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PCM II Midterm > Heart Exam > Flashcards

Heart Exam Flashcards

1
Q

What are the five things a heart exam should include?

A

History, physical, ECG, x-ray, labs

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2
Q

What are some key things you should note on an inspection portion of the physical exam?

A

face(acromegalic, cushnoid, down’s, hyperthyroid, jaundice, cyanotic, pallor, clubbing of nails, body habitus, hydration, shape of chest, landmarks

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3
Q

What are some important things that should be included in a cardiac history?

A

fatigue, dyspnea, chest pain, palpations, syncope, underlying etiologies, anatomic abnormalities, family history

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4
Q

What is the order of a cardiac physical exam?

A

Inspection, palpation, percussion, auscultation

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5
Q

What are some key things to be palpated in the cardiac PE?

A

apex beat, thrills/turbulent blood flow, PMI over 4th or 5th intercostal space at midclavicular line

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6
Q

What are some things to be percussed in a cardiac PE?

A

cardiac size, start left and move medially to note cardiac DULLNESS

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7
Q

Why is it important to inspect JVP?

A

reflects the activity of the R side of the heart

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8
Q

What is the “a” wave?

A

R atrial contraction, tricuspid valve open, coincides with S1 and precedes carotid pulsation

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9
Q

What is the “c” wave?

A

backward push by TV closure during isovolumetric contraction

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10
Q

What is the “x” wave?

A

Passive atrial filling and relaxation

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11
Q

What does a steep x descent indicate?

A

cardiac tamponade, constrictive pericarditis

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12
Q

What is the “V” wave?

A

atrial filling with TV closed

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13
Q

What does a prominent v wave indicate?

A

pulmonary hypertension, tricuspid regurgitation

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14
Q

What does a prominent a wave indicate?

A

RA/RV obstruction, increased RV pressure, pulmonary hypertension, pulmonary emboli, a-v dissociation

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15
Q

What is the “y” slope?

A

opening of tricuspic valve and rapid RV filling during RV diastole

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16
Q

What does an increased JVP indicate?

A

SVC obstruction, heart failure, pericarditis, cardiac tamponade, RV infarction, cardiomyopathy

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17
Q

What does a positive HJR indicate?

A

Poorly compliant RV, RV failure, constrictive pericarditis, obstructive RV filling by TS

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18
Q

What is the S1 sound?

A

closing of mitral and tricuspid valves

19
Q

What is the S2 sound?

A

Closing of aortic and pulmonic valves

20
Q

What is the S3 sound?

A

patho in adults over 40, due to high pressures and abrupt deceleration of inflow across mitral valve at end of filling phase

21
Q

What is the S4 sound?

A

Atrial gallop from forceful contraction of atria against stiff ventricle

22
Q

What is a split S2 sound?

A

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

23
Q

Where do you listen for the mitral valve?

A

5th left ICS at mid clavicular line

24
Q

Where do you listen for the tricuspid valve?

A

fourth left ICS at LSB

25
Q

Where do you listen for the aortic valve?

A

second ICS to the R of the sternum

26
Q

Where do you listen for the pulmonic valve?

A

second ICS to the L of the sternum

27
Q

What is a grade 1 murmur?

A

barely audible

28
Q

What is a grade 6 murmur?

A

Loud, heard without stethoscope

29
Q

What is a grade 2 murmur?

A

Soft, easily heard

30
Q

What is a grade 5 murmur?

A

loud with minimal contact between chest and stethoscope

31
Q

What is a grade 3 murmur?

A

loud without a thrill

32
Q

What is a grade 4 murmur?

A

loud with a thrill

33
Q

What is grading system for pulses?

A 
0- absent
1- barely palpable
2- normal
3- strong
4- bounding
34
Q

What is the grading system for edema?

A 
0- absent
1- barely detectable, nonpitting
2- slight indentation, 10-15 sec
3- depper, >1 min
4- marked indentation, 2-5 min
35
Q

What is the diaphragm of the stethoscope used to listen for?

A

high pitched sounds, S1, S2, AR, MR

36
Q

What is the bell of the stethoscope used for?

A

low pitched sounds, S3, S4, MS, carotid bruit

37
Q

What are systolic murmurs?

A

between S1 and S2, aortic stenosis, pulmonic stenosis, mitral regurgitation, tricuspid regurgitation

38
Q

What are diastolic murmurs?

A

between S2 and S1, aortic or pulmonic regurgitation ,mitral or tricuspid stenosis

39
Q

What is a fixed S2 split?

A

wide split that does not vary with respiration, prolonged right ventricular systole, RV failure or ASD

40
Q

What is paradoxical splitting?

A

splitting that appears on expiration, typically due to left bundle branch block

41
Q

What is an early systolic ejection?

A

pathologic halting of aortic and pulmonic valves as they open in systole, indicates CVD

42
Q

What is a systolic click?

A

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

43
Q

What is an opening snap?

A

stenotic mitral valve

PCM II Midterm (6 decks)

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