Clinical Skills Flashcards
Where can you palpate the apex of the heart?
5th left intercostal space in the midclavicular line (mitral area)
Where do you auscultate the aortic valve?
2nd right ICS sternal edge
Where do you auscultate the tricuspid valve?
4th left ICS sternal edge (lower left sternal edge)
Where do you auscultate the pulmonary valve?
2nd left ICS sternal edge
Where do you auscultate the mitral valve?
5th left ICS midclavicular line
Why is JVP a good measure of right atrial pressure?
There are no valves between the internal jugular vein and the right atrium
How is JVP estimated?
the vertical distance between the manubriosternal angle and the top of the venous column
IJV pulsations are _____1_____ but compression of the _____2____ causes a temporary increase in venous pressure making the JVP more visible. This is known as _____3_____
1 not usually visible
2 right upper abdomen
3 the hepatojugular reflex
Is the JVP pulse palpable?
No
Stenosis is…. so will be heard when….
Narrowing of valve causing turbulent blood flow so will be heard when the valve is open
Regurgitation results in …. so will be heard when ….
blood leaking back so will be heard when the valve is closed.
Systolic Murmurs?
Mitral regurgitation
Tricuspid Regurgitation
Pulmonary Stenosis
Aortic Stenosis
Diastolic Murmurs?
Mitral stenosis
Tricuspid stenosis
Pulmonary regurgitation
Aortic Regurgitation
The murmur of mitral stenosis will be accentuated if you listen….
At the apex and roll the patient onto their left
Check for aortic regurgitation by…
Asking the patient to lean forward, exhale and auscultate over lower left sternal edge.
A third heart sound is an ______1_______
It occurs ___2____ and is related to _____3_____ They are best heard at ___4____
1) early diastolic low frequency filling sound
2) immediately after the 2nd heart sound
3) acceleration and deceleration of blood during early passive filling of the ventricle
4) apex with the bell of the stethoscope
Are third sounds always pathological?
In young people they can be physiological in older patients with suspected or known cardiac disease it is likely to be due to left ventricular dysfunction and they should be referred for an echo
A fourth heart sound is a _____1________ it occurs ____2_____ It is due to ___3_____
Common causes of this are _____4_______
1) late diastolic low frequency filling sound
2) shortly before the first heart sound
3) Atrial contraction causing rapid blood flow into a less compliant or stiff ventricle
4) myocardial ischaemia, hypertension and aortic stenosis
Are fourth heart sounds always pathological?
Yes
Describe the a wave of JVP
This is produced by atrial systole
When are a waves increased and when do you get giant cannon waves?
a waves are increased with right ventricular hypertrophy. Giant cannon waves occur in complete heart block and VT
Describe the c wave of JVP
The c wave occurs during the x descent and is due to transmission of right ventricular systolic pressure before the tricuspid valve closes
When does the x descent of JVP occur?
When atrial contraction finishes
When does the v wave occur?
Occurs with venous return filling the right atrium.
When do massive v waves occur?
Massive v waves occur in tricuspid regurgitation
When does the y descent occur?
This follows the v wave when the tricuspid valve opens
When is a steep y wave seen?
constrictive pericarditis and tricuspid incompetence
Anatomical position of the carotid pulse?
anterior to the sternocleidomastoid muscle at the level o the superior border of the thyroid cartilage
Anatomical position of the brachial artery?
Medial to the biceps brachia tendon in the cubital fossa
Anatomical position of the radial artery?
Lateral to the tendon of the flexor carpi radialis
Anatomical position of the femoral artery?
Inferior to the midpoint of the inguinal ligament
Anatomical position of the popliteal artery?
In the popliteal fossa which is immediately posterior to the knee
Anatomical position of the posterior tibial artery?
Between the posterior border of the medial malleolus and the achilles tendon
Anatomical position of the dorsals pedis artery?
Medial to the tendon of extensor hallucis longus on the dorsum of the foot
Tests used to assess CVD risk?
urinalysis for protein, funds examination for hypertensive retinopathy, 12 lead ECG, blood tests for glucose, electrolytes, creatine, eGFR and cholesterol
What heart enlargement is difficult to see on x-ray?
Right sided
