)
-S2 usually loudest at base (aortic valve closing)
-Systole is between S1 and S2
-Diastole is between S2 and S1
-Systole is shorter than diastole
-Pulses are palpable during systole
-First identify S1 and S2, then figure out what else you hear
Heart Sounds
-Both R and L sides of heart are contracting, so heart sounds are composed of two components
-Left heart
–S1 = Mitral closure; S2 = Aortic closure
-Right heart
–S1 = Tricuspid closure; S2 = Pulmonic closure
-R side of heart contracts slightly later than L
–S1 = M1T1
–S2 = A2P2

22
Q

heart sounds: splitting

A
  • Splitting refers to the separation of heart sounds into 2 components (R/L)
  • Though both S1 and S2 can be split, the splitting of S2 is more important clinically
  • Physiologic splitting
  • -Separation of S1 or S2 into separate sounds accentuated by inspiration, disappears with expiration
  • Right heart normally moves a little more slowly than left heart
  • Lag is accentuated by increased intrathoracic pressure (inspiration)
  • In people that are older, splitting it a sign of pathology
23
Q

extra heart sounds: systole

A
  • Ejection sounds are pathologic, caused by opening of valves that should be closed (early in systole, immediately after S1, affect either aortic or pulmonic valves, High pitched, Sharp clicking quality, Heard best with diaphragm)
  • Clicks (mid to late systole, Mitral Valve Prolapse (MVP) most common, High pitched, use diaphragm)
24
Q

extra heart sounds: diastole

A
  • Opening snap (caused by opening of stenotic MV, Loud, high pitched snapping sound)
  • S3 (ventricular gallop) (Physiological or pathological, can be physiologic in children but usually pathologic in pts over 40)
  • S4 (atrial gallop) (Dull low pitched sound, heard best with bell, more often pathologic)
25
Q

heart murmurs

A
  • Murmurs are of longer duration than heart sounds
  • Often caused by turbulent blood flow through a valve
  • Can indicate disease (or benign)
  • Heard best over respective auscultatory areas for the involved valve
26
Q

innocent murmurs

A
  • Turbulent blood flow across valve due to strong ventricular ejection of blood
  • Common in children, young adults
  • No evidence of cardiovascular disease
  • No physiological or structural abnormalities
27
Q

pathologic murmurs

A
  • Arise from structural abnormalities in valves
  • Stenosis
  • Regurgitation
28
Q

grading of heart murmurs

A
  • Grade 1 - very faint
  • Grade 2 - quiet, but heard immediately
  • Grade 3 - moderately loud
  • Grade 4 - loud
  • Grade 5 - very loud, heard with stethoscope partially off of chest
  • Grade 6 - heard with stethoscope completely off of chest
29
Q

systolic murmurs

A
  • Early systolic (ejection)
  • Midsystolic
  • Late systolic
  • Holosystolic
  • May be innocent or pathologic
30
Q

diastolic murmurs

A
  • Diastolic murmurs
  • Early diastolic
  • Mid-diastolic
  • Late diastolic
  • Always pathologic
31
Q

heart murmurs quality

A

Harsh (stenosis)
Blowing (regurgitation)
Rumbling
Musical

32
Q

heart murmurs contour

A
  • Pattern of sound intensity over time
  • -Crescendo = gets louder
  • -Decrescendo = gets softer
  • -Crescendo-decrescendo
  • -Plateau = intensity constant
33
Q

adventitious heart sounds

A

Mixed cycle: not confined to one aspect of cardiac cycle

  • Pericardial Friction Rub (Inflammation of pericardial sac)
  • Patent Ductus Arteriosus (Congenital opening between aorta and pulmonary arteries)
  • Venous Hum (continuous) (Benign turbulent blood flow in jugular veins)
34
Q

CV exam checklist

A
  • inspect the precordium with the patient supine, HOB at 30 degrees
  • inspect carotid arteries and jugular veins for pulsations/distention (tangential lighting)
  • measur JVP
  • auscultate carotid arteries before palpating for thrills (one at a time)
  • palpate precordium for lifts and thrills; palpate apical impulse
  • palpate for PMI in LLD
  • auscultate with diaphragm in aortic, pulmonic, tricuspid, mitral areas
  • auscultate with bell in aortic, pulmonic, tricuspid, mitral areas
  • auscultate with bell in LLD
  • auscultate with diaphragm sitting up, leaning forward, exhale fully

Physical Diagnosis (13 decks)

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