CV-PV exam Flashcards
What measurements above the RA and above the Sternal angle is considered an elevated Jugular venous pressure
RA >8cm, Sternal angle >3cm at head of bed 30degrees
How to tell carotid from jugular pulsations/oscillations
jugular vein oscillations will obliterate with pressure while carotid pulsations will not
Lifts and heaves signify?
LA/LV enlargement
Thrills signify
valvular dysfunction, vibration
PMI should be found
5th ICS/ MCL
PMI lateral displacement shows
cardiomyopathy, LV enlargement
Auscultation aortic valve
2nd ICS, RSB
Auscultation pulmonic valve
2nd ICS, LSB
Auscultation Tricuspid valve
3rd/4th ICS, LLSB
Mitral valve area
5th ICS, MCL
S1
beginning of systole, AV/PV open, MV/TV closed, heard all over, loudest at apex
S2
beginning of diastole, MV/TV open, AV/PV closed, loudest at the base 2nd-3rd ICS
Split S1 caused by
one ventricle depolarizing before the other, can not be caused by inspiration
Split S2 caused by
can be caused by inspiration
Midsystolic click
most common, MVP
Aortic ejection click
Early systole, AS, Bicuspid aortic valve
Pulmonic ejection click
early systole, pulmonary stenosis, pulmonary HTN
Opening snap
Early diastole, LSB, MVS
S3
low pitch, early diastole, volume overload, heart failure,
S4
late diastole, atrial ejection into a distended ventricle, cardiomyopathy, delayed conduction
Pericardial friction rub
inflammation of pericardium, high pitched scratchy
Grading murmurs
Grade I through Grade VI
Grade I
Barely audible
Grade II
audible, but soft
Grade III
Easily audible
Grade IV
easily audible and associated with a thrill
Grade V
Easily audible, associated with a thrill and still heart with the stethoscope only lightly on the chest
Grade VI
Can be heard without the stethoscope
Murmurs during systole
aortic stenosis
Mitral regurgitation
pulmonic stenosis
tricuspid regurgitation
Murmurs during diastole
aortic regurgitation
mitral stenosis
pulmonic regurgitation
tricuspid stenosis
Aortic stenosis
mid systolic, medium pitch, crescendo-decrescendo pattern, Harsh and Raspy, 2nd ICS at right sternal border, often radiates to the neck (key distinguishing factor), sitting and leaning forward, squatting increases the intensity
mitral regurgitation
Pan-systolic (holosystolic), medium to high pitch, harsh, blowing, may be associated with an S3, Apical, radiates to left axillary region
Pulmonic stenosis
Midsystolic, medium pitch, crescendo-decrescendo, Harsh, 2-3 ICS, LSB, Radiates to left shoulder, neck region, Pathologic S2 splitting
Tricuspid regurgitation
Holosystolic, medium pitch, blowing, left lower sternal border, radiates to right sternum, diploid process and possibly left MCL, increases with inspiration
Aortic regurgitation
Decrescendo diastolic, grade I-III, high pitch, blowing, 2nd-4th ICS, LSB, Holding breath after exhalation, holding hand-letting go
Mitral Stenosis
Mid-late diastolic, Grade I-VI, low pitch, diastolic rumble, Decrescendo (opening snap follows S2)
Pulmonic regurgitation
Early diastolic, Grade I-VI, High pitch, Decrescendo, Blowing, LSB
Tricuspid stenosis
mid-late diastolic, Grade I-VI, Low pitch diastolic rumble, Decrescendo (opening snap follows S2), rumbling
Venous stasis
Brown discoloration (hemosiderin deposits), medial malleoli ulcers d/t bacterial invasion of poorly drained tissue,
Arterial insufficiency
Arterial ulcers usually occur on the tip of the toes, metatarsal heads and lateral malleoli, hair loss
0 pulses
Absent
+1 pulses
diminished
+2 pulses
Normal
+3 pulses
Full
+4 pulses
Bounding
Pulsus Alternans
Pulses alternating strong and weak, can be found in left ventricular dysfunction
pulses paradoxus
Cardiac tamponade, volume stronger with expiration
Bounding
Warm sepsis
Bisferiens
double systolic peak, aortic stenosis and aortic regurgitation
