CV Exam Lab Flashcards
Order for normal CV Exam
inspection
palpation of PMI & anterior chest
percuss (for cardiac border)
auscultate
What is most important when listening w/ stethoscope?
always listen on bare skin
What does a barrel chest indicate?
COPD
What is pectus carinatum?
pigeon chest
What is pectus excavatum?
funnel chest
Landmarks for chest inspection
sternal notch & angle sternal border mid-clavicular line anterior axillarly line xiphoid process nipples
Where do you palpate for PMI?
used to estimate location of apex/left border
near 4th-5th intercostal space in mid-clavicular line
palpate for thrill
Where do you auscultate in CV exam?
aortic valve-R 2nd ICS @ SB
pulmonic valve-L 2nd ICS @ SB
tricuspid valve-L 4th ICS @ SB
bicuspid valve-L 5th ICS @ mid-clavicular line
How do you listen for carotid bruits?
using BELL of diaphragm AFTER palpating pulse
ask pt to inhale & hold breath while listening
S1 heart sound
closure of tricuspid & bicuspid valves
S2 heart sound
closure of aortic & pulmonic valves (may split w/ inspiration which is normal)
S3 heart sound
dull, low pitch that best heard w/ bell (during rapid filling of ventricles)
normal in children but pathologic if <40
“Kent-tuck-y”
S4 heart sound
dull, low pitch, heard w/ bell (atrial gallop from forceful contraction of atria v stiff ventricle)
“Ten-nes-see”
What are systolic murmurs?
fall between S1 & S2 heart sounds
aortic stenosis
pulmonic stenosis
mitral regurgitation
tricuspid regurgitation
What are diastolic murmus?
fall between S2 & S1 heart sounds
aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis
Grading scale for murmurs
Grade 1-very faint
Grade 2-quiet but can be heard w/ stethoscope
Grade 3-moderately loud, NO thrill
Grade 4-loud w/ palpable thrill
Grade 5-very loud w/ thrill
Grade 6-heard w/ stethoscope that is off chest
Where do you palpate & assess the carotid pulse?
medial to SCM
do NOT assess both carotid pulses @ same time
use bell of stethoscope for bruits (audible) & palpate for thrills
Normal peripheral pulse
+2/4 average intensity, expected normal
Normal capillary refill
refill time should be 2 seconds or less
Where do you examine for pitting edema?
dorsum of foot anterior tibia (mid-shin) posterior medial malleolus
+0/4 is normal
+2/4 is slight indent that stays for 10-15 sec
Why would JVP be measured?
suspected heart failure
measure vertical distance above sternal angle where horizontal object crosses ruler & add 5cm to distance for JVP
Allen test
evaluates functioning of radial & ulnar arteries
indicates lack of dual blood supply to hand (negative indication for radial catheterization)
