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Physical Dx > Exam 2: Cardiovascular Assessment part 1 > Flashcards

Exam 2: Cardiovascular Assessment part 1 Flashcards

1
Q

What is the precordium?

A

The anterior chest wall overlying the heart

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2
Q

What is pectus excavatum?

A

Sternal depression

“Funnel chest”

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3
Q

Wha is pectus carinatum?

A

Sternal protrusion

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4
Q

Is pectus excavatum or pectus carinatum more common?

A

Pectus excavatum

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5
Q

What side of the stethoscope is used for high pitched sounds?

A

Diaphragm

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6
Q

What side of the stethoscope is used for low pitched sounds?

A

Bell

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7
Q

What are the 4 key areas for cardiac auscultation?

A
  • Aortic: Second intercostal space, right sternal border
  • Pulmonic: 2nd intercostal splice, left sternal border
  • Tricupid: 4th and 5th intercostal space, left sternal border
  • Mitral: 5th intercostal space, mid-clavicular line
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8
Q

What produces the S1 “Lub” sound?

A

Closure of the mitral and the tricuspid valves

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9
Q

What is systole?

A

Ventricular contraction

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10
Q

What can cause an accentuated S1?

A

Diseased AV valve or more forceful closure of AV valve

-tachycardia, fever, HTN, exercise, anemia, hyperthyroidism, or mitral stenosis

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11
Q

What can cause diminished S1?

A

Weak contraction of the heart or reduced sound transmission

-Thick chest wall or emphysematous lungs

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12
Q

Is S1 one S2 louder at the apex?

A

S1

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13
Q

What produces the S2 “Dub” sound?

A

Closure of the aortic and pulmonic valves

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14
Q

Is S1 or S2 louder at the base?

A

S2

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15
Q

What is diastole?

A

Relaxation of the heart

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16
Q

Is systole or diastole longer?

A

Diastole

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17
Q

What is physiological splitting on S2?

A

When the right sided pressures are lower than the left, the sounds occurs slightly later on the right.

-May hear A2 and P2 during inspiration

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18
Q

What is pathologic S2 splitting?

A

When there is delayed closure of the pulmonic valve or there is delayed contraction of the left ventricle

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19
Q

What is paradoxical splitting and when does it occur?

A

When P2 occurs before A2; occurs during expiration and gone during inspiration.
-Can be a result of LBBB

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20
Q

What is wide pathologic splitting?

A

An increase in usual splitting during inspiration that can be a result of pulmonic stenosis, mitral regurgitation, and RBBB

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21
Q

What is fixed pathologic splitting?

A

Splitting that does not vary with respiration and can be a result of atrial septal defect and right ventricular failure

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22
Q

What is S3?

A

Low pitched sound created in early diastole by filling of the ventricles with blood from the atria

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23
Q

Where is S3 best heard?

A

With bell at apex

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24
Q

What is a pathologic S3 and what is the cause?

A
  • ventricular gallop

- caused by heart failure, anemia, volume overload of ventricle, and decreased myocardial contractility

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25
Q

When is S4 and what causes it?

A

S4 is in second phase of ventricular filling in diastole, as the atria contract and eject blood into the ventricles (atrial kick)
-Produced by the rush of blood causing vibration of valves, papillary muscle, and ventricular wall

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26
Q

Where is S4 best heard?

A

With bell at apex

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27
Q

Can S3 be normal?

A

Yes, it can be heard in children, healthy young adults, and pregnant women

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28
Q

What is pathologic S4?

A
  • atrial gallop
  • if over 40, usually pathologic
  • Due to resistance to ventricular filling (deceased compliance) from HTN, CAD, cardiomyopathy
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29
Q

What causes a right sided S4?

A

Pulmonary HTN or pulmonary stensosis

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30
Q

What is a murmur?

A

A prolonged heart sound made by blood rushing though a narrowed valve, leaking valve, or a wall between chambers of the heart

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31
Q

What is a grade 1/6 murmur?

A

Barely audible in a quiet room

32
Q

What is a grade 2/6 murmur?

A

Quiet, but clearly audible

33
Q

What is a grade 3/6 murmur?

A

Moderately loud

34
Q

What is a grade 4/6 murmur?

A

Loud with associated thrill

35
Q

What is a grade 5/6 murmur?

A

Very loud, heard with stethoscope partially off chest, with an obvious thrill

36
Q

What is a grade 6/6 murmur?

A

Very loud, heard with stethoscope entirely off chest, obvious thrill

37
Q

What is a crescendo murmur?

A

It becomes louder

38
Q

What is a decrescendo murmur?

A

It becomes softer

39
Q

What is a crescendo- decrescendo murmur?

A

It first rises, and then falls in intensity

40
Q

What is a plateau murmur?

A

Stays the same intensity throughout

41
Q

What type of murmur is usually crescendo-decrescendo and usually due to obstructed flow across semilunar valves, aortic stenosis, or atrial septal defect?

A

Mid systolic murmur

42
Q

What type of murmur is usually plateau and caused by regurgitation across AV valves or ventricular septal defect?

A

Pansystolic or holosystolic murmur

43
Q

What type of murmur is typical of mitral prolapse?

A

Late systolic murmur

44
Q

Where is a murmur caused by a narrowed aortic valve best heard?

A

At the base along the right and left sternal borders

45
Q

What type of murmur is common in children and young adults, is a grade 2 or less, and becomes softer when sitting?

A

An innocent systolic murmur

46
Q

What is an atrial septal defect?

A

a congenital anomaly resulting in left to right shunting of blood (LA to RA) with RV enlargement and increased flow through pulmonic valve
-associated midsystolic murmur and wide, fixed splitting of S2

47
Q

Where would be midsystolic murmur from atrial septal defect best be heard?

A

Second intercostal space

48
Q

What is mitral or tricuspid valve regurgitation?

A

When pressure in the left and right ventricle is significantly higher than in the atria, when the ventricles contract there is leakage of blood from LV to LA (or RV to RA)

49
Q

Where would a pansystolic murmur from a ventricular septal defect best be heard?

A

Left lower sternal border

50
Q

When are systolic murmurs heard?

A

After S1 but before S2

51
Q

What are the 3 main types of systolic murmurs?

A

Midsystolic, pansystolic (Holosystolic) or late systolic murmurs

52
Q

What are the 3 types of diastolic murmurs?

A

Early, mid, and late diastolic

53
Q

What type of murmur is usually decrescendo and caused by regurgitant flow across leaking semilunar valve?

A

Early diastolic murmur

54
Q

What type of murmur is caused from turbulent flow across the AV valves?

A

Mid diastolic

55
Q

When are diastolic murmurs heard?

A

After S2 but before S1

56
Q

Where is a diastolic murmur caused by atrial regurgitation best heard?

A

At the apex

57
Q

What type of murmur does aortic regurgitation cause?

A

Early Diastolic decrescendo murmur

58
Q

What type of murmur does an atrial septal defect cause?

A

Midsystolic murmur

59
Q

What type of murmur does aortic stenosis cause?

A

Crescendo-decrescendo systolic murmur

60
Q

What type of murmur does mitral or tricuspid stenosis cause?

A

Middiastolic murmur

61
Q

What sound does mitral stenosis make?

A

An opening snap and a diastolic rumble

62
Q

What is patent ductus arteriosus and what type of murmur does it cause?

A
  • It is failure of channel between aorta and pulmonary artery to close after birth
  • Causes a continuous murmur
63
Q

What causes a to-and -fro murmur?

A

Aortic stenosis/regurgitation or severe aortic regurgitation
-These are systolic-diastolic murmurs

64
Q

What is aortic stenosis with aortic regurgitation and what type of murmur does it cause?

A
  • It is obstruction of outflow due to narrowed valve and failure to complete closure of aortic valve during diastole with leakage of blood back into left ventricle
  • Causes systolic-diastolic murmur
65
Q

What positional changes can enhance murmurs?

A
  • Leaning forward

- Left lateral decubitus position

66
Q

How can you alter hemodynamics to enhance a murmur?

A

-by altering preload or afterload but squatting, valsalva, and isometric exercise

67
Q

How is the specialized exam of auscultating the cardiac base, leaning forward performed?

A

Ask pt to lean forward, exhale completely, and hold breath in expiration. Listen at the base, this is beast for hearing murmurs from aortic or pulmonic regurgitation

68
Q

How does standing or the strain phase of valsalva affect murmurs?

A

Left ventricular volume is decreased from decreased venous return to the heart. This decreases vascular tone (lowers BP and pulmonary vascular resistance
-Most murmurs decrease in intensity except hypertrophic cardiomyopathy when it increases

69
Q

How does squatting or the release phase of valsalva effect murmurs?

A

Increased left ventricular volume from increased venous return to heart
-Increases vascular tone and pulmonary vascular resistance

70
Q

You hear a medium pitch, harsh, crescendo-decrescendo murmur with a loud thrill, best heard in the second right intercostal space. What murmur are you suspicious of?

A

Midsystolic murmur from aortic stenosis

71
Q

You hear a high pitch, blowing, decrescendo murmur, heard best at the 2nd and 4th left intercostal space. Sound is enhanced with patient sitting forward with full exhalation. What murmur are you suspicious of?

A

Diastolic aortic regurgitation murmur

72
Q

You hear a low pitch “rumble” that is S1 accentuated with an opening snap after S2. Sound is enhanced with patient in left lateral decubitus position and is best heard at the apex. What murmur are you suspicious of?

A

Mid-late Diastolic mitral stenosis

73
Q

You hear a medium to high pitch blowing murmur that radiating to the left axilla. It is best heard at the apex. What murmur are you suspicious of?

A

Pansystolic mitral regurgitation murmur

74
Q

You hear a low pitch murmur with an opening snap that is increased with inspiration and squatting. It is best heard at the lower left sternal border. What murmur are you suspicious of?

A

Mid-late diastolic murmur from tricuspid stenosis

75
Q

You hear a medium pitch, blowing murmur that radiates to the right sternum and xiphoid. It increases slightly with inspiration and is best heard at the left lower sternal border. What murmur are you suspicious of?

A

Pansystolic murmur from tricuspid regurgitation

76
Q

You heard a medium pitch, harsh murmur that radiates that the left shoulder and neck. It is best heard at the 2nd and 3rd left intercostal space. What murmur are you suspicious of?

A

Mid systolic murmur from pulmonic stenosis

77
Q

You hear nothing a high pitch, blowing decresendo murmur that increases with inspiration. It is best heard at the 2nd left intercostal space. What murmur are you suspicious of?

A

Early diastolic murmur from pulmonic regurgitation

Physical Dx (14 decks)

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