Cardiovascular Examination

Question 1

symptoms to be aware of

Answer 1

angina
• shortness of breath
• claudication
• syncope/near syncope
• weakness/fatigue
• diaphoresis
• nausea/vomiting

Question 2

what is angina

Answer 2

Discomfort anywhere above the umbilicus
brought on by physical exertion or
emotional stress and relieved by rest or
nitroglycerin

Question 3

It is likely to be angina if:

Answer 3

relieved by rest or nitroglycerin
• of relatively short duration
• accompanied by associated symptoms
• made worse with exercise or activity
• discomfort that comes on at a predictable
workload

Question 4

physical exam inspection

Answer 4

general appearance
• facial characteristics
• evaluation of the neck
• evaluation of the chest
• cough
• appearance of extremities

Question 5

normal hart sounds

Answer 5

S1- lub
closure of the mitral and tricuspid valves
S2- dub
closure of aortic and pulmonic valves

Question 6

abnormal heart sounds

Answer 6

S3
• Poor ventricular compliance and turbulence
• Low frequency sound in early diastole
S4
exaggerated atrial contraction and turbulence
low frequency sound in late diastole

Question 7

peripheral vascular exam includes

Answer 7

• skin color, size, and shape of extremity
• presence of edema - girth measurements
• trophic changes - hair, skin, nails
• ulcerations, varicosities

Question 8

arterial insufficiency characteristics

Answer 8

• claudication/pain at rest
• diminished pulses
• pale color
• cool skin
• no or mild edema
• trophic changes
• ulcers on toes
• gangrene may occur

Question 9

venous insufficiency characteristics

Answer 9

no pain, maybe aching
• normal pulse
• normal or cyanotic color
• normal temperature
• marked edema
• may have thick skin, brown
pigmentation
• ulcers usually on ankles
• gangrene does not occur

Question 10

Buergers test

Answer 10

position patient in supine
• elevate leg to 60 degrees for 60 seconds
• grade time to develop pallor
• 0=no pallor
• 1 = some pallor at 60 sec
• 2 = pallor after 30-60 sec,
• 3 = pallor after less than 30 sec
• 4 = pallor without elevation
• have patient sit up and flex knees over edge of table
• venous refill with dependency - veins should bulge outward within 30 seconds
• confirms arterial disease if longer

Question 11

in a supine to standing test what should happen to the DBP

Answer 11

it should increase in standing with a maintenance of SBP

an abnormal response would be for DBP to decrease in standing which could indicate a failing pump

Question 12

what is pulsus alternans

Answer 12

• Palpation of femoral or radial artery
• Breath held in mid-expiration
• Positive finding is alternating strong and
weak pulse beats
• Indicates depressed myocardial function,
CHF

Question 13

what is pulsus paradoxus

Answer 13

a greater than 10 mmHg decrease in SBP during insporation; could be a sign of cardiac tamponade, constrictive
pericarditis, restrictive cardiomyopathy