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Cardiovascular > CM Cardiac Exam > Flashcards

CM Cardiac Exam Flashcards

1
Q

What are the five elements of the cardiac exam?

A

IPIPA

Inspection of general appearance
Palpation of the arterial pulse
Inspection of the jugular venous pulse
Palpation of the precordial impulses
Auscultation of heart sounds
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2
Q

What signs may be found on general appearance in the cardiac exam?

A

Cyanosis, clubbing, peripheral edema

Point to cardiac pathologies

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3
Q

What can be determined by palpating the carotid artery?

A

Peripheral pulse/heart rate

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4
Q

What does a slow rate of rise in the arterial pulse suggest?

A

Aortic stenosis

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5
Q

What is the jugular venous pulse and why do we use it?

A

The jugular venous pulse is a measure of the right atrial pressure, since the right atrium itself is not directly accessible on physical exam

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6
Q

What is a normal jugular venous pulse?

A

5-9 cm of water at the angle of Louis

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7
Q

What is the angle of Louis?

A

The junction of the sternal body and the manubrium, found 5 cm above the right atrium and acts as a reference point to measure jugular venous pulse

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8
Q

How do the carotid pulse and JVP differ in terms of palpability?

A

The carotid pulse is easily palpable, the JVP is not

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9
Q

How do the carotid pulse and JVP differ in terms of peaks per cardiac cycle?

A

The JVP has 2 peaks and 2 troughs for each cardiac cycle

The carotid pulse has 1 pulsation per cycle

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10
Q

How do the carotid pulse and JVP change with position?

A

The JVP changes with patient position, while the carotid pulse does not change with position

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11
Q

How do the caroid pulse and JVP change with inspiration?

A

The JVP decreases with inspiration, while the carotid pulse does not vary with the respiratory cycle

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12
Q

What do the 2 peaks of the JVP represent?

A

The a wave and v wave in each cardiac cycle

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13
Q

What do the 2 troughs of the JVP represent?

A

The x descent and y descent in each cardiac cycle

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14
Q

What does Point of Maximal Impulse refer to?

A

PMI typically refers to the apex of the left ventricle

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15
Q

Where is PMI normally found?

A

Point of Maximal Impulse is normally found in the 5th intercostal space, 1-2cm in diameter and medial to the midclavicular line

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16
Q

What does a PMI lateral to the midclavicular line suggest?

A

Cardiomegaly

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17
Q

During ausculation, what pathologies are found in the Left Lateral Decubitus positoin?

A

While the patient is in the LLD position, 3rd and 4th heart sounds as well as Mitral Stenosis murmurs can be found

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18
Q

During ausculation, when the patient is seated upright and leaning forward, what can be heard and where?

A

Aortic regurgitation murmur can be heard at the left sternal border

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19
Q

What causes S1?

A

S1 is caused by closure of the Mitral and Tricuspid valves

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20
Q

What causes S2?

A

S2 is caused by closure of Aortic and Pulmonic valves

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21
Q

When does the Carotid pulse occur?

A

During Systole, between S1 and S2

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22
Q

Where is S1 loudest?

A

S1 is loudest at the apex of the heart (APTM)

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23
Q

Where is S2 loudest?

A

S2 is loudest at the base of the heart (APTM)

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24
Q

At what heart rate is Diastole longer than Systole?

A

HR < 120

25
Q

What causes split S2?

A

Inspiration causes a more negative intrathoracic pressure, causing the pulmonary valve to close slower than the aortic valve and splitting the S2 sound

26
Q

What causes an S3 sound?

A

S3 sounds are due to blood flowing against a distended or incompliant ventricle, and suggests that too much blood is flowing into the ventricle

27
Q

What conditions cause an S3 sound?

A

Congestive Heart Failure, Restrictive Cardiomyopathy

28
Q

How can an S3 sound be heard?

A

S3 sounds are heard at the apex with the patient in the LLD position during early diastole (immediately after S2)

29
Q

What causes an S4 sound?

A

S4 sounds are found when atrial contraction forces blood into a stiff ventricle

30
Q

What conditions cause an S4 sound?

A

Left Ventricular Hypertrophy

31
Q

How can an S4 sound be heard?

A

S4 sounds are heard at the apex with the patient in LLD position, low pitch sound during late diastole

32
Q

How are S3 and S4 sounds different?

A

S3 sounds are early diastole immediately after S2 while S4 are late diastole right before S1

33
Q

What characteristics describe a murmur?

A 
Timing (Systole/diastole)
Timing within Systole/diastole (early, mid, late, holo)
Shape (crescendo/decrescendo)
Location of maximal intensity
Radiation of murmur
Intensity rating out of 6
Quality (blowing/harsh)
34
Q

What are the common systolic murmurs?

A

Aortic stenosis and mitral regurgitation

35
Q

Describe aortic stenosis?

A

Systolic murmur
Crescendo-decrescendo
Heard in the aortic area and radiates to the carotid arteries

36
Q

Describe mitral regurgitation?

A

Holosytolic murmur heard best at the apex, radiates to the axilla

37
Q

What sounds should be heard in Diastole?

A

No sound should be heard in diastole; should be totally silent and all murmurs are pathologic

38
Q

What are common diastolic murmurs?

A

Aortic regurgitation and Mitral stenosis

39
Q

Describe Aortic regurgitation?

A

Blowing, decrescendo murmur heard best along the sternal border

Associated with widened pulse pressure

40
Q

What pressure change is Aortic regurgitation associated with?

A

Aortic regurgitation is associated with a widened pulse pressure

41
Q

Describe Mitral regurgitation?

A

Low pitched rumbling diastolic murmur heard at the apex, best heard in the LLD position

42
Q

What should be palpated to obtain a heart rate?

A

Carotid artery, better than radial

43
Q

What pulse contour would be expected with aortic stenosis?

A

Delayed and diminished arterial pulse

44
Q

What pulse contour would be expected with aortic regurgitation?

A

Bounding arterial pulse

45
Q

What pulse contour would be expected with shock?

A

Weak and thready arterial pulse

46
Q

What are the two properties of the JVP and what are they used for?

A

Height of JVP = volume status

Contour of JVP = clues to cardiac disease

47
Q

How is JVP calculated from the angle of Louis?

A

Measure the vertical distance from the angle of Louis to the meniscus of the JVP, then add 5cm

Normal JVP <= 9cm

48
Q

How should an inability to find the JVP be reported?

A

If the JVP cannot be found, report as “JVP not visualized”

Do NOT say “No JVD”, because this implies no distension/elevation

49
Q

Why is a visible JVP in an upright patient automatically a sign that they are fluid overloaded?

A

Normally, the angle of Louis is 5cm from the R. Atrium (which is why we add +5cm to our verticle measure from the angle of Louis)

In an upright patient with visible JVP, the distance of the JVP from the angle of Louis + 5cm is always >= 9cm

50
Q

When does S1 occur on a venous pressure tracing?

A

S1 occurs after the A wave (atrial contraction) and during the C wave (ventricular contraction)

51
Q

What is the X descent?

A

Relaxation of the right atrium

52
Q

What is the V wave?

A

Venous return to the right atrium with a closed tricuspid valve

53
Q

What is the Y descent?

A

Rapid transfer of blood from the Right atrium to the Right ventricle after the tricuspid valve opens

54
Q

What is a thrill?

A

A murmur that can be felt, at least a 4/6

55
Q

When can an S3 sound be normal?

A

During periods of increased cardiac output, such as pregnancy

56
Q

When can an S4 sound be normal?

A

Never

57
Q

What is a murmur?

A

An extra heart sound due to turbulent flow across a vavle

58
Q

Differentiate a murmur and a bruit?

A

A murmur is turbulent flow across a vale while a bruit is turbulent flow across an artery

Cardiovascular (25 decks)

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