Cardiovascular Exam Flashcards
Percussion for cardiac size
Start far left (resonance over lungs) and move medially to find cardiac “dullness”
–used if PMI cannot be determined!
aortic auscultation
R 2nd intercostal space at sternal border
pulmonic auscultation
L 2nd intercostal space at sternal border
tricuspid auscultation
L 4th intercostal space at sternal border
mitral auscultation
L 5th intercostal space at mid-clavicular line
S1
closing of mitral & tricuspid valves
S2
closing of aortic & pulmonary valves
S3
abrupt deceleration of inflow across the mitral valves @ the end of the rapid filling phase. Normal in children & young adults
“Ken-Tuck-Y”
S4
Atrial gallop from forceful contraction of atria against stiffened ventricle. Can be normal in athletes
“Ten-Nes-See”
Jugular venous distention
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
Measuring JVP
lay pt supine allowing veins to engorge, then raise to 30-45
Normal: 0-9
Finding point of maximal impulse
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)
hepatojugular reflex
distension of the neck veins precipitated by the maneuver of firm pressure over the liver
Causes of hepatojugular reflex
poorly compliant RV, RV failure
constrictive pericarditis
obstructive RV filling
Aortic stenosis
Crescendo-decrescendo murmur. Heard between S1-S2
old person, syncope, angina, dyspnea
calcified aortic valve
radiates up to the carotids
Mitral regurgitation
Heard during ventricular systole (between S1 & S2)
holosystolic murmur
radiates to axilla
“rheu-mitral”
Tricuspid regurgitation
Heard during ventricular systole (between S1-S2)
holosystolic murmur
History of IV drug usage
“Tri not to relapse”
Aortic Regurgitation
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
Mitral stenosis
Diastolic murmur
opening “snap”
history of rheumatic fever
“Oh snap Maddy Steilen”
HOCM
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
Mitral Valve Prolapse
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
A wave
Corresponds to R atrial contraction
Giant A wave seen in
obstruction between RA and RV increased pressure in RV pulmonary hypertension recurrent pulmonary emboli complete heart block (atria and ventricle dissociation)
C wave
backwards push by closure of the tricuspic valve during isovolumetric contraction
