Exam 2: Cardiovascular Assessment Part 2

Question 1

What does an aortic or pulmonic ejection click sound like and what does it indicate?

Answer 1

• High pitched sound at beginning of systole
• indicated valve disease, dilated aorta or pulmonary artery, or pulmonary hypertension

** Best heard with diaphragm of stethoscope

Question 2

What is a mitral valve prolapse?

Answer 2

Ballooning of mitral leaflets into the left atrium during systole.
-Mid to late systolic clicks are often present.

Question 3

What causes venous hum?

Answer 3

• Turbulent blood flow through jugular veins

- both systolic and diastolic sounds

Question 4

What causes pericardial friction rub and what are the 3 components of it?

Answer 4

• Caused by inflammation of pericardial sac

- 3 components are scratchy, squeaky, and intermittent

Question 5

What does increased jugular pressure indicate?

Answer 5

• Increased pressure in the right atrium related to intravascular fluid volume
• Mainly reflect right heart function

Question 6

What is best used to assess jugular venous pressure?

Answer 6

Right internal jugular vein or external jugular vein

Question 7

How do you perform the specialized exam of measurement of JVP?

Answer 7

Stand on the patients right with the exam table at 30 degrees.
Patients head is turned slightly to the right. Find the highest point of oscillation in the right internal jugular vein.
Measure the vertical distance above the sternal angle.
Add 5 cm and the sum is JVP.

Question 8

What can cause increased JVP?

Answer 8

Hypervolemia from heart failure, pulmonary HTN, increased venous vascular tone, and pericardial tamponade

Question 9

What is considered an elevated JVP?

Answer 9

8cm above the RA

Question 10

What causes decreased JVP?

Answer 10

Hypovolemia due to blood loss or decreased venous vascular tone

Question 11

How do you perform the specialized exam Hepatojugular reflux?

Answer 11

Patient is supine with the exam table at 30 degrees. Apply firm, sustained pressure to the abdomen in the RUQ over the liver region. Observe the neck for an increase in JVP, followed by a decrease when the hand is released.
JVP will transiently increase in all patients, but is exaggerated in right heart failure.

Question 12

What is a positive hepatojugular reflex?

Answer 12

Greater than 3cm increase, or is remained elevated.

Question 13

What is a thrill and what causes it?

Answer 13

Buzzing or vibratory sensation, caused by vigorous blood flow through any narrowed opening.

Question 14

What is a lift (or heave) and what causes it?

Answer 14

Vigorous cardiac impulse that can be seen/felt through the chest wall, may be caused by ventricular hypertrophy or hyperdynamic ventricular activity.

Question 15

Where should you palpate when checking for lifts and thrills?

Answer 15

The left sternal border

Question 16

Where should you palpate for the apical impulse?

Answer 16

The apex

Question 17

What does the point of maximal impulse represent?

Answer 17

Pulsation of the left ventricle.

Question 18

Where is the point of maximal impulse for patients with COPD?

Answer 18

Mya be in the xiphoid or epigastric area due to right ventricular hypertrophy

Question 19

What is cardiac percussion used for?

Answer 19

Estimating cardiac size

Question 20

What does a cardiac impulse lateral to the mid clavicular line or larger than normal suggest?

Answer 20

Left ventricular enlargement

Question 21

How do you perform the specialized exam of cardiac percussion?

Answer 21

Begin at the 5th intercostal space in the mid axillary line and percussion medically, listening for onset of dullness.

Ex) Left border of cardiac dullness (LBCD) is 2cm lateral to the midclavicular line in the 5th ICS

Question 22

What does auscultating the cardiac apex with the bell while the patient is in the left lateral decubitus position help you hear?

Answer 22

-Low pitched filling sounds, such as gallops and murmurs

Question 23

What does it mean it mean if pulses are 1+?

Answer 23

Pulses are diminished and weaker than expected

Question 24

What does it mean if pulses are 2+?

Answer 24

Brisk and normal

Question 25

What does it mean if pulses are 3+?

Answer 25

They are bounding

Question 26

How would cardiogenic shock affect the carotid arteries?

Answer 26

It could make the carotid pulse small and weak

Question 27

How does aortic regurgitation affect the carotid pulse?

Answer 27

It makes it bounding

Question 28

How does aortic stenosis affect the carotid pulse?

Answer 28

It delays the pulse

Question 29

What is a bruit?

Answer 29

A murmur like sound arising from turbulent arterial blood flow

Question 30

How do you perform the Allen test and what is a normal result?

Answer 30

Ask the patient to make a tight first. Compress both the radial and ulnar arteries. Ask patient to open hand (it should be pale). Release pressure over ulnar artery.
If normal, the palm flushes within 3-5 seconds

Question 31

What does the Allen test evaluate?

Answer 31

Patency of the ulnar artery.

Question 32

Where should you auscultate the abdomen for bruits?

Answer 32

The aorta, renal arteries, iliac arteries, and femoral arteries

Question 33

How do you perform Homans sign and what does it evaluate for?

Answer 33

• Check for calf pain on passive dorsiflexion of the foot.

- It is an unreliable test for presence of DVT

Question 34

How do you perform Buerger test?

Answer 34

• Raise both legs to about 90 degrees for up to 2 minutes. Then ask patient to sit up with legs dangling.
• Check for return of color to skin and an abnormal test is when it takes longer than 10 seconds for the color to return.