Examination of the Cardiac Patient Lecture Powerpoint

Question 1

Cardiac disease is a ____ illness that requires an entire ____

Answer 1

systemic, general physical examination

Question 2

Cardinal symptoms when obtaining history of heart disease (5)

Answer 2

• Chest pain or discomfort
• dyspnea
• syncope
• palpitations
• edema (worse in morning or evening?)

Question 3

Most common congenital abnormality of heart, what does this predispose patients to?

Answer 3

Bicuspid aortic valve, aortic aneurysm

Question 4

General appearance characteristics on cardiac exam (3)

Answer 4

• malnourishment
• cachexia (wasting)
• obesity

Question 5

HEENT fundoscopic characteristics on cardiac exam (7)

Answer 5

• retinal hemorrhages
• papiledema
• cotton wool spots
• exopthalmos (hyperthyroidism)
• arcus senilis (ring around iris)
• xanthomas
• distended neck veins

Question 6

Chest and lung characteristics on cardiac exam (4)

Answer 6

• pectus excavatum
• pectus carinatum
• pre-sacral edema (more accurate measure)
• wheezes/rales/rhonchi

Question 7

JVD elevations indicate…

Answer 7

….right sided heart pressure elevation (increased CVP), indicative of potential right sided heart failure

Question 8

If the PMI is displaced to the left think of these 2 conditions, if the right think of this condition

Answer 8

• Long standing systemic hypertension or aortic valve stenosis,
• COPD

Question 9

Why does physiologic splitting of S2 occur?

Answer 9

-The pressure from inflation of the lungs and depression of the diaphragm causes external pressure on vena cava to decrease resulting in it widening and sucking in more blood to the right heart delaying closure of the pulmonic valve after the aortic valve (a2 before p2)

Question 10

Cause of paradoxically splitting of S2

Answer 10

Left bundle branch block

Question 11

S4 gallops are always ___, while S3 is only sometimes and S3 is associated with this condition

Answer 11

Pathologic, S3 often associated with chronic heart failure

Question 12

5 steps in assessing a murmur

Answer 12

• Determine where it is heard best
• explain what type it sounds like
• perform valsalva: have patient clench to decrease venous return to better isolate the sound (less blood moves in and out of heart)
• perform handgrip: increase pressure (afterload) which will increase aortic pressure (less blood going out so more blood remains in heart to regurgitate
• leg lift/squatting to increase venous return to right side of heart (more blood comes in and out of heart)

Question 13

Hypertrophic obstructive cardiomyopathy and pathonomonic sign

Answer 13

Genetic disorder with autosomal dominance that can cause sudden cardiac death in youthful athletes most often with potential to later in life result in atrial fib and other arrhythmias
-valsalva causing increased sound

Question 14

Acute pericarditis pain is worsened upon ___ and ____

Answer 14

inspiration, laying in recumbant position

Question 15

Parvus et tartus pulse

Answer 15

Delayed and weak pulse

Question 16

Parvus et tardus at the carotid pulse is pathonomonic for this condition

Answer 16

Aortic stenosis

Question 17

Corrigan’s pulse

Answer 17

Rapid upstroke and collapse of the carotid artery pulse

Question 18

Corrigan’s pulse pathonomonic for this condition

Answer 18

Aortic insufficiency

Question 19

Quinke’s sign

Answer 19

Pulsation of capillary bed in nails during capillary refill indicative of aortic insufficiency

Question 20

Duroziez’s sign

Answer 20

Systolic and diastolic murmurs heard over femoral artery when gradually compressed with the stethoscope indicative of aortic insufficiency

Question 21

Arachnodactyly

Answer 21

Hyperlaxity of the joints often seen in marfan syndrome

Question 22

Persistant splitting of S2 at rest is representative of…

Answer 22

….a right bundle branch block

Question 23

S3 cause

Answer 23

Rapid ventricular filling creating an early diastolic sound of blood sloshing into the ventricle (large and floppy)

Question 24

S4 cause

Answer 24

Atria pushing blood into stiff ventricle creating a late diastolic sound of blood rubbing the wall as a bolus is pushed in (stiff noncompliant ventricle)

Question 25

Louder S2 than S1 indicates…

Answer 25

…Pulmonary disease

Question 26

Having afib once puts at risk for….

Answer 26

…having it recurrence

Question 27

Valsalva should ___ aortic stenosis, ___ HOCM, ___mitral and tricuspid regurg

Answer 27

Decrease, increase, decrease

Question 28

Handgrip should ___ aortic stenosis, ___ HOCM, and ___ mitral regurg

Answer 28

Decrease, decrease, increase

Question 29

Leg lift/squatting should ___ aortic stenosis, ____ HOCM, ___mitral regurg and tricuspid regurg

Answer 29

Increase, decrease, increase