Cardiovascular Exam

Question 1

A pulse described as “full, increased” would be graded as…?

Answer 1

3+

Question 2

A “water-hammer pulse” can be palpated where? What does it indicate?

Answer 2

Water-hammer pulse is due to large stroke volume and backflow of blood from the aorta into LV; indicative of aortic regurgitation

Question 3

Describe the expected sound of Pulmonary Stenosis

Answer 3

○ Harsh, loud, ejection click
○ LEFT 2nd ICS/3rd ICS
○ Radiates to the LEFT shoulder
○ Increases with inspiration

Question 4

Describe the expected sound of Aortic Stenosis

Answer 4

○ Harsh quality
○ RIGHT 2nd ICS/3rd ICS
○ Radiates to suprasternal notch and carotids
○ Delayed pulses (pulsus tardus et parvus)

Question 5

Describe the expected sound of Mitral Regurgitation

Answer 5

○ Blowing quality, holosystolic
○ Prominent at apex, radiates to LEFT axilla
○ Loudness correlates with degree of valve insufficiency

Question 6

Describe the expected sound of Tricuspid Insufficiency

Answer 6

○ Blowing quality, increases with inspiration
○ Holosystolic
○ Lower LEFT sternal border

Question 7

Describe the expected sound of Aortic Regurgitation

Answer 7

○ Blowing, decrescendo murmur
○ LEFT 2nd ICS to the 4th ICS
○ Auscultate with diaphragm

Question 8

Describe the expected sound of Mitral Stenosis

Answer 8

○ Rumbling, low pitched
○ Best heard at apex
○ Auscultate with bell

Question 9

Describe the expected sound of Tricuspid Stenosis

Answer 9

○ Increases in intensity with inspiration

○ Decreases in intensity with expiration and valsalva maneuver

Question 10

How may JVP appear in patients with obstructive lung disease?

Answer 10

In patients with obstructive lung disease, JVP can appear elevated on expiration, but the veins collapse on inspiration. This finding does not indicate heart failure