Evaluating the Heart

Question 1

What happens during diastole? Do you feel a pulse?

Answer 1

Ventricles relax and fill
No pulse felt
AP closes

Question 2

What happens during systole? Do you feel a pulse?

Answer 2

Ventricles contract
Pulse felt
MT closes

Question 3

What’s the S1 sound and what causes it?

Answer 3

S1 = “lub”

Sound of MT closing

Question 4

Where would you hear the S1 sound loudest?

Answer 4

Lower toward the apex of the heart

Question 5

How can you determine whether sound is S1 or S2?

Answer 5

Feeling pulse

Pulse coincides with S1

Question 6

What symptoms would you note that would get you to check the heart sounds?

Answer 6

SOB, fatigue, Orthopnea
Edema, nocturia
Ischemic chest pain, irregular rhythm or rate

Question 7

How would you palpate to feel for S1?

Answer 7

At site of strongest pulse - typically radial

Palpate 30-60 seconds

Question 8

Where would you auscultate the heart?

Answer 8

Mitral = Apex of heart
5th intercostal space on left( 1/2 way btw nipple and sternum)
Aortic = Base of heart
2nd intercostal space on right

Question 9

How could you make it easier to hear heart sounds?

Answer 9

Have patient lean forward

Question 10

Is the mitral sound related to inflow or outflow?

Answer 10

Inflow into left ventricle

Question 11

Is the Aortic sound related to inflow or outflow?

Answer 11

Outflow

Question 12

How would you go about auscultating the heart?

Answer 12

Snake stethoscope down pt’s shirt
Have them position stethoscope head
Have them put fingers on either side of head
Grab stethoscope head and listen

Question 13

How would you direct the pt to the mitral heart sound?

Answer 13

Base of sternum, 4 fingers over, 4 fingers up

Question 14

How would you direct the pt to the aortic heart sound?

Answer 14

4 fingers under clavicle right near the sternum

Question 15

What is an S2 split and when would you hear it?

Answer 15

When aortic and pulmonic don’t close at same time
Happens during inhale in young pts
Nbd

Question 16

When would you hear an S3 sound? What does it sound like?

Answer 16

Ventricular

Lub Duba

Question 17

When would you hear an S4 sound? What does it sound like?

Answer 17

Late diastolic/atrial

t’lub dub

Question 18

When causes a heart murmur?

Answer 18

Disrupted flow of blood from valves
Stenosis: Valve can’t open as much as it should
Regurgitation: Valve doesn’t close quite right

Question 19

What causes stenosis heart murmur?

Answer 19

Aortic (systolic) or triscupid (diastolic) stenosis

Question 20

What causes regurgitation heart murmur?

Answer 20

Mitral (systolic) or pulmonic (diastolic) regurgitation

Question 21

How would you tell which valve was causing the murmur?

Answer 21

Do EKG

Question 22

What are signs and symptoms that would lead you to do a vascular eval?

Answer 22

Ischemic diseases
TIA
Angina
Peripheral vascular disease

Question 23

What are the 5 p’s to watch out for that would lead to a vascular eval?

Answer 23

Pain, pallor, paresthesia, paralysis, pulselessness

Question 24

What do you look for when inspecting pt for vascular dz

Answer 24

Extremities for pallor, cyanonsis or loss of hair on toes

Question 25

Where would you listen when you auscultate the carotids and what are you listening for?

Answer 25

Listening at base of neck, in the middle where it bifurcates and at the angle of the jaw
Do bifurcation if only can do one

Question 26

What can you specifically hear at the bifurcation of the carotid?

Answer 26

Bruit if the carotid >50% stenosed but

Question 27

What’s the general rule for auscultating and palpating the carotid?

Answer 27

Auscultate high, palpate low

Question 28

Where would you palpate the patient for a vascular eval?

Answer 28

Carotids (ONE AT A TIME) at base of neck
Temporal artery (in front of tragus)
Radial pulse + brachial pulse
Dorsalis pedis + posterior tibial

Question 29

Where is the dorsalis pedis and posterior tibial pulse? What can you do to make them easier to feel?

Answer 29

Dorsalis pedis: Lateral to highest cuneiform on foot
Dorsiflexion
Posterior tibial pulse: Posterior and slightly superior to medial malleolus
Plantar flexion

Question 30

Where’s the brachial pulse and what could you do to make it easier to feel?

Answer 30

Below biceps on bony area

Hyperextend it.