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Fall 2014 - HP1 Cardio > Cardiovascular Physical Exam > Flashcards

Cardiovascular Physical Exam Flashcards

1
Q

What is the sequence of the physical exam (4 steps)?

A
  • inspection
  • palpation
  • auscultation
  • percussion
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2
Q

What tools might you need during the cardio PE?

A
  • gown/draping for pt
  • exam table w/ HOB elevation 30 degrees
  • stethoscope
  • tangential light
  • ruler
  • BP cuff
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3
Q

First component of cardio physical exam?

A

good set of vitals

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4
Q

What should you do during the inspection portion of cardio PE?

A
  • look for scars, abnormalities, and apical impulse

- use tangential light

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5
Q

What should you do during the palpation portion of cardio PE?

A
  • feel for heaves (large areas of sustained outward motion)

- feel for thrills (vibration/palpable murmurs)

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6
Q

What might heaves indicate?

A

right ventricular hypertrophy

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7
Q

What are the 4 auscultatory areas and where are they anatomically?

A
  1. aortic: 2nd ICS at right sternal border
  2. pulmonic: 2nd ICS at left sternal border
  3. RV/tricuspid area: 3-5 ICS along left sternal border
  4. LV/bicuspid area: apex of heart at left 5th ICS along midclavicular line
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8
Q

Pulsations felt in the aortic area might indicate what?

A

aortic aneurysm or dilated aorta

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9
Q

Where should the API normally be located? What characteristics should be noted about the API?

A
  • in the 4th or 5th ICS along the midclavicular line
  • location
  • diameter
  • amplitude
  • duration
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10
Q

If the diameter of the API exceeds 3 cm, you should evaluate the patient for ______.

A

enlarged left ventricle

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11
Q

What can be used to decrease the sounds caused by chest hair against the stethoscope diaphragm?

A

-warm water or KY jelly

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12
Q

What types of sounds are heard with the diaphragm?

A
  • high pitched sounds

- S1, S2, aortic or mitral regurgitations, pericardial friction rubs

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13
Q

What types of sounds are heard with the bell?

A
  • low pitched sounds

- S3, S4, mitral stenosis

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14
Q

How does listening technique with the diaphragm differ from listening with the bell?

A
  • diaphragm: press firmly against skin

- bell: press gently against skin

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15
Q

S1

A

caused by closure of mitral and tricuspid valves

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16
Q

S2

A

closure of aortic valve

17
Q

S3

A
  • immediately after S2
  • rapid deceleration of blood against ventricle wall
  • Kentucky
18
Q

S4

A
  • immediately before S1
  • decreased ventricular compliance
  • Tennessee
19
Q

When the patient is sitting up, leaning forward, and holding breath - what are you listening for?

A

-aortic stenosis, aortic regurgitation, pericardial rubs

20
Q

When the patient is in left lateral decubitus - what are you listening for?

A

S3, S4, mitral stenosis

21
Q

How are heart murmurs graded?

A
  • scale of 1-6
  • 1: very faint, not heard in all positions
  • 2: quiet but not difficult to hear
  • 3: moderately loud
  • 4: loud with or w/o thrills
  • 5: very loud, +/- thrills, may be heard with steth partly off chest
  • 6: may be heard with steth completely off chest, +/- thrills
22
Q

What should you inspect during peripheral cardio exam?

A
  • skin color, loss of hair, unhealed wounds/ulcers
  • note nail beds for cyanosis or clubbing
  • assess for varicose veins
  • assess for swelling/edema
  • look for scars, needle track marks
23
Q

Lipodermatosclerosis

A

hardening/thickening of skin

24
Q

Clubbing

A
  • seen on fingertips

- can be from chronic hypoxia, COPD

25
Q

Pitting Edema

A

-can be volume overload, venous insufficiency, etc

26
Q

What should you palpate during peripheral cardio exam?

A
  • palpate skin temp and texture
  • assess cap refill in nail beds
  • assess pulses proximally and move distally
  • palpate abdominal aorta: pulse presence, rate, amplitude, regularity
27
Q

What should be auscultated peripherally?

A
  • listen just above the umbilicus for bruits

- may also listen over the renal, iliac and femoral arteries

28
Q

Measuring JVP

A
  • patient supine w/ HOB 30 degrees
  • locate sternal angle (angle of Louis) and place ruler vertically
  • locate internal jugular venous pulsation
  • put a card at apex of jugular pulsation perpendicular to the ruler
  • measurement > 9 cm is abnormal and sign of CHF or fluid overload or R side heart failure
29
Q

Ankle Brachial Index

A
  • establishes ratio of systolic BP at ankle and over the brachial artery
  • theoretically they should be the same so ABI = 1.0
  • 0.9-1.0 is normal
  • moderate dz: 0.75-0.9
  • severe dz: 0.5-0.75
  • limb threatening: below 0.5
30
Q

Homan’s Sign/Test

A
  • passive dorsiflexion of ankle (to stretch the calf)

- pain is suspicious for DVT

31
Q

Allen’s Test

A
  • tests for patency of both the radial and ulnar arteries
  • squeeze both at same time, then release one to see if it refills the hand
  • repeat with the other artery

Fall 2014 - HP1 Cardio (5 decks)

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