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PCM > CPA: Normal Cardiac/Vascular exam > Flashcards

CPA: Normal Cardiac/Vascular exam Flashcards

1
Q

When do you use the Diaphragm vs. Bell, what does each help you listen to?

A

Diaphragm - high pitched sounds (S1, S2, AR, MR, Friction Rubs)

Bell - low pitched (S3, S4, MS, carotid bruit)

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2
Q

A central protrusion of pt’s chest indicates what; while a central depression indicates?

A

Protrusion - Pectus carinatum

Depression - Pectus excavatum

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3
Q

What are thrills?

A

Turbulent blood flow causing murmurs (humming vibrations)

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4
Q

Point of maximal impulse (PMI) is usually palpated where, position of the patient can be?

A
  • Near 4th-5th intercostal space in MCL

- Supine or left lateral decubitus

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5
Q

When percussing for estimation of heart size what is proper procedure?

A

Start far left (resonance) and move medially to find cardiac dullness

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6
Q

Criteria (size) when palpating for impulse?

A

Small, brisk beat measuring less than 2.5 cm, should last the first 2/3 of systolic period (or less).

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7
Q

Where is Erb’s point listening post and what is heard there?

A

L 3rd ICS at SB; point at which S1 and S2 heard equally

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8
Q

What is an S3 sound?

A
  • Dull, low pitch (heard w/ bell)

- Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of rapid filling phase

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9
Q

When is S3 normal and abnromal, what does it sound like (name that state!)?

A
  • Normal in children/young adults
  • Pathologic >40 y/o

(Kent-Tuck-Y)

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10
Q

What is the S4 sound?

A
  • Dull, low pitch (heard w/ bell)

- Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle

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11
Q

When is an S4 normal and what is the sound (state)?

A

Normal in trained athletes (Ten-Nes-See)

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12
Q

Jugular veins reflect the activity of which side of the heart, indicates which pressure?

A

Right side - gives indication of the RAP

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13
Q

Most common cause of an elevated JVP?

A

Elevated RV diastolic pressue

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14
Q

Systolic murmurs are heard between?

A

S1 and S2

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15
Q

Systolic murmurs may indicate which pathologies?

A
  • Aortic stenosis
  • Pulmonic stenosis
  • Mitral regurgitation
  • Tricuspid regurgitation
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16
Q

Diastolic murmurs are heard between?

A

S2 and S1

17
Q

Diastolic murmurs may indicate which pathologies?

A
  • Aortic regurgitation
  • Pulmonic regurgitation
  • Mitral stenosis
  • Tricuspid stenosis
18
Q

How is JVP measured and what is normal?

A
  • Pt placed supine to allow veins to engorge, then raise to 30-45 degrees

Normal: 0-9

19
Q

Where is carotid pulse felt, and how do you assess both?

A
  • Medial to the SCM

- Only assess ONE AT A TIME!!!

20
Q

How are pulses graded?

A 
4+ Bounding
3+ Strong, full, increases
2+ Normal, average intensity
1+ Diminished, barely palpable
0 Absent, not palpable
21
Q

What is the normal capillary refill time?

A

2 seconds or less

22
Q

Examining for pitting edema is done by pressing firmly for 5 seconds in which locations?

A

1) Dorsum of foot
2) Anterior tibia
3) Behind medial malleolus

23
Q

What is the grading for edema?

A
  • Absent
  • 1+ Barely detectable, slight pitting (2mm); disappears rapidly

2+ Slight indentation (4mm); 10-15 secs

3+ Deeper indentation (6mm); may be >1 min

4+ Very marked indentation (8mm); 2-5 minutes

24
Q

When is the “A wave” for jugular pressure?

A

R atrial contraction; TV open; coincides with S1

25
Q

When would you see a giant A wave?

A

Obstruction between RA and RV, increased RV pressure, pulmonary HTN, complete heart block

26
Q

What is the “C wave” in jugular pressure?

A

Backward push by closure of TV during isovolumetric systole and by impact of carotid artery adjacent to the JV

27
Q

What is the “X wave” in jugular pressure?

A

Passive atrial filling and atrial relaxation, blood flowing into RA, closure of TV

28
Q

When do you see a steep X descent?

A

Cardiac tamponade and constrictive pericarditis

29
Q

What is the “V wave” in jugular pressure?

A

Atrial filling, increasing volume and pressure in atria when TV closed

30
Q

When would you see a prominent V wave?

A

Pulmonary HTN

31
Q

What is the “Y slope/descent” in jugular pressure?

A

Open TV and rapid RV filling in diastole

32
Q

When would you see a deep Y descent?

A

Severe tricuspid regurgitation

33
Q

When would you see a slow Y descent?

A

Obstruction to RV filling (TS or RA myxoma)

34
Q

Increased JVP in?

A
  • SVC obstruction
  • Severe heart failure
  • Constrictive pericarditis, cardiac tamponade, RV infarction
  • Restrictive cardiomyopathy
35
Q

What is the normal ejection fraction %?

A

50-60%

36
Q

Steps to CV exam in order

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation

PCM (14 decks)

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