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Physical Diagnosis II Exam Two > Heart Exam > Flashcards

Heart Exam Flashcards

1
Q

When is the cardiac assessment performed?

A

1 all sports, pre-employment, routine physicals
2 rule out viscerosomatic causes of neck, arm, and chest pain
3 presentation of potential heart related signs or symptoms

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2
Q

What are the characteristic symptoms of acute heart failure?

A

1 substernal chest pain/pressure
2 GI discomfort (MC in females)
3 exertional dyspnea

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3
Q

Where else can pain from a myocardial infarct manifest besides the chest?

A

1 jaw
2 neck
3 arms
4 back

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4
Q

What are the characteristic symptoms of right-sided chronic heart failure?

A

1 ankle edema *
2 fatigue
3 dyspnea

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5
Q

What are the characteristic symptoms of left-sided chronic heart failure?

A

1 exertional dyspnea *
2 cough
3 orthopnea
4 pink, frothy sputum

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6
Q

Bibasilar cracks would be a presentation with what kind of chronic heart failure?

A

Left-sided

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7
Q

Topographically, where is the base of the heart? Apex?

A 
Base = 2nd intercostal space
Apex = 5th intercostal space
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8
Q

What side of the heart is more muscular and why?

A

Left; has to propel blood to the fingers, toes, and nose

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9
Q

Why is the right side of the heart less muscular?

A

Only has to pump blood to the nearby lungs

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10
Q

What is the term used for the chest surface that overlies the heart?

A

Precordium

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11
Q

What is the traditional cardiac physical assessment procedure sequence?

A

1 inspection of precordium
2 palpation of precordium and peripheral pulses
3 percussion of heart border
4 auscultation of normal/abnormal heart sounds (BP, too)

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12
Q

The cardiac exam should also be done at the same time as the assessment of which other major organ?

A

Lungs

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13
Q

What visible features of the fingers could indicate heart issues?

A

Edema, cyanosis or clubbing

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14
Q

What is the term of the point of maximum impulse of the heart?

A

Apical impulse

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15
Q

At what location is the apical impulse visible?

A

Left 5th ICS medial to the midclavicular line

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16
Q

What would an apical impulse that is lateral to the midclavicular line indicate?

A

Cardiac hypertrophy or displacement

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17
Q

What should be investigated on the jugular veins?

A

Engorgement and accentuated waves

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18
Q

What problem would be indicated by distention of the jugular veins?

A

Problem with the right side of the heart (examples = tricuspid stenosis or regurgitation

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19
Q

What is indicated by accentuated A and V waves of the jugular veins?

A

Right sided heart issue

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20
Q

What is the term for the vibrations caused by turbulent blood flow in the heart that are visible externally?

A

Precordial “thrills”

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21
Q

What are the usual causes of diminished blood flow to the head and extremities?

A

1 atherosclerotic plaques
2 clots
3 aneurysms
4 impingement

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22
Q

The heart should be percussed in which direction?

A

Lateral to medial in ICS 5-2

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23
Q

What two sounds must be differentiated upon percussion of the cardiac region?

A

Resonant lung sound compared to a dull heart muscle sound

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24
Q

What is the X-ray way of physically assessing the size and placement of the heart?

A

P-A chest film at 72 inches (best way)

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25
Q

What are the 3 ways in which the position and size of the heart can be physically assessed?

A

1 palpation
2 percussion
3 P-A chest film at 72 inches

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26
Q

What are the ICS locations for each cardiac valve?

A 
Aortic = 2nd right next to the sternum
Pulmonic = 2nd left next to the sternum
Tricuspid = 4th left next to the sternum
Mitral = 5th left just inside midclavicular line
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27
Q

Which part of the stethoscope enables the hearing of subtle high pitched abnormalites? Low pitched?

A

High pitched = diaphragm

Low pitched = bell

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28
Q

Which part of the stethoscope is applied firmly and which is applied lightly?

A 
Firmly = diaphragm
Lightly = bell
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29
Q

The first heart sound, S1 or “Lubb” is made by the nearly spontaneous closure of which two heart valves?

A

Mitral and tricuspid

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30
Q

The first heart sound, S2 or “Dup” is made by the nearly spontaneous closure of which two heart valves?

A

Aortic and pulmonic

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31
Q

Which heart sounds marks the beginning of systole, and which marks the beginning of diastole?

A 
Systole = Lubb
Diastole = Dup
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32
Q

Which has a long pause: the time between the Lubb and Dup (systolic pause) or the time between the Dup and the next Lubb (diastolic pause)?

A

Dup and the next Lubb (3X)

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33
Q

What acronym is used to assess the audible characteristics of the expected and unexpected heart sounds?

A 
Quality
Pitch
Intensity
Duration 
(QPID)
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34
Q

Which valve technically closes first during the S1 sound?

A

Mitral

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35
Q

Which heart sound is relatively longer and lower pitched: Lubb or Dup?

A

Lubb

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36
Q

Where is the first heartbeat sound (Lubb) heard the loudest?

A

Mitral valve (cardiac apex)

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37
Q

In what patient position will the apex of the heart be brought closest to the chest so the mitral and tricuspid valve sounds are accentuated?

A

Left lateral recumbent position

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38
Q

Which heart sound should be in sync with the apical impulse and carotid pulse?

A

Lubb

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39
Q

Which heart valve closes a fraction faster than the other during the S2 heart sound?

A

Aortic

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40
Q

Which heart sound is relatively shorter and higher pitched than the other?

A

Dup

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41
Q

At which heart valve is the second heart sound the loudest?

A

Aortic

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42
Q

In what patient position is the base of the heart moved closest to the chest so that the aortic and pulmonic sounds are accentuated?

A

Sitting up and leaning forward

43
Q

What are the added heartbeat sounds?

A

1 splits
2 gallops
3 clicks and snaps

44
Q

A split S1 maybe be a normal finding on what kind of patient?

A

Thin patient

45
Q

Where and when would a split S1 best be heard?

A

Tricuspid site immediately following diastolic pause

46
Q

A right bundle branch block (RBBB) or delayed tricuspid closure is a possible abnormal cause of which type of split heartbeat?

A

Split S1

47
Q

What procedure is best used to diagnosed a right bundle branch block?

A

EKG

48
Q

If a patient presented with a right bundle branch block, the signs and symptoms would be similar to what kind of chronic heart failure?

A

Right-sided

49
Q

What are the three variations of a split S2?

A

1 physiologic
2 paradoxical
3 fixed

50
Q

Which type of split heartbeat sound is common in kids?

A

Physiologic S2 split

51
Q

Is a physiologic S2 split heard better upon inspiration or expiration?

A

Inspiration

52
Q

Is a paradoxical S2 split heard better upon inspiration or expiration?

A

Expiration

53
Q

What kind of condition could result in a paradoxical split S2 heartbeat due to a delayed aortic valve?

A

Left bundle branch block (LBBB)

54
Q

Is a fixed S2 split heard better upon inspiration or expiration?

A

During both

55
Q

In what kind of S2 split does blood from the left heart get shunted to the right heart causing extra workload for the right side?

A

Fixed S2

56
Q

What kind of condition could lead to a fixed S2 split heartbeat?

A

Septal defect

57
Q

What is another name for the S3 heartbeat?

A

Ventricular gallop or third heartbeat

58
Q

What is another name for the S4 heartbeat?

A

Atrial gallop or fourth heartbeat or presystolic gallop

59
Q

Which gallop occurs during early diastole? Late diastole?

A 
Early = ventricular, S3
Late = atrial, S4
60
Q

Where is the S3, ventricular gallop, heart sound heard best and with what part of the stethoscope?

A

Apex with bell (mitral site)

61
Q

What does a ventricular or atiral gallop imply when seen in people over 40 years old?

A

Acute or chronic heart failure

62
Q

In what individuals may a ventricular gallop/S3 heart sound be functional?

A

1 thin children
2 teens and young adults
3 late-stage pregnancy

63
Q

The cadence of a ventricular gallop resembles what other split heart sound?

A

S2 split

64
Q

How do the S3 and S4 heart sounds differ from the S2 and S1 splits (respectively)?

A

Subtle and low pitched

65
Q

What is the hypothesis as to what causes a gallop?

A

Blood striking a damaged and therefore stiffened ventricular wall

66
Q

In which individuals may an atrial gallop/S4 heart sound be functional?

A

Well conditioned athletes

67
Q

The cadence of an S4 heart sound resembles what other heart sound?

A

S1 split

68
Q

Where is the S4, atrial gallop, heart sound heard best and with what part of the stethoscope?

A

Apex with bell (mitral site)

69
Q

What causes the opening snap and ejection click heart sounds?

A

Thickening, deformity, or calcification of the atrioventricular or semilunar valves (respectively)

70
Q

What are examples of conditions that can lead to the presence of opening snap heart sounds?

A

Childhood strep throat or rheumatic fever

71
Q

What valves are affected by opening snaps?

A

Mitral and tricuspid

72
Q

What valves are affected by ejection clicks?

A

Aortic and pulmonic

73
Q

The cadence of opening snaps resemble what other heart sounds?

A

Fixed S2 split (also S3)

74
Q

Where are the ejection clicks best heard?

A

Apex

75
Q

How is the sound of an ejection click different than a ventricular gallop?

A

Earlier and higher pitched

76
Q

Why are opening snaps often hard to hear?

A

Overshadowed by other abnormal heart sounds

77
Q

The cadence of ejection clicks resemble with other heart sounds?

A

Split S1 (also S4)

78
Q

How is the sound of an ejection click different from an atrial gallop?

A

Midsystolic and higher pitched

79
Q

What is the most common cause of murmurs?

A

Faulty valves

80
Q

How is the quality of a murmur usually heard as?

A

Blowing or rumbling

81
Q

What type of murmur refers to a short, late diastolic murmur?

A

Presystolic

82
Q

What type of murmur refers to a short, early systolic murmur?

A

Protosystolic

83
Q

What type of murmur extends from S1 to S2 (all of systole)?

A

Pansystolic or holosystolic

84
Q

What type of murmur is present throughout systole and into some of diastole?

A

Continuous

85
Q

In what ICS is a murmur heard best in each heart valve?

A 
Aortic = 2nd right 
Pulmonic = 2nd left
Tricuspid = 5th left
Mitral = 5th left just medial to midclavicular line
86
Q

What type of murmurs become louder during inspiration due to decreased thoracic pressure?

A

Those involving right-sided heart valves

87
Q

Innocent murmurs in children are best heard with what part of the stethoscope? Where and during what phase of the heart cycle?

A 
Part = bell
Where = at pulmonic site
Phase = systolic
88
Q

What would be unique about the symptomatology of an individual with an innocent murmur?

A

Free of obvious cardiac signs or symptoms

89
Q

What is the term used for murmurs that are not significant enough to cause any clinical issues?

A

Benign murmurs

90
Q

Murmurs of which phase in the heart cycle should always be considered abnormal?

A

Diastolic

91
Q

A systolic murmur is heard between which heart sounds?

A

S1 and S2

92
Q

A diastolic murmur is heard between which heart sounds?

A

S2 and S1

93
Q

Does stenosis occur with a murmur that is created during the opening or closing of a valve?

A

Opening

94
Q

Does regurgitation occur with a murmur that is created during the opening or closing of a valve?

A

Closing

95
Q

What is the cause of a machinery murmur?

A

Patent ductus arteriosus

96
Q

Where is a machinery murmur heard?

A

2nd ICS

97
Q

What is another name for an innocent murmur, and in which population is it seen?

A

Still’s murmur; in children

98
Q

In what heart phase do we see an Austin Flint murmur?

A

Late diastole

99
Q

What type of murmur is associated with aortic insufficiency causing the mitral valve to vibrate due to regurgitant blood?

A

Austin Flint murmur

100
Q

What is the acronym for remembering the systolic murmurs?

A

ASMR and PSTR

101
Q

What is the acronym for remembering the diastolic murmurs?

A

ARMS and PRTS

102
Q

What are the sounds heard due to inflammation of the pericardial sac with or without fluid that are high-pitched, grating, scratching noises?

A

Pericardial friction rubs

103
Q

How are friction rubs best auscultated?

A

Patient leaning forward in deep expiration

104
Q

Pericardial friction rubs are best heard during what phase of the heart cycle?

A

Both systole and diastole

Physical Diagnosis II Exam Two (2 decks)

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