CV Exam Flashcards
Aortic Stenosis is best heard where?
Suprasternal notch
Aortic Insufficiency is best heard where?
Left 2nd ICS @ SB
Mitral valve regurgitation is best heard where?
At the Apex of the heart (5th ICS, left, 1.0 cm, medial to mid coronal line)
What are thrills?
They are turbulent blood flow causing murmurs
Where is the PMI (Point of maximal impulse) palpated?
Left 4th-5th ICS at mid clavicular line
The level of JVP (Jugular Venous Pressure) gives and indication of what?
Right Atrial Pressure
Internal jugular is bettter than external jugular
What is Kussmal’s Sign
when the neck veins stay up (superficial) during inspiration
To measure the JVP; how is this done?
Measure from top level of Jugular venous pulse to sternal angle and then add 5
How does Triscupid valve regurgitation typically present on a Jugular venous pressure wave?
Prominent V wave
An obstruction betweeen the RA and RV presents as what in a jugular venous pressure wave?
Prominent A wave
What is the C wave due to?
It is due to bowing back of the AV valve against the atria, during isovolumetric ventricular contraction
What is the X wave in the jugular venous pressure graph indicative of?
Passive atrial filling and atrial relaxation (blood flowing from the Vena cava into the RA)
What condition(s) does a steep X wave indicate?
Cardiac Tamponade & Constrictive Pericarditis (Fluid around thee HRT, impedes venous return)
What does the V wave indicated in a jugular venous pressure wave graph?
Atrial filling (increase in atrial volume)
What does a prominent V wave indicate?
Tricuspid valve regurgitation and pulmonary HTN
What does the Y slope indicated on a jugular venous pressure slope graph?
Open TV and rapid RV filling in RV diastole
What is HJR?
Also, what does a positive finding of this test indicate?
HJR: Hepatojugular Reflex (w/ application of pressure over the liver, the neck veins can distend)
2) Pericarditis or RV failure
When is the S1 and S2 sound split and when is it unified?
Split: Inspiration (More time for RV to deliver blood flow to the lung)
Unified: Expiraiton
What does a pulse of 4/4; described as
Bounding
Where is edema most palpable?
Ant. Tibia, Medial Malleolus, dorsum of the foot
What is the subcostal view useful for during a V scan?
Visualizing four chambers & looking for pericardial fluid
Probe is angled superior to the heart
What is a parasternal axis useful for when using a V scan?
It can asses left ventricular and atrial funciton.
useful for evaluating for LV hypertrophyy and systolic function
Tech: Left 3rd and 4th ribs
When are systolic murmurs best heard?
Between S1 and S2
When are diastolic murmurs heard?
Between S2 and S1
What is the rule regarding HR and temperature?
1* F above normal = 10 bpm
LVH (left ventricular hypertrophy) will result in what, regarding PMI?
Lateral displacement; downward to the 6th and 7th ICS
RVH will result in what regarding PMI?
Sustained systolic lift at lower left sternal area
What is a midsysotlic murmur?
Begins after S1 and stops just prior to S2
What is a holosystolic murmur?
Begins at S1 and Stops at S2
What is a late systolic murmur?
Usually starts with S1 and stops at S2, without a gap between murmur and heart sounds
