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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?

25
What causes split S2?
Inspiration causes a more negative intrathoracic pressure, causing the pulmonary valve to close slower than the aortic valve and splitting the S2 sound
26
What causes an S3 sound?
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
What conditions cause an S3 sound?
Congestive Heart Failure, Restrictive Cardiomyopathy
28
How can an S3 sound be heard?
S3 sounds are heard at the apex with the patient in the LLD position during early diastole (immediately after S2)
29
What causes an S4 sound?
S4 sounds are found when atrial contraction forces blood into a stiff ventricle
30
What conditions cause an S4 sound?
Left Ventricular Hypertrophy
31
How can an S4 sound be heard?
S4 sounds are heard at the apex with the patient in LLD position, low pitch sound during late diastole
32
How are S3 and S4 sounds different?
S3 sounds are early diastole immediately after S2 while S4 are late diastole right before S1
33
What characteristics describe a murmur?
``` 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
What are the common systolic murmurs?
Aortic stenosis and mitral regurgitation
35
Describe aortic stenosis?
Systolic murmur Crescendo-decrescendo Heard in the aortic area and radiates to the carotid arteries
36
Describe mitral regurgitation?
Holosytolic murmur heard best at the apex, radiates to the axilla
37
What sounds should be heard in Diastole?
No sound should be heard in diastole; should be totally silent and all murmurs are pathologic
38
What are common diastolic murmurs?
Aortic regurgitation and Mitral stenosis
39
Describe Aortic regurgitation?
Blowing, decrescendo murmur heard best along the sternal border Associated with widened pulse pressure
40
What pressure change is Aortic regurgitation associated with?
Aortic regurgitation is associated with a widened pulse pressure
41
Describe Mitral regurgitation?
Low pitched rumbling diastolic murmur heard at the apex, best heard in the LLD position
42
What should be palpated to obtain a heart rate?
Carotid artery, better than radial
43
What pulse contour would be expected with aortic stenosis?
Delayed and diminished arterial pulse
44
What pulse contour would be expected with aortic regurgitation?
Bounding arterial pulse
45
What pulse contour would be expected with shock?
Weak and thready arterial pulse
46
What are the two properties of the JVP and what are they used for?
Height of JVP = volume status Contour of JVP = clues to cardiac disease
47
How is JVP calculated from the angle of Louis?
Measure the vertical distance from the angle of Louis to the meniscus of the JVP, then add 5cm Normal JVP <= 9cm
48
How should an inability to find the JVP be reported?
If the JVP cannot be found, report as "JVP not visualized" Do NOT say "No JVD", because this implies no distension/elevation
49
Why is a visible JVP in an upright patient automatically a sign that they are fluid overloaded?
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
When does S1 occur on a venous pressure tracing?
S1 occurs after the A wave (atrial contraction) and during the C wave (ventricular contraction)
51
What is the X descent?
Relaxation of the right atrium
52
What is the V wave?
Venous return to the right atrium with a closed tricuspid valve
53
What is the Y descent?
Rapid transfer of blood from the Right atrium to the Right ventricle after the tricuspid valve opens
54
What is a thrill?
A murmur that can be felt, at least a 4/6
55
When can an S3 sound be normal?
During periods of increased cardiac output, such as pregnancy
56
When can an S4 sound be normal?
Never
57
What is a murmur?
An extra heart sound due to turbulent flow across a vavle
58
Differentiate a murmur and a bruit?
A murmur is turbulent flow across a vale while a bruit is turbulent flow across an artery

Cardiovascular (25 decks)

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