Heart Exam Flashcards
When is the cardiac assessment performed?
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
What are the characteristic symptoms of acute heart failure?
1 substernal chest pain/pressure
2 GI discomfort (MC in females)
3 exertional dyspnea
Where else can pain from a myocardial infarct manifest besides the chest?
1 jaw
2 neck
3 arms
4 back
What are the characteristic symptoms of right-sided chronic heart failure?
1 ankle edema *
2 fatigue
3 dyspnea
What are the characteristic symptoms of left-sided chronic heart failure?
1 exertional dyspnea *
2 cough
3 orthopnea
4 pink, frothy sputum
Bibasilar cracks would be a presentation with what kind of chronic heart failure?
Left-sided
Topographically, where is the base of the heart? Apex?
Base = 2nd intercostal space Apex = 5th intercostal space
What side of the heart is more muscular and why?
Left; has to propel blood to the fingers, toes, and nose
Why is the right side of the heart less muscular?
Only has to pump blood to the nearby lungs
What is the term used for the chest surface that overlies the heart?
Precordium
What is the traditional cardiac physical assessment procedure sequence?
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)
The cardiac exam should also be done at the same time as the assessment of which other major organ?
Lungs
What visible features of the fingers could indicate heart issues?
Edema, cyanosis or clubbing
What is the term of the point of maximum impulse of the heart?
Apical impulse
At what location is the apical impulse visible?
Left 5th ICS medial to the midclavicular line
What would an apical impulse that is lateral to the midclavicular line indicate?
Cardiac hypertrophy or displacement
What should be investigated on the jugular veins?
Engorgement and accentuated waves
What problem would be indicated by distention of the jugular veins?
Problem with the right side of the heart (examples = tricuspid stenosis or regurgitation
What is indicated by accentuated A and V waves of the jugular veins?
Right sided heart issue
What is the term for the vibrations caused by turbulent blood flow in the heart that are visible externally?
Precordial “thrills”
What are the usual causes of diminished blood flow to the head and extremities?
1 atherosclerotic plaques
2 clots
3 aneurysms
4 impingement
The heart should be percussed in which direction?
Lateral to medial in ICS 5-2
What two sounds must be differentiated upon percussion of the cardiac region?
Resonant lung sound compared to a dull heart muscle sound
What is the X-ray way of physically assessing the size and placement of the heart?
P-A chest film at 72 inches (best way)
What are the 3 ways in which the position and size of the heart can be physically assessed?
1 palpation
2 percussion
3 P-A chest film at 72 inches
What are the ICS locations for each cardiac valve?
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
Which part of the stethoscope enables the hearing of subtle high pitched abnormalites? Low pitched?
High pitched = diaphragm
Low pitched = bell
Which part of the stethoscope is applied firmly and which is applied lightly?
Firmly = diaphragm Lightly = bell
The first heart sound, S1 or “Lubb” is made by the nearly spontaneous closure of which two heart valves?
Mitral and tricuspid
The first heart sound, S2 or “Dup” is made by the nearly spontaneous closure of which two heart valves?
Aortic and pulmonic
Which heart sounds marks the beginning of systole, and which marks the beginning of diastole?
Systole = Lubb Diastole = Dup
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)?
Dup and the next Lubb (3X)
What acronym is used to assess the audible characteristics of the expected and unexpected heart sounds?
Quality Pitch Intensity Duration (QPID)
Which valve technically closes first during the S1 sound?
Mitral
Which heart sound is relatively longer and lower pitched: Lubb or Dup?
Lubb
Where is the first heartbeat sound (Lubb) heard the loudest?
Mitral valve (cardiac apex)
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?
Left lateral recumbent position
Which heart sound should be in sync with the apical impulse and carotid pulse?
Lubb
Which heart valve closes a fraction faster than the other during the S2 heart sound?
Aortic
Which heart sound is relatively shorter and higher pitched than the other?
Dup
At which heart valve is the second heart sound the loudest?
Aortic
In what patient position is the base of the heart moved closest to the chest so that the aortic and pulmonic sounds are accentuated?
Sitting up and leaning forward
What are the added heartbeat sounds?
1 splits
2 gallops
3 clicks and snaps
A split S1 maybe be a normal finding on what kind of patient?
Thin patient
Where and when would a split S1 best be heard?
Tricuspid site immediately following diastolic pause
A right bundle branch block (RBBB) or delayed tricuspid closure is a possible abnormal cause of which type of split heartbeat?
Split S1
What procedure is best used to diagnosed a right bundle branch block?
EKG
If a patient presented with a right bundle branch block, the signs and symptoms would be similar to what kind of chronic heart failure?
Right-sided
What are the three variations of a split S2?
1 physiologic
2 paradoxical
3 fixed
Which type of split heartbeat sound is common in kids?
Physiologic S2 split
Is a physiologic S2 split heard better upon inspiration or expiration?
Inspiration
Is a paradoxical S2 split heard better upon inspiration or expiration?
Expiration
What kind of condition could result in a paradoxical split S2 heartbeat due to a delayed aortic valve?
Left bundle branch block (LBBB)
Is a fixed S2 split heard better upon inspiration or expiration?
During both
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?
Fixed S2
What kind of condition could lead to a fixed S2 split heartbeat?
Septal defect
What is another name for the S3 heartbeat?
Ventricular gallop or third heartbeat
What is another name for the S4 heartbeat?
Atrial gallop or fourth heartbeat or presystolic gallop
Which gallop occurs during early diastole? Late diastole?
Early = ventricular, S3 Late = atrial, S4
Where is the S3, ventricular gallop, heart sound heard best and with what part of the stethoscope?
Apex with bell (mitral site)
What does a ventricular or atiral gallop imply when seen in people over 40 years old?
Acute or chronic heart failure
In what individuals may a ventricular gallop/S3 heart sound be functional?
1 thin children
2 teens and young adults
3 late-stage pregnancy
The cadence of a ventricular gallop resembles what other split heart sound?
S2 split
How do the S3 and S4 heart sounds differ from the S2 and S1 splits (respectively)?
Subtle and low pitched
What is the hypothesis as to what causes a gallop?
Blood striking a damaged and therefore stiffened ventricular wall
In which individuals may an atrial gallop/S4 heart sound be functional?
Well conditioned athletes
The cadence of an S4 heart sound resembles what other heart sound?
S1 split
Where is the S4, atrial gallop, heart sound heard best and with what part of the stethoscope?
Apex with bell (mitral site)
What causes the opening snap and ejection click heart sounds?
Thickening, deformity, or calcification of the atrioventricular or semilunar valves (respectively)
What are examples of conditions that can lead to the presence of opening snap heart sounds?
Childhood strep throat or rheumatic fever
What valves are affected by opening snaps?
Mitral and tricuspid
What valves are affected by ejection clicks?
Aortic and pulmonic
The cadence of opening snaps resemble what other heart sounds?
Fixed S2 split (also S3)
Where are the ejection clicks best heard?
Apex
How is the sound of an ejection click different than a ventricular gallop?
Earlier and higher pitched
Why are opening snaps often hard to hear?
Overshadowed by other abnormal heart sounds
The cadence of ejection clicks resemble with other heart sounds?
Split S1 (also S4)
How is the sound of an ejection click different from an atrial gallop?
Midsystolic and higher pitched
What is the most common cause of murmurs?
Faulty valves
How is the quality of a murmur usually heard as?
Blowing or rumbling
What type of murmur refers to a short, late diastolic murmur?
Presystolic
What type of murmur refers to a short, early systolic murmur?
Protosystolic
What type of murmur extends from S1 to S2 (all of systole)?
Pansystolic or holosystolic
What type of murmur is present throughout systole and into some of diastole?
Continuous
In what ICS is a murmur heard best in each heart valve?
Aortic = 2nd right Pulmonic = 2nd left Tricuspid = 5th left Mitral = 5th left just medial to midclavicular line
What type of murmurs become louder during inspiration due to decreased thoracic pressure?
Those involving right-sided heart valves
Innocent murmurs in children are best heard with what part of the stethoscope? Where and during what phase of the heart cycle?
Part = bell Where = at pulmonic site Phase = systolic
What would be unique about the symptomatology of an individual with an innocent murmur?
Free of obvious cardiac signs or symptoms
What is the term used for murmurs that are not significant enough to cause any clinical issues?
Benign murmurs
Murmurs of which phase in the heart cycle should always be considered abnormal?
Diastolic
A systolic murmur is heard between which heart sounds?
S1 and S2
A diastolic murmur is heard between which heart sounds?
S2 and S1
Does stenosis occur with a murmur that is created during the opening or closing of a valve?
Opening
Does regurgitation occur with a murmur that is created during the opening or closing of a valve?
Closing
What is the cause of a machinery murmur?
Patent ductus arteriosus
Where is a machinery murmur heard?
2nd ICS
What is another name for an innocent murmur, and in which population is it seen?
Still’s murmur; in children
In what heart phase do we see an Austin Flint murmur?
Late diastole
What type of murmur is associated with aortic insufficiency causing the mitral valve to vibrate due to regurgitant blood?
Austin Flint murmur
What is the acronym for remembering the systolic murmurs?
ASMR and PSTR
What is the acronym for remembering the diastolic murmurs?
ARMS and PRTS
What are the sounds heard due to inflammation of the pericardial sac with or without fluid that are high-pitched, grating, scratching noises?
Pericardial friction rubs
How are friction rubs best auscultated?
Patient leaning forward in deep expiration
Pericardial friction rubs are best heard during what phase of the heart cycle?
Both systole and diastole
