Cardiovascular Examination Flashcards
What is the mediastinum?
Connective tissue-lined compartment located centrally in the thoracic cavity
*Houses the heart and the vessels
*Aorta, pulmonary arteries
* Superior and inferior vena cava
Which ventricle is the most anterior structure of the heart?
Right ventricle
What are the atrioventricular valves/
Mitral and tricuspid valves
What are the semilunar valves?
Aortic and pulmonic valves
What are the heart sounds produced when the heart valves close/
S1 and s2
During systole what valves are open and closed?
Open: Pulmonic and aortic
Closed: Mitral and tricuspid
*To prevent backwards blood flow
During diastole which valves are open and closed?
Open: Mitral and tricuspid
Closed: Pulmonic and aortic
What is the cardiac cycle/=?
The complete movement of the heart
*One heartbeat to the beginning of the next heartbeat
Describe systole
Period of ventricular contraction
*When the left ventricle ejects blood into the aorta
Describe diastole
ventricular relaxation
*once the ventricle ejects much of the blood into the aorta, the pressure levels start to fall off
During systole what valves are open and closed?
The aortic valve is open
*allowing ejection of the blood from the LV into the aorta
Mitral valve is closed
*Preventing blood from regurgitating back into the left
atrium
Tricuspid valve is closed
*When blood is ejected from the right ventricle into the pulmonary artery
During diastole which valves are open or closed?
Aortic valve is closed (Pulmonic)
*Preventing regurgitation of the blood from the aorta back into the left ventricles
Mitral valve is open
*Allowing blood to flow from the left atrium into the relaxed left ventricle
Tricuspid valves opens
*As blood flows into the relaxed right ventricle
What produces heart sound S1
Closure of the mitral valves and the tricuspid valve
*right side of the heart
*Systole
What corresponds with systolic blood pressure?
Maximal Left ventricular pressure
What produces heart sound S2?
Aortic valve closure and pulmonic valve closure
*diastole begins
What is an opening snap?
Happens during mitral stenosis
*opening of the mitral valve
*early diastolic sound
*High pitched (diaphragm)
What happens during systole?
Ventricles contract
*the RV pumps blood into the pulmonary arteries (Pulmonic valve is open)
What happens during diastole?
Ventricles Relax
*Blood flows from RA to RV (Tricuspid valve is open)
Blood flows from LA to LV (Mitral valves is open)
What is the definition of preload?
Volume overload
*Load that stretches the cardiac muscle before contraction
*volume of blood in the right ventricle at the end of diastole
What is the definition of myocardial contractility?
Ability of cardiac muscle to contract in systole
What is the definition of afterload?
Pressure overload
*degree of vascular resistance to ventricular contraction
*Pressure that the left ventricle is overcoming
What is the definition of cardiac output?
Stoke volume X Heart rate
*The volume of blood ejected from each ventricle in 1 minute
What is the definition of stoke volume?
The volume of blood ejected with each heartbeat
What is blood pressure?
Cardiac output X systemic vascular resistance
Where is the aortic listening post located?
Right 2nd interspace
Where is the pulmonic listening valve located?
Left 2nd interspace
Where is the right ventricular listening post located?
Left sternal border
Where is the left ventricular (mitral) listening post located?
Apex of the heart
Where is the tricuspid listening post located?
Epigastric
Which part of the physical examination is usually rarely performed in the CV exam?
Percussion
What is a cause of clubbing?
Chronic hypoxia
What is orthostatic blood pressure?
Reduction of SBP of at least 20mmHG OR
DBP of at least 10mmHG
What does the jugular venous pressure represent?
Right atrial pressure
How is JVP best estimated from?
From the right internal jugular vein
What is the difference between the Internal jugular vein and carotid artery?
IJV: Not palpable, soft, 2 elevation, between 2 heads of sternocleidomastoid muscle
Carotid: Palpable, vigorous thrust, height unchanged by position or inspiration
What type of lighting do you use to examine the neck vessels?
Tangential lighting
How is the carotid pulse best heard?
With the bell
What are the different types of upstroke with the carotid pulse/
Brisk: Normal
Delayed: Aortic stenosis
Bounding: Aortic insufficiency
What is a thrill when feeling for the carotid pulse?
Palpable vibrations with Palpation of the carotid
What is a bruits when listening to the carotid pulse?
Murmur-like sounds airing from turbulent arterial blood flow
When do you use your finger pads during Palpation of the cardiac exam/
Feeling for heaves and lifts
When do you use the palmar aspects of the MCPJ’s during Palpation of the cardiac exam?
Feeling for thrills
*Grade IV or higher murmur
What is the apical pulse (point of maximal intensity)?
Brief early pulsation of the left ventricle as it moves anteriorly during contraction and contracts the chest wall
Where is the point of maximal intensity located?
Found inn the fifth intercostal space OR medial to the left mid clavicular line
When do you use the diaphragm?
For higher pitched sounds
*S1 and S2
*Murmurs of aortic and mitral regurgitation
*Pericardial friction rubs
When do you use the bell?
For lower pitched sounds
*S3 and S4
*Mitral stenosis
What side do you use in the left lateral decubitus position?
The bell
*listening over the mitral area
Which side do you use in the seated, leaning forward position?
Diaphragm
*aortic, LSB, apex
What are the different types of heart sounds/
S1 (LUB)
*systole
S2 (DUB)
*diastole
What produces S1?
Closure of the mitral and tricuspid valves
*systole/contraction
What produces S2?
Closure of the aortic and pulmonic valves
*diastole/ relaxation
When is S1 heard louder than S2?
At the apex
When is S2 heard best?
At the base
What are the two components of S2?
A2: Aortic (loudest)
P2: Pulmonic
When is a split S2 heard best?
Heard best with inspiration (pulmonic area)
Where does fixed splitting occur?
In atrial septal defect and right ventricular failure
What is a S3 heart sound (ventricular gallop)
-Early diastolic sound
-Older patients: may indicate heart failure
-LUB Dub ta
- best heard at LLD bell
What causes a S3 heart sound
Rapid ventricular filing
-When mitral valve opens
-heard best at apex in LLD with bell
What is a S4 heart sound (atrial gallop)
Late diastole (just before S1)
- when atria contract to force blood into left ventricle
Ta LUB Dub
What is a cause of a S4 heart sound
Increased resistance to ventricular filling
What is an opening snap?
Very early diastolic sound
Caused by a stenotic mitral valve
-best heard with the diaphragm (mitral area)
What grade of murmur produces a thrill?
4/6 and up
What are the most common type of systolic murmurs?
Midsystolic ejection murmurs
Where are innocent (systolic) murmurs located?
LSB
-Turbulent blood flow from left ventricle to aorta
Where is aortic stenosis located (pathological systolic murmur)
Right 2nd and 3rd ICS
-turbulent blood flow increases left ventricular afterload
What is a pulmonic stenosis murmur (pathological systolic)
Left 2nd and 3rd ICS
Valvular stenosis impairs flow across the valve, increasing right ventricular afterload
*congenital
What is a mitral regurgitation murmur/
Located at the apex
-mitral valve fails to close fully in systole, blood regurgitates from left ventricle to left atrium, increasing left ventricular pre-load
What is tricuspid regurgitation? (Systolic murmur)
Location: LLSB
-tricuspid valve. Fails to close fully in systole, blood regurgitates from right ventricle to right atrium
What is a ventricular septal defec?
-opening between the ventricles
-will be a continuous murmur in both systole and diastole
What is aortic regurgitation murmur? (Diastolic)
-aortic valve leaflets fail to close completely during diastole
-blood regurgitates from aorta back into the left ventricle
What is mitral stenosis? (Diastolic murmur)
Rapid ventricular filling over thickened, stenotic valve causes turbulent blood flow
MC cause: rheumatic fever
Opening snap follows S2
What is a continuous murmur?
Patent Ductus Ateriosus
-opening between pulmonary artery and aorta
-Machinery-like
-Left 2nd ICS
When are ejection clicks heard?
Heard in systole
When are opening snap heard?
Heard in diastole
-heard in mitral stenosis
What is a pericardial fricition rub/
Coarse grating sounds
*left 3rd ICS
What is Ms. ARD
Mitral Stenosis and Aortic Regurgitation (Diastolic murmurs)
What is Mr. PASS
Mitral Regurgitation, Physiolgic and Aortic Stenosis (systolic murmurs)
Gradin of pitting edema
1+ 2mm
2+ 4mm
3+ 6mm
4+ 8mm
How do varicose veins happen?
Valves become incompetent
What are the 5 P’s of acute arterial occlusion
Pain
Pallor
Pulselessness
Parenthesias
Paralysis
