Cardiovascular Exam

Question 1

Percussion for cardiac size

Answer 1

Start far left (resonance over lungs) and move medially to find cardiac “dullness”
–used if PMI cannot be determined!

Question 2

aortic auscultation

Answer 2

R 2nd intercostal space at sternal border

Question 3

pulmonic auscultation

Answer 3

L 2nd intercostal space at sternal border

Question 4

tricuspid auscultation

Answer 4

L 4th intercostal space at sternal border

Question 5

mitral auscultation

Answer 5

L 5th intercostal space at mid-clavicular line

Question 6

S1

Answer 6

closing of mitral & tricuspid valves

Question 7

S2

Answer 7

closing of aortic & pulmonary valves

Question 8

S3

Answer 8

abrupt deceleration of inflow across the mitral valves @ the end of the rapid filling phase. Normal in children & young adults
“Ken-Tuck-Y”

Question 9

S4

Answer 9

Atrial gallop from forceful contraction of atria against stiffened ventricle. Can be normal in athletes
“Ten-Nes-See”

Question 10

Jugular venous distention

Answer 10

level of JVP visibility gives an indication of central venous pressure and right atrial pressure

–common causes of elevated JVP: elevated right ventricle diastolic pressure, severe heart failure, constrictive pericarditis, RV infarction

Question 11

Measuring JVP

Answer 11

lay pt supine allowing veins to engorge, then raise to 30-45

Normal: 0-9

Question 12

Finding point of maximal impulse

Answer 12

if pt is upright–feel at 5th intercostal space, 1 cm medial to the mid-clavicular line
if pt is supine @ 45 degree angle– 4th or 5th intercostal space at mid-clavicular line

can also feel for thrills–turbulent blood flow (murmur)

Question 13

hepatojugular reflex

Answer 13

distension of the neck veins precipitated by the maneuver of firm pressure over the liver

Question 14

Causes of hepatojugular reflex

Answer 14

poorly compliant RV, RV failure
constrictive pericarditis
obstructive RV filling

Question 15

Aortic stenosis

Answer 15

Crescendo-decrescendo murmur. Heard between S1-S2
old person, syncope, angina, dyspnea
calcified aortic valve
radiates up to the carotids

Question 16

Mitral regurgitation

Answer 16

Heard during ventricular systole (between S1 & S2)
holosystolic murmur
radiates to axilla
“rheu-mitral”

Question 17

Tricuspid regurgitation

Answer 17

Heard during ventricular systole (between S1-S2)
holosystolic murmur
History of IV drug usage
“Tri not to relapse”

Question 18

Aortic Regurgitation

Answer 18

early blowing diastolic murmur–becomes quieter because pressure in aorta decreases overtime–less blood to flow backwards
Marfan’s, connective tissue disorders
head bobbing
femoral bruits

Question 19

Mitral stenosis

Answer 19

Diastolic murmur
opening “snap”
history of rheumatic fever
“Oh snap Maddy Steilen”

Question 20

HOCM

Answer 20

Family history of sudden cardiac death @ young age

softer with increased preload due to blood pushing the interventricular septum over–easier for blood to get pumped out

Question 21

Mitral Valve Prolapse

Answer 21

Mid-systolic click–due to chordae tendinae being forcefully pulled on as cusps go backwards into atria
clinical presentation of young women with a psychiatric history or myxomatous valvular disease in stem question
Increase in preload softens the murmur– allowing the prolapsed leaflets to return to normal orientation

Question 22

A wave

Answer 22

Corresponds to R atrial contraction

Question 23

Giant A wave seen in

Answer 23

obstruction between RA and RV
increased pressure in RV
pulmonary hypertension
recurrent pulmonary emboli
complete heart block (atria and ventricle dissociation)

Question 24

C wave

Answer 24

backwards push by closure of the tricuspic valve during isovolumetric contraction

Question 25

X wave

Answer 25

downward displacement of tricuspid valve during ventricular ejection phase. Atria passively filling from vena cava

steep X descent in cardiac tamponade & constrictive pericarditis

Question 26

V wave

Answer 26

Increasing pressure due to atria filling against closed tricuspid valve

prominent v wave in tricuspid regurgitation & pulmonary hypertension

Question 27

Y slope

Answer 27

Rapid filling of right ventricle from right atria

deep Y descent in tricuspid regurgitation
slow y descent suggests obstruction to ventricular filling (tricuspid stenosis)