Cardiovascular Physical Exam Flashcards
Common Heart Attack symptoms
Chest or left arm pain or discomfort usually with exertion but can occur at rest (angina)
Shortness of breath (dyspnea) at rest OR more easily brought on with usual activities OR or exercise limiting OR accompanied with increased sputum production
Clamminess and profuse sweating
Common A-Fib symptoms
Fainting (syncope) or near fainting (pre-syncope)
Palpitations
Common heart failure symptoms
- Difficulty laying flat (because of increased shortness of breath; orthopnea)
- Nighttime dyspnea causing the patient to get up (paroxysmal nocturnal dyspnea or PND)
- Lower-extremity or sacral edema
Common peripheral artery disease symptoms
Pain in the legs brought on with predictable walking distances eased with 5-10 minutes of rest and (claudication)
5 stethoscope points
Aortic - right 2nd IS
Pulmonic - Left 2nd IS
Erb’s point - Left 3rd IS
Tricuspid - Lower left sternal border, 4th IS
Mitral - Left 5th IS, medial to midclavicular line
Long, low - pitched. Loudest at apex
S1
Short, high-pitched. Loudest at base
S2
Aortic Valve Stenosis
Narrowing of aortic valve
Aortic Valve regurgitation
Blood flow back into L ventricle
Mitral valve stenosis
Narrowing of Mitral valve
Mitral valve regurgitation
blood flows back into the left atrium
Systolic murmurs occur when?
After the 1st “lub”
When do diastolic murmors occur
After 2nd “lub”
Two types of Gallops that can be heard
S3 - Ventricular gallop (systolic CHF, hypertension, HOCM) “SLOSH-ing-in”
S4 - Atrial gallop (diastolic CHF) “a-STIFF-wall”
What causes a radiation of murmors?
To the carotid arteries, can be accompanied by parvus et tardus (aortic stenosis). Parvus (weak/small/diminished). Tardus (tardy).
To the axilla or left sternal edge (mitral regurgitation)
What causes the accentuation of a murmor?
To the carotid arteries, can be accompanied by parvus et tardus (aortic stenosis)
To the axilla or left sternal edge (aortic regurgitation)
Pertinant positive findings for hands and fingers
Nail clubbing. (infective endocarditis, cyanotic heart, etc.)
Janeway lesions. Non-tender nodes (bacterial endocarditis)
Osler Nodes. Tender red nodules (bacterial endocarditis)
Sweaty/clammy hands (can be ACS)
Cool to touch (can be poor cardiac output)
Tar stains (smoking)
Poor capillary refill, >2 seconds (hypovolemic)
Poor Color “dusky” (cyanosis, hypoxia)
Radial pulse (arrhythmia, tachycardia, delay)
Pertinent positive body findings on exam
Scars - of the neck, chest, arms and legs
Neck - Carotid endarterectomy
Chest - sternotomy, pacemaker, chest tubes, etc.
Arms/Legs - vein and artery graft harvest sites
Pertinent positive pulse findings on exam
Slow/late carotid pulse/tardus (carotid stenosis)
weak/small carotid pulse/parvus (carotid stenosis)
Carotid Bruit (carotid stenosis)
Collapsing pulse/Water Hammer (aortic regurgitation)
Narrow pulse pressure (BP reading - aortic stenosis)
Wide pulse pressure (BP reading - aortic regurgitation)
Bounding abdominal midline (aortic aneurysm)
Pertinent eye findings on exam
Corneal Arcus
Xanthelasmas/Xanthomas
Hypercholesterolemia
Pertinent chest wall findings on exam
Chest wall deformities
Pectus Excavatum
Pectus Carinatum
Chest wall scars (see above)
Visible pulsations at apex (ventricular hypertrophy)
