CV Exam, Cardiac Cycle, and Heart Sounds Flashcards
Five finger method for assessment of the CV system?
1) History
2) Physical
3) ECG
4) X-ray
5) Labs
What is the proper sequence for a physical with CV system?
1) Inspection
2) Palpation
3) Percussion
4) Auscultation
IPPA!
- Common error to listen to the heart first
What are different ways the patient can be position for auscultation of the heart?
Sitting, supine, left lateral decubitus, leaning forward, standing
What is the rule of thumb for every 1 °F rise in a pt’s body temp past 100.4 °F in regards to HR?
Every 1°F > 100.4 °F = increase HR by 10 beats
What is occurring during S1, marks beginning of, loudest at?
- Mitral (1st) and Tricuspid closure (2nd)
- Beginning of ventricular systole
- Loudest at apex
What is occurring during S2, marks what event, loudest at?
- Aortic (1st) closure and pulmonic closure (2nd)
- End of systole, beginning of diastole
- Loudest at the base
Where is aortic valve heard?
2nd ICS to the R of sternum
Where is pulmonic valve heard?
2nd ICS to L of the sternum
Where is the tricuspid valve heard?
4th ICS at LSB
Where is the mitral valve heard?
Apex of heart = 5th left ICS at mid-clavicular line
What is splitting of S2, heard when?
During inspiration you get increased venous return and more time for RV to deliver blood to lung (delays pulmonic valve closure)
What is the grading system for murmurs (1-6)?
1) Barely audible, faint
2) Soft, but easily heard, quiet
3) Loud, w/o a thrill
4) Loud with a thrill
5) Loud w/ minimal contact between stethoscope and chest - thrill
6) Loud, can be heard w/o a stethoscope - thrill
What’s a Kussmauls Sign, seen in?
- Venous column (JVP) rises during inspiration, rather than falls
- Seen in R heart failure, constrictive pericarditis or RV infarction
Clubbing of nails can indicate?
- Congenital heart disease (cyanotic)
- Cystic fibrosis
- Interstitial lung disease
Why would you want to have a pt stand up when listening for murmurs?
To hear if the murmurs are louder or quieter
What cardiac issues are pts with Marfan’s syndrome prone to?
Aortic aneurysms and leaking -> they have a weak aorta
What does having your pt lean forward when listening to the heart help with?
Increases heart sounds and helps hear pericarditis
What are the symptoms of acromegaly?
Big jaws, prominent masculine features, big nose, lots of hair, etc -> predisposition for coronary heart disease and hypertension
What are the symptoms of hyperthyroidism
Bulging eyes, tremors, tachycardias, sweaty, anxious -> extra stress on the heart
What are symptoms of myxedema?
Very hypothyroid -> have slow HR, hyperlipidemia, hypertension, dry skin, patchy hair loss, trouble hearing
What is Schamroth’s window?
The little light that comes through when you put your nails together -> lost in clubbed fingers
% range for normal, mildy reduced, moderately reduced, and severely reduced Ejection fraction?
Normal: 50-60%
Mild: 40-49%
Mod: 30-39%
Severe: 15-29%
What is preload and what does increased preload do?
- Stretching of myocytes prior to contraction. The EDP at the beginning of systole
- Increased preload = increases active force development
What is afterload and what does increased afterload do?
- Load on heart during ejection of blood from ventricle. Ventricular pressure at the end of systole (ESP)
- Increased afterload will decrease volume of blood ejected each beat
