Exam 2 cardiovascular

Question 1

grade 1 murmur

Answer 1

 Barely audible
 Heard only after listener “tunes in”

Question 2

grade 2 murmur

Answer 2

 Clearly audible, faint, but heard immediately

Question 3

grade 3 murmur

Answer 3

 Moderately loud, relatively easy to hear with a thrill

Question 4

grade 4 murmur

Answer 4

Loud, with a palpable thrill

Question 5

grade 5 murmur

Answer 5

Very loud with a palpable thrill and can be heard with the rim of a stethoscope

Question 6

grade 6 murmur

Answer 6

Loudest, audible without touching the stethoscope to the patient’s chest

Question 7

HPI questions for chest pain

Answer 7

• ask whether the patient has ever experienced a heart attack, irregular heart rhythm, frequent chest pain.
• ask about conditions that may increase the risk for cardiac disorders, such as hypertension, high cholesterol, high triglycerides, chronic kidney disease, or
  activity intolerance, dyspnea
• (e.g., “Are you able to complete housework without
  frequent breaks?”)

Question 8

symptom analysis for chest pain

Answer 8

onset, duration, location, severity, and associated symptoms

Question 9

where to palpate for heaves/lifts

Answer 9

Palpate the precordium, apex (and apical impulse),
left sternal border, and base
of the heart (turning them to the left will provide clearer sounds)

Question 10

healthy apical impulsation location (PMI)

Answer 10

5th intercostal space midclavicular line left side

Question 11

heart enlargement and apical pulse location

Answer 11

apical impulse moves laterally and inferiorly

Question 12

other reasons for apical displacement

Answer 12

pregnancy moves the pulse laterally or medially, dextrocardia moves the pulse medially.

Question 13

Hepatojugular reflux​ assessment (JVP assessment)

Answer 13

• Position patient with the head of the bed raised​
• Apply firm, sustained pressure to the abdomen in the midepigastric region​
• Have the patient breathe regularly​
• Observe the neck for an elevation in JVP followed by an abrupt fall in JVP when the hand is removed from the abdomen​
• Repeat the procedure if the measurement is greater than 3 cm (could indicate right sided heart failure)

Question 14

assessing the basic jugular vein distension (JVD) - also a way to assess JVP

Answer 14

• The examiner visually inspects the neck for bulging of the jugular veins, especially when the patient is in a semi-recumbent position (45 degrees).
• The height of the vein distension above the sternal angle is measured.
• Greater than 4 cm above the sternal angle is considered elevated.

Question 15

true JVP measurement in cm H2O

Answer 15

most accurate assessment - you assess the height of the blood column in the jugular vein, which indirectly reflects central venous pressure (CVP) and right atrial pressure.

Question 16

how to assess true JVP measurement in cm H2O

Answer 16

• The JVP is assessed by observing the pulsations of the internal jugular vein in the neck.
• A ruler is used to measure the vertical distance between the sternal angle (Angle of Louis) and the highest point of pulsation in the jugular vein (all the same so far).
• This measurement is then added to the estimated distance from the sternal angle to the right atrium (approximately 5 cm) to get an estimate of the JVP.
• A JVP greater than 8 cm above the sternal angle is considered elevated.
• Normal JVP is between 6-8 cm H2O

Question 17

systole

Answer 17

begins with ventricular contraction. The first heart
sound (S1) is heard during systole when the mitral and tricuspid valves close (“lub”). Pressure (due to ventricular contraction) in the heart rises as the aortic and pulmonary valves open - blood is ejected from the left ventricle into the aorta and from the right ventricle into the pulmonary artery. As the pressure falls, the aortic and pulmonary valves close. This is the second heart sound (S2) (“dub”) at the end of systole.

Question 18

diastole

Answer 18

passive process during which the heart chambers relax, dilate, and fill with blood. As systole ends, diastole begins with the opening of the mitral and tricuspid valves. This allows blood to
leave the atria and enter the ventricles

Question 19

semilunar valves

Answer 19

aortic (left) and pulmonic (right)

Question 20

atrioventricular valves

Answer 20

mitral (left) and tricuspid (right)

Question 21

S1 (lubb sound)

Answer 21

 Created by closing of mitral and tricuspid
valves (atrioventricular valves) during systole
 Best heard at the apex of the heart or the
mitral apical area

Question 22

S2 (dubb sound)

Answer 22

Created by the closing of aortic and pulmonic
valves (semilunar valves) at the beginning
of diastole, during which the ventricles fill
 Best heard in aortic and pulmonic areas

Question 23

Physiologic splitting of S2

Answer 23

normal and indicates delayed closure of the pulmonic
valve (not simultaneous closing)
* Occurs on inspiration and disappears on
expiration

Question 24

Paradoxical splitting s2

Answer 24

disappears with inspiration and reappears with expiration (opposite of physiologic) delayed aortic closure

Question 25

Fixed/pathologic splitting s2

Answer 25

may be heard with both inspiration and expiration and occurs with late closure of the pulmonic valve (does not vary with respirations).

Question 26

S3

Answer 26

an additional, low-pitched sound heard after the normal "lub-dub" (S1 and S2). occurs when blood rapidly fills the left ventricle during early diastole. rapid filling causes vibrations in ventricle walls, creating audible sound.

Question 27

s3 causes

Answer 27

(can be normal finding in young healthy adults) can also occur during heart failure, mitral regurgitation, pregnancy, anemia, and hyperthyroidism

Question 28

s3 characteristics

Answer 28

Low-pitched sound * Heard early in diastole, after the S2 * Best heard with the bell of the stethoscope placed at the apex (tip) of the heart * May be louder when the patient lies on their left side

Question 29

S4

Answer 29

late diastole, just before the first heart sound (S1). It is characterized by a low-pitched, gallop-like sound.

Question 30

s4 causes

Answer 30

indicates increased resistance to ventricular filling during diastole. caused by: Left ventricular hypertrophy, Aortic stenosis, Myocardial infarction, Hypertension, and Diastolic heart failure

Question 31

Location and Auscultation s4

Answer 31

apex of the heart, on the left side of the chest. It may be more prominent when the patient is lying on their left side

Question 32

considerations s4

Answer 32

abnormal finding - may indicate underlying heart condition. In some healthy older adults, it may be a normal finding due to age-related changes in the heart

Question 33

Gallops

Answer 33

extra low-pitched heart sounds – S3 and S4 (depends on when you hear it)

Question 34

Mitral snaps

Answer 34

heard when a thickened, diseased mitral valve opens - may be secondary to rheumatic heart disease. This sound results from diseased valves sticking together and making a snapping noise once they are forced open by blood flow

Question 35

Ejection click

Answer 35

a sharp, high-pitched sound; it's an extra systolic sound heard best when the patient leans forward and the heart is closer to the chest wall. It is caused by mitral valve prolapse (leaflets bulge into atrium)

Question 36

Friction rub

Answer 36

a scraping sound heard that is caused by irritation and inflammation of the parietal and visceral layers of the pericardium (heart tissue). A scratchy or rubbing sound that is louder with exhalation and when the patient leans forward. The sound occurs during contraction. The rub is best heard during the maximal movement of the heart - atrial systole, ventricular systole, and the filling phase of early ventricular diastole

Question 37

Murmurs

Answer 37

whooshing sound resulting from the turbulent flow of blood through the heart and large vessels, often caused by incompetent valves. Murmurs may sometimes be felt on palpation