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Physical Assessment > Cardiovascular Examination > Flashcards

Cardiovascular Examination Flashcards

1
Q

What is the mediastinum?

A

Connective tissue-lined compartment located centrally in the thoracic cavity
*Houses the heart and the vessels
*Aorta, pulmonary arteries
* Superior and inferior vena cava

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2
Q

Which ventricle is the most anterior structure of the heart?

A

Right ventricle

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3
Q

What are the atrioventricular valves/

A

Mitral and tricuspid valves

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4
Q

What are the semilunar valves?

A

Aortic and pulmonic valves

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5
Q

What are the heart sounds produced when the heart valves close/

A

S1 and s2

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6
Q

During systole what valves are open and closed?

A

Open: Pulmonic and aortic
Closed: Mitral and tricuspid
*To prevent backwards blood flow

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7
Q

During diastole which valves are open and closed?

A

Open: Mitral and tricuspid
Closed: Pulmonic and aortic

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8
Q

What is the cardiac cycle/=?

A

The complete movement of the heart
*One heartbeat to the beginning of the next heartbeat

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9
Q

Describe systole

A

Period of ventricular contraction
*When the left ventricle ejects blood into the aorta

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10
Q

Describe diastole

A

ventricular relaxation
*once the ventricle ejects much of the blood into the aorta, the pressure levels start to fall off

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11
Q

During systole what valves are open and closed?

A

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

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12
Q

During diastole which valves are open or closed?

A

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

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13
Q

What produces heart sound S1

A

Closure of the mitral valves and the tricuspid valve
*right side of the heart
*Systole

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14
Q

What corresponds with systolic blood pressure?

A

Maximal Left ventricular pressure

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15
Q

What produces heart sound S2?

A

Aortic valve closure and pulmonic valve closure
*diastole begins

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16
Q

What is an opening snap?

A

Happens during mitral stenosis
*opening of the mitral valve
*early diastolic sound
*High pitched (diaphragm)

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17
Q

What happens during systole?

A

Ventricles contract
*the RV pumps blood into the pulmonary arteries (Pulmonic valve is open)

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18
Q

What happens during diastole?

A

Ventricles Relax
*Blood flows from RA to RV (Tricuspid valve is open)
Blood flows from LA to LV (Mitral valves is open)

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19
Q

What is the definition of preload?

A

Volume overload
*Load that stretches the cardiac muscle before contraction
*volume of blood in the right ventricle at the end of diastole

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20
Q

What is the definition of myocardial contractility?

A

Ability of cardiac muscle to contract in systole

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21
Q

What is the definition of afterload?

A

Pressure overload
*degree of vascular resistance to ventricular contraction
*Pressure that the left ventricle is overcoming

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22
Q

What is the definition of cardiac output?

A

Stoke volume X Heart rate
*The volume of blood ejected from each ventricle in 1 minute

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23
Q

What is the definition of stoke volume?

A

The volume of blood ejected with each heartbeat

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24
Q

What is blood pressure?

A

Cardiac output X systemic vascular resistance

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25
Q

Where is the aortic listening post located?

A

Right 2nd interspace

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26
Q

Where is the pulmonic listening valve located?

A

Left 2nd interspace

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27
Q

Where is the right ventricular listening post located?

A

Left sternal border

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28
Q

Where is the left ventricular (mitral) listening post located?

A

Apex of the heart

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29
Q

Where is the tricuspid listening post located?

A

Epigastric

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30
Q

Which part of the physical examination is usually rarely performed in the CV exam?

A

Percussion

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31
Q

What is a cause of clubbing?

A

Chronic hypoxia

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32
Q

What is orthostatic blood pressure?

A

Reduction of SBP of at least 20mmHG OR
DBP of at least 10mmHG

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33
Q

What does the jugular venous pressure represent?

A

Right atrial pressure

34
Q

How is JVP best estimated from?

A

From the right internal jugular vein

35
Q

What is the difference between the Internal jugular vein and carotid artery?

A

IJV: Not palpable, soft, 2 elevation, between 2 heads of sternocleidomastoid muscle
Carotid: Palpable, vigorous thrust, height unchanged by position or inspiration

36
Q

What type of lighting do you use to examine the neck vessels?

A

Tangential lighting

37
Q

How is the carotid pulse best heard?

A

With the bell

38
Q

What are the different types of upstroke with the carotid pulse/

A

Brisk: Normal
Delayed: Aortic stenosis
Bounding: Aortic insufficiency

39
Q

What is a thrill when feeling for the carotid pulse?

A

Palpable vibrations with Palpation of the carotid

40
Q

What is a bruits when listening to the carotid pulse?

A

Murmur-like sounds airing from turbulent arterial blood flow

41
Q

When do you use your finger pads during Palpation of the cardiac exam/

A

Feeling for heaves and lifts

42
Q

When do you use the palmar aspects of the MCPJ’s during Palpation of the cardiac exam?

A

Feeling for thrills
*Grade IV or higher murmur

43
Q

What is the apical pulse (point of maximal intensity)?

A

Brief early pulsation of the left ventricle as it moves anteriorly during contraction and contracts the chest wall

44
Q

Where is the point of maximal intensity located?

A

Found inn the fifth intercostal space OR medial to the left mid clavicular line

45
Q

When do you use the diaphragm?

A

For higher pitched sounds
*S1 and S2
*Murmurs of aortic and mitral regurgitation
*Pericardial friction rubs

46
Q

When do you use the bell?

A

For lower pitched sounds
*S3 and S4
*Mitral stenosis

47
Q

What side do you use in the left lateral decubitus position?

A

The bell
*listening over the mitral area

48
Q

Which side do you use in the seated, leaning forward position?

A

Diaphragm
*aortic, LSB, apex

49
Q

What are the different types of heart sounds/

A

S1 (LUB)
*systole
S2 (DUB)
*diastole

50
Q

What produces S1?

A

Closure of the mitral and tricuspid valves
*systole/contraction

51
Q

What produces S2?

A

Closure of the aortic and pulmonic valves
*diastole/ relaxation

52
Q

When is S1 heard louder than S2?

A

At the apex

53
Q

When is S2 heard best?

A

At the base

54
Q

What are the two components of S2?

A

A2: Aortic (loudest)
P2: Pulmonic

55
Q

When is a split S2 heard best?

A

Heard best with inspiration (pulmonic area)

56
Q

Where does fixed splitting occur?

A

In atrial septal defect and right ventricular failure

57
Q

What is a S3 heart sound (ventricular gallop)

A

-Early diastolic sound
-Older patients: may indicate heart failure
-LUB Dub ta
- best heard at LLD bell

58
Q

What causes a S3 heart sound

A

Rapid ventricular filing
-When mitral valve opens
-heard best at apex in LLD with bell

59
Q

What is a S4 heart sound (atrial gallop)

A

Late diastole (just before S1)
- when atria contract to force blood into left ventricle
Ta LUB Dub

60
Q

What is a cause of a S4 heart sound

A

Increased resistance to ventricular filling

61
Q

What is an opening snap?

A

Very early diastolic sound
Caused by a stenotic mitral valve
-best heard with the diaphragm (mitral area)

62
Q

What grade of murmur produces a thrill?

A

4/6 and up

63
Q

What are the most common type of systolic murmurs?

A

Midsystolic ejection murmurs

64
Q

Where are innocent (systolic) murmurs located?

A

LSB
-Turbulent blood flow from left ventricle to aorta

65
Q

Where is aortic stenosis located (pathological systolic murmur)

A

Right 2nd and 3rd ICS
-turbulent blood flow increases left ventricular afterload

66
Q

What is a pulmonic stenosis murmur (pathological systolic)

A

Left 2nd and 3rd ICS
Valvular stenosis impairs flow across the valve, increasing right ventricular afterload
*congenital

67
Q

What is a mitral regurgitation murmur/

A

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

68
Q

What is tricuspid regurgitation? (Systolic murmur)

A

Location: LLSB
-tricuspid valve. Fails to close fully in systole, blood regurgitates from right ventricle to right atrium

69
Q

What is a ventricular septal defec?

A

-opening between the ventricles
-will be a continuous murmur in both systole and diastole

70
Q

What is aortic regurgitation murmur? (Diastolic)

A

-aortic valve leaflets fail to close completely during diastole
-blood regurgitates from aorta back into the left ventricle

71
Q

What is mitral stenosis? (Diastolic murmur)

A

Rapid ventricular filling over thickened, stenotic valve causes turbulent blood flow
MC cause: rheumatic fever
Opening snap follows S2

72
Q

What is a continuous murmur?

A

Patent Ductus Ateriosus
-opening between pulmonary artery and aorta
-Machinery-like
-Left 2nd ICS

73
Q

When are ejection clicks heard?

A

Heard in systole

74
Q

When are opening snap heard?

A

Heard in diastole
-heard in mitral stenosis

75
Q

What is a pericardial fricition rub/

A

Coarse grating sounds
*left 3rd ICS

76
Q

What is Ms. ARD

A

Mitral Stenosis and Aortic Regurgitation (Diastolic murmurs)

77
Q

What is Mr. PASS

A

Mitral Regurgitation, Physiolgic and Aortic Stenosis (systolic murmurs)

78
Q

Gradin of pitting edema

A

1+ 2mm
2+ 4mm
3+ 6mm
4+ 8mm

79
Q

How do varicose veins happen?

A

Valves become incompetent

80
Q

What are the 5 P’s of acute arterial occlusion

A

Pain
Pallor
Pulselessness
Parenthesias
Paralysis

Physical Assessment (12 decks)

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