Cardiovascular Exam - Part 1

Question 1

Stethoscope

Answer 1

Anterior and inferior

Diaphragm for high-pitched
Bell for low-bitched

Question 2

Sinus tachycardia

Answer 2

Regular rate at 100-180

Fever, exercise, emotion, pain, anemia, CHF, volume depltion/shock, thyrotoxicosis, drugs

Question 3

SInus bradycardia

and SVT

Answer 3

Regular rate at <50-60
Athleticism, drugs, sinus node pathology

SVT
Regular at 150-250
Sudden onset and resolution
May stop with cough or carotid massage

Question 4

A fib

Sinus arrhythmia

Answer 4

A fib - Irregularly irrgular…usually fast

Rate speeding during inspiration but no clinical significance

Question 5

Small and weak pulses

Large, bdounig pulses

Answer 5

Low pulse pressure (SBP-DBP)…CHF, hypovolemia, severe aortic stenosis

High pulse pressure, hyperdynamic state and aortic insufficiency

Question 6

Pulsus alternans

Bigeminal pulse

Answer 6

Regular rhythm, alternating strong and weak pulse, left ventricular failure

Rhythmically irregular rhythm, alternating strong and premature beats…PACs and PVCs

Question 7

Paradoxical pulse

Answer 7

Dec in pulse amplitude or in SBP by more than 10 mmHg during inspiration

Cardiac tamponade, constrictive pericarditis, COPD< severe asthma

Question 8

Orthostatic hypotension

Answer 8

Fall in SBP by 20 upon rising

Hypovolemia, drugs, prolong bed rest, autonomic neuropathy

Question 9

JVP - waves

Answer 9

Direct connection to the right atrium

AXVY

Atrial contraction
Atrial relaxaton
Venous filling
Atrial emptying

Question 10

JVP

Answer 10

Normal form 6-8 cm H2O

Question 11

JVD vs. JVP

Answer 11

JVD is from external veins

Question 12

JVP and pulse waves

Answer 12

A fib - Lose A

Tricuspid stenosis/pulm HTN/right sided HF - very pronounced A bc atrium contracting against resistance

Tricuspid regurgitation - high V

Question 13

Hypetrophies

Answer 13

Concentric - hypertrophic cardiomyopathy (pressure)

Dilated cardiomyopathy (volume overload)

Question 14

Systole and diastole

Answer 14

Systole - ventricular conctraction…S1 - closing of mitral and tricuspid…opening of aortic and pulm

Diastole - ventricular relaxation..closing of A and P=S2…opening of M and T

Phase 1 D - rapid filling of V
Phase 2 D - atrial contraction

Question 15

PMI

Answer 15

Not shifted…hypertrophic…very strong

Lateral - dilated and weak PMI that fills your palm

Question 16

Accentuated S1
Diminished S1
Varying S1

Answer 16

Hyperdynamic state - exercise, anemia, hyperthyroid…ONLY sign for mitral stenosis

Diminished S1 - delayed conduction from A to V…poor ventricular contraction (CHF)…calcified and immbole mitral valve (MR)

Varying S1 - complete heart block or irregular rhythm (a fib)

Question 17

Physiologic split of S2

Answer 17

Right sided heart activites are slightly longer than left

During inspiration, right sided act are even longer—-
Neg intrathoracic pressure increases blood flow to Rt atrium
—Lung expansion increases pulmonary hangout interval

Question 18

Splitting of S2

Answer 18

Physiologic in inspiration (A2 then P2)

Wide in RBBB, pulomonic steonisis, pulm HTN

Paradoxial (in exp rather than ins) in LBBB and aortic stenosis

Fixed (equal in both expiration and inspiration) in ASD and right ventricular failure

Question 19

INcreased A2 and P2

Answer 19

A2 - HTN, dilated aoritc root

P2 - pulm HTN< dialted pulm artery, ASD

Question 20

Decreased A2

Decreased P2

Answer 20

A2 - calcific aortic stenosis

Dec P2 - Aging (inc AP diameter of chest) or pulmonic steoniss

Question 21

S3

Answer 21

End of the rapid filling phase of diastole

Ventricles are expanded and walls tensed…sudden halt of blood mass against ventricular walls

Low -pitched short and faint sound (use bell)

At the apex or yphoid

Normal S3 in children, adolescents, last timerster of preg, anemia, febrile, and hyperthyroid

ABnoraml S3 denotes serious myocardila dysfunction

Basically means a dilated LV - MI or volume overload

Question 22

S4

Answer 22

Sudden tensiing of ventricular musculature and chordae tendinaea

During atrium contraction at end of diastole

Indicative of dec ventricular compliance (inc stiffness)

Low pitch and low instensity

At apex of LLSB

Normal S4 in atheletes

Normally in long standing HTN