Cardiovascular Examination Flashcards
1
Q
What exposure is required for a cardiovascular examination?
A
From the pubic symphisis upwards
2
Q
What position is required for a cardiovascular examination?
A
Supine position with the upper body elevated 45 degrees
3
Q
What are the surface projections of the heart?
A
4
Q
What pulses are palpated for a cardiovascular examination (8)?
A
- Common Carotid Pulse
- Brachial Pulse
- Radial Pulse
- Ulnar Pulse
- Femoral Pulse
- Popliteal Pulse
- Posterior tibial Pulse
- Dorsalis pedis Pulse
5
Q
How does one assess the common carotid artery pulse?
A
- Palpated in the neck: medial to the sternocleidomastoid muscle and lateral to the thyroid cartilage
- Make sure the patients head is straight if the neck to twisted to the left you will not be able to palpate the right common carotid pulse
6
Q
How does one assess the brachial artery pulse?
A
- In the cubital fossa
- Medial side of the tendon of biceps brachii and keep the elbow fully extended
7
Q
How does one assess the radial artery pulse?
A
- At the wrist between the distal end of the radius and lateral to the tendon of flexor carpi radialis muscle
8
Q
How does one assess the ulnar artery pulse?
A
- At the wrist over the distal end of the forearm lateral to the tendon of flexor capri ulnaris muscle
9
Q
How does one assess the femoral artery pulse?
A
10
Q
How does one assess the popliteal artery pulse?
A
11
Q
How does one assess the posterior tibial artery pulse?
A
12
Q
How does one assess the dorsalis pedis artery pulse?
A
13
Q
What is assessed is peripheral pulses (5)?
A
- Pulse rate
- Rhythm
- Character and volume
- Symmetry of pulses
- Radio-femoral delays between major arteries
14
Q
How is the apex beat assessed?
A
- To palpate for the apex beat you should first locate the 2nd rib by finding the sternal angle as they are on the same level
- Afterwards, you should count down to the 5th intercostal space on the left and move laterally to the mid-clavicular line
- Once you have done so you should start to feel for the apex beat laterally and move more medially in case the apex beat is displaced
- The apex beat is non-palpable in many patients but you can ask the patient to lean towards their left side, which may help you to feel it
- You can also get the patient to jog on the spot for 1 minute to increase their heart rate but this would waste valuable time during the exam
15
Q
How are heaves assessed?
A
- To feel for heaves place your hand vertically adjacent to the sternum on the left and right side
- If heaves are present you should feel the heel of your hand lift off the chest
16
Q
How are thrills assessed?
A
- Thrills are felt in the same areas as the points of auscultation across all 4 valves as they are just palpable murmurs
- To feel for them instead place your hand horizontally with your fingers more than the rest of your hand as they are more sensitive to the vibrations
17
Q
What is the clinical significance of heaves?
A
- The main causes of heaves are hypertrophy of the left or right ventricle depending on where you feel the heaves due to there being more muscle to push against the anterior chest wall
18
Q
Where does the auscultation of the aortic valve take place?
A
- Right 2nd intercostal space next to the sternum
19
Q
Where does the auscultation of the pulmonary valve take place?
A
- Left 2nd intercostal space next to the sternum
20
Q
Where does the auscultation of the tricuspid valve take place?
A
- Left 5th intercostal space near the sternum
21
Q
Where does the auscultation of the mitral valve take place?
A
- Left 5th intercostal space at the mid-clavicular line
22
Q
What are the 2 types of aortic murmurs (accentuating manoeuvre: get the patient to lean forward and get them to breath out)?
A
- Aortic Stenosis
- Aortic Regurgitation
23
Q
What are the 2 types of mitral murmurs (accentuating manoeuvre: get the patient to lean forward and get them to breath out)?
A
- Mitral Stenosis
- Mitral Regurgitation
24
Q
How does aortic stenosis present on auscultation?
A
- Ejection Systolic Murmur
- Radiates to carotid arteries
- Loudest on Expiration
25
How does aortic regurgitation present on auscultation?
* Early Diastolic Murmur
* No radiating sounds
* Loudest on Expiration
26
How does mitral stenosis present on auscultation?
* Low rumbling mid-diastolic with opening snap murmur
* Radiates to left axilla
* Loudest on Expiration
27
How does mitral regurgitation present on auscultation?
* Pan-systolic murmur
* Radiates to the left axilla
* Loudest on expiration
28
What is sinus bradycardia? What are the possible causes (2)?
* **ECG appearance:**
* Each **P wave is followed by a QRS complex (1:1)**
* **Rate** is **regular** (even R-R intervals) and **slow** (
* **Causes:**
* Vagal stimulation
* Muscular heart (reduced heart rate to maintain same cardiac output)
29
What is sinus tachycardia? What are the possible causes (1)?
* **ECG appearance:**
* Each **P wave is followed by a QRS complex (1:1)**
* **Rate** is **regular** (even R-R intervals), and **fast** (\>107bpm)
* **Causes:**
* Often physiological response (i.e. secondary)
30
What is sinus arrhytmia?
* **ECG appearance:**
* Each **P wave is followed by a QRS wave**
* **Rate** is **irregular** (variable R-R intervals), and **normal** (65-100bpm)
* R-R intervals varies with breathing cycle
31
What is atrial fibrillation? What are the physiological risks of atrial fibrillation?
* **ECG appearance:**
* **Oscillating baseline** given the atria are contracting asynchronously
* The **rhythm** can be **irregular** and **rate** may be **slow**
* **Physiological risk:**
* Turbulent flow pattern **increases clot risk**
32
What is atrial flutter?
* **ECG appearance:**
* **Regular saw-tooth pattern** in baseline (leads II, III, and AVF)
* **Atrial:ventricular** beats (**2:1** ratio or **3:1** ratio)
* There are **P waves without succeeding QRS complexes**
33
What is first degree heart block?
* **ECG appearance:**
* The **PR segment is inappropriately long,** there is impaired conduction through the atrioventricular node to the ventricles
* Prolongation is caused by **slower AV conductio**n
* There is a **regular rhythm, 1:1 ratio of P waves to QRS complexes**
34
What is a Mobitz - I (Second degree) heart block?
* **ECG appearance:**
* **Progressive prolongation of the PR interval** until a beat is dropped
* **Majority** of **P waves** are **followed by QRS complex**
* **Regularly irregular rhythm**, caused by diseased AV node (i.e. 75 75 40 75 75 40)
35
What is a Mobitz - II (Second degree) heart block?
* **ECG appearance:**
* **P waves are regular**, however only **some are followed by QRS complex**
* There is **NO PR prolongation**
* **Regularly irregular rhythm**
36
What is third degree heart block?
* **ECG appearance:**
* **P waves are regular**, **QRS are regular** however there is **no relationship**
* Truly **non-sinus rhythmn**
* ****There is **complete AV nodal failure**
37
What is ventricular tachycardia? How is it managed?
* **ECG appearance:**
* **P waves are hidden**, given that there is **dissociated atrial rhythm**
* **Rate is regular** and **fast** (100-200bpm)
* **Management:**
* **Shockable** rhythm
38
What is ventricular fibrillation? What is its physiological effect?
* **ECG appearance:**
* **Rhythm** is **irregular** and **\>250bpm**
* Uncoordinated manner, the **QRS complexes are irregular,** thus there is **no coordination of muscular contraction**
* **Physiological effects:**
* **Unstable to generate cardiac output**
39
What causes ST elevation? By what measurement is ST elevation classified?
* **Infarction** (tissue death caused by hypoperfusion)
* \>2mm above the isoelectric line
40
What causes ST depression?
* **Myocardial infarction** (coronary insufficiency)
41
Where does **Lead 1** go from and to (1L)?
* Right arm → Left arm
42
Where does **Lead 2** go from and to (2L)?
* Right arm → Left leg
43
Where does **Lead 3** go from and to (3L)?
* Left arm → Left leg
44
What is the direction of depolarisation (negative / anode to positive / cathode) in Lead 1?
* Right arm → Left arm
45
Where is V1 placed?
* **Right sternal border** in the **4th intercostal space**
46
Where is V2 placed?
* **Left sternal border** in the **4th intercostal space**
47
Where is V3 placed?
* Halfway **between V2 and V4**
48
Where is V4 placed?
* In the **5th intercostal space** at the **mid clavicular line**
49
Where is V5 placed?
* **Anterior axillary line** at the **level of V4**
50
Where is V6 placed?
* **Mid axillary line** at the **level of V4**
51
Which electrode is placed in the fourth intercostal space at the mid clavicular line?
* V4
52
Which coronary artery is associated with Lead 1?
* **Left circumflex artery**
53
Which coronary artery is associated with Lead 2?
* **Right coronary artery**
54
Which coronary artery is associated with Lead 3?
* **Right coronary artery**
55
Which coronary artery is associated with aVL?
* **Left circumflex artery**
56
Which coronary artery is associated with aVF?
* **Right coronary artery**
57
Which coronary artery is associated with V1?
* **Left anterior descending artery**
58
Which coronary artery is associated with V2?
* **Left anterior descending artery**
59
Which artery is associated with V3?
* **Right coronary artery**
60
Which coronary artery is associated with V4?
* **Right coronary artery**
61
Which coronary artery is associated with V5?
* **Left circumflex artery**
62
Which coronary artery is associated with V6?
* **Left circumflex artery**
63
Which ECG leads are associated with the lateral view of the heart (4)?
* Lead 1
* aVL
* V5
* V6
64
Which coronary artery is associated with leads of the lateral view of the heart?
* **Left circumflex artery**
65
Which ECG leads are associated with the anterior view of the heart (2)?
* V4
* V3
66
Which coronary artery is associated with the anterior view of the heart?
* **Right coronary artery**
67
Which ECG leads are associated with the inferior view of the heart (3)?
* Lead 2
* Lead 3
* aVF
68
Which coronary artery is associated with the inferior view of the heart?
* **Right coronary artery**
69
Which ECG leads are associated with the septal view of the heart (2)?
* V1
* V2
70
Which coronary artery is associated with the septal view of the heart?
* **Left anterior descending artery**
71
Which leads are bipolar (3)?
* Lead 1
* Lead 2
* Lead 3
72
Which leads are located on the limbs (6)?
* Lead 1
* Lead 2
* Lead 3
* aVR
* aVL
* aVF
73
Where is the cathode (+ve) located at Lead 1?
* Left arm
