Heart Exam Flashcards
What are the five things a heart exam should include?
History, physical, ECG, x-ray, labs
What are some key things you should note on an inspection portion of the physical exam?
face(acromegalic, cushnoid, down’s, hyperthyroid, jaundice, cyanotic, pallor, clubbing of nails, body habitus, hydration, shape of chest, landmarks
What are some important things that should be included in a cardiac history?
fatigue, dyspnea, chest pain, palpations, syncope, underlying etiologies, anatomic abnormalities, family history
What is the order of a cardiac physical exam?
Inspection, palpation, percussion, auscultation
What are some key things to be palpated in the cardiac PE?
apex beat, thrills/turbulent blood flow, PMI over 4th or 5th intercostal space at midclavicular line
What are some things to be percussed in a cardiac PE?
cardiac size, start left and move medially to note cardiac DULLNESS
Why is it important to inspect JVP?
reflects the activity of the R side of the heart
What is the “a” wave?
R atrial contraction, tricuspid valve open, coincides with S1 and precedes carotid pulsation
What is the “c” wave?
backward push by TV closure during isovolumetric contraction
What is the “x” wave?
Passive atrial filling and relaxation
What does a steep x descent indicate?
cardiac tamponade, constrictive pericarditis
What is the “V” wave?
atrial filling with TV closed
What does a prominent v wave indicate?
pulmonary hypertension, tricuspid regurgitation
What does a prominent a wave indicate?
RA/RV obstruction, increased RV pressure, pulmonary hypertension, pulmonary emboli, a-v dissociation
What is the “y” slope?
opening of tricuspic valve and rapid RV filling during RV diastole
What does an increased JVP indicate?
SVC obstruction, heart failure, pericarditis, cardiac tamponade, RV infarction, cardiomyopathy
What does a positive HJR indicate?
Poorly compliant RV, RV failure, constrictive pericarditis, obstructive RV filling by TS
What is the S1 sound?
closing of mitral and tricuspid valves
What is the S2 sound?
Closing of aortic and pulmonic valves
What is the S3 sound?
patho in adults over 40, due to high pressures and abrupt deceleration of inflow across mitral valve at end of filling phase
What is the S4 sound?
Atrial gallop from forceful contraction of atria against stiff ventricle
What is a split S2 sound?
A split S2 sound is normally heard during inspiration because of increased venous return during inspiration and more time for RV to deliver blood to the lungs
Where do you listen for the mitral valve?
5th left ICS at mid clavicular line
Where do you listen for the tricuspid valve?
fourth left ICS at LSB
Where do you listen for the aortic valve?
second ICS to the R of the sternum
Where do you listen for the pulmonic valve?
second ICS to the L of the sternum
What is a grade 1 murmur?
barely audible
What is a grade 6 murmur?
Loud, heard without stethoscope
What is a grade 2 murmur?
Soft, easily heard
What is a grade 5 murmur?
loud with minimal contact between chest and stethoscope
What is a grade 3 murmur?
loud without a thrill
What is a grade 4 murmur?
loud with a thrill
What is grading system for pulses?
0- absent 1- barely palpable 2- normal 3- strong 4- bounding
What is the grading system for edema?
0- absent 1- barely detectable, nonpitting 2- slight indentation, 10-15 sec 3- depper, >1 min 4- marked indentation, 2-5 min
What is the diaphragm of the stethoscope used to listen for?
high pitched sounds, S1, S2, AR, MR
What is the bell of the stethoscope used for?
low pitched sounds, S3, S4, MS, carotid bruit
What are systolic murmurs?
between S1 and S2, aortic stenosis, pulmonic stenosis, mitral regurgitation, tricuspid regurgitation
What are diastolic murmurs?
between S2 and S1, aortic or pulmonic regurgitation ,mitral or tricuspid stenosis
What is a fixed S2 split?
wide split that does not vary with respiration, prolonged right ventricular systole, RV failure or ASD
What is paradoxical splitting?
splitting that appears on expiration, typically due to left bundle branch block
What is an early systolic ejection?
pathologic halting of aortic and pulmonic valves as they open in systole, indicates CVD
What is a systolic click?
usually caused by mitral valve prolapse, squatting often delays the click due to increased venous return while standing moves the click closer to the S1
What is an opening snap?
stenotic mitral valve
