Cardiovascular OSCE Flashcards
Differentiate between bell and diaphragm of stethoscope
Diaphragm for high pitched sounds: S1, S2, AR, MR, friction rubs
Bell for low pitched sounds: S3, S4, MS, carotid bruit
4 primary steps to CV exam
- Inspection
- Palpation
- Percussion
- Auscultation
General appearance findings for CV exam
Consciousness Cyanosis Flushing Respiratory patterns Anxiety/distress Body habitus Diaphoresis Neck veins - JVD
Look at shape, landmarks, scars/signs of trauma
What palpation area is used to estimate the location of the apex/left border of the heart?
PMI
Patient position for assessing PMI
Upright, supine, or lateral decubitus
Where is PMI usually palpated
Near 4-5th intercostal space in midclavicular line
T/F: PMI may not be felt in healthy heart/patient
True
Describe a normal PMI
Impulse should be a small, brisk beat and measure less than 2.5 cm. The impulse should last through the first 2/3 of the systolic period (or less). It should not be felt through the second heart sound
What palpation technique is used when PMI is not felt? Describe this technique
Percussion
Start far left where “resonant” and move medially to find cardiac “dullness”
4 auscultation listening posts for CV exam
Aortic valve - R 2nd ICS at SB
Pulmonic valve - L 2nd ICS at SB
Tricuspid valve - L 4th ICS at SB
Mitral valve - L 5th ICS at midclavicular line
How do heart sounds correspond with systole and diastole?
Diastole –> S1 –> systole –> S2 –> diastole
Heart sound S1
Closure of tricuspid and mitral valves
Heart sound S2
Closure of aortic and pulmonic valves
[may split with inspiration]
Heart sound S3
Dull, low pitch, best heart with bell
[due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of rapid filling phase]
Physiologic in children/young adults, pathologic in greater than 40 y/o
KENTUCKY
Heart sound S4
Dull, low pitch, best heart with bell
[atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle]
Can be normal in trained athletes
TENNESSEE
Where are systolic murmurs heard in relation to heart sounds
Between s1 and s2
What are the 4 major causes of systolic murmurs
Aortic stenosis
Pulmonic stenosis
Mitral regurg
Tricuspid regurg
Where are diastolic murmurs heard in relation to heart sounds
Between S2 and S1
4 major causes of diastolic murmurs
Aortic regurg
Pulmonic regurg
Mitral stenosis
Tricuspid stenosis
Murmur grading scale
Grade 1 = very faint
Grade 2 = quiet, but heard easily with stethoscope
Grade 3 = moderately loud, no thrill
Grade 4 = loud with palpable thrill
Grade 5 = very loud with thrill, may be heard with steth partly off chest
Grade 6 = heard with steth entirely off chest
Assessing the carotid pulse
Medial to SCM
Assess for thrills and bruits
Do not assess both carotid pulses simultaneously
Possible locations for assessing peripheral pulses
Radial Brachial Femoral Popliteal Dorsalis pedis Posterior tibial
Pulse grading scale
0/4 = absent, not palpable
1/4 = diminished, barely palpable
2/4 = average intensity, expected, normal
3/4 = strong, full, increased
4/4 = bounding
Should you be concerned if you are only able to locate and palpate EITHER the dorsalis pedis OR posterior tibial pulse?
No, not as long as patient’s lower extremity is otherwise intact
