Cardiovascular Physical Exam Flashcards
What is the sequence of the physical exam (4 steps)?
- inspection
- palpation
- auscultation
- percussion
What tools might you need during the cardio PE?
- gown/draping for pt
- exam table w/ HOB elevation 30 degrees
- stethoscope
- tangential light
- ruler
- BP cuff
First component of cardio physical exam?
good set of vitals
What should you do during the inspection portion of cardio PE?
- look for scars, abnormalities, and apical impulse
- use tangential light
What should you do during the palpation portion of cardio PE?
- feel for heaves (large areas of sustained outward motion)
- feel for thrills (vibration/palpable murmurs)
What might heaves indicate?
right ventricular hypertrophy
What are the 4 auscultatory areas and where are they anatomically?
- aortic: 2nd ICS at right sternal border
- pulmonic: 2nd ICS at left sternal border
- RV/tricuspid area: 3-5 ICS along left sternal border
- LV/bicuspid area: apex of heart at left 5th ICS along midclavicular line
Pulsations felt in the aortic area might indicate what?
aortic aneurysm or dilated aorta
Where should the API normally be located? What characteristics should be noted about the API?
- in the 4th or 5th ICS along the midclavicular line
- location
- diameter
- amplitude
- duration
If the diameter of the API exceeds 3 cm, you should evaluate the patient for ______.
enlarged left ventricle
What can be used to decrease the sounds caused by chest hair against the stethoscope diaphragm?
-warm water or KY jelly
What types of sounds are heard with the diaphragm?
- high pitched sounds
- S1, S2, aortic or mitral regurgitations, pericardial friction rubs
What types of sounds are heard with the bell?
- low pitched sounds
- S3, S4, mitral stenosis
How does listening technique with the diaphragm differ from listening with the bell?
- diaphragm: press firmly against skin
- bell: press gently against skin
S1
caused by closure of mitral and tricuspid valves
S2
closure of aortic valve
S3
- immediately after S2
- rapid deceleration of blood against ventricle wall
- Kentucky
S4
- immediately before S1
- decreased ventricular compliance
- Tennessee
When the patient is sitting up, leaning forward, and holding breath - what are you listening for?
-aortic stenosis, aortic regurgitation, pericardial rubs
When the patient is in left lateral decubitus - what are you listening for?
S3, S4, mitral stenosis
How are heart murmurs graded?
- 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
What should you inspect during peripheral cardio exam?
- 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
Lipodermatosclerosis
hardening/thickening of skin
Clubbing
- seen on fingertips
- can be from chronic hypoxia, COPD
