Heart - Lab Flashcards
When assessing arteries, which part of the stethoscope should be used? Diaphragm or bell?
bell
What are some pathological conditions that can be detected by inspection and palpation of the heart?
cardiac or ventricular hypertrophy, murmurs, and congestive heart failure
In most patients, the apical impulse will correspond with what?
the palpated point of maximal impulse (PMI)
What are heaves?
unexpectedly vigorous cardiac impulses
What are thrills caused by?
they are fine vibrations caused by underlying turbulence
Where will you find the apical impulse?
visible in most adults around the midclavicular line in the 4th or 5th intercostal space
Describe the technique used to palpate the apical impulse
place hand in the expected area of the apical impulse, ask patient to exhale and hold while they lean forward to bring the apex closer to the chest wall
The apical impulse is displaced laterally to midclavicular line, what could this be indicative of?
left ventricular hypertrophy
Increased amplitude of the apical impulse could be result from…
hyperthyroidism, severe anemia, pressure overload of the left ventricle (aortic stenosis) or volume overload of the left ventricle (mitral regurgitation)
Enlarged right ventricle, dilated pulmonary artery, or an aneurysm of the aorta can cause…
PMI to be located somewhere other than the apical impulse
If right ventricular hypertrophy is suspected, where will the heave be located?
along the left sternal border
If left ventricular hypertrophy is suspected, where will the heave be located?
apex
What are the 5 designated areas of auscultation for the heart?
1) aortic
2) pulmonic
3) tricuspid
4) mitral
5) Erb’s point
Name this location of auscultation:
3rd intercostal space at the left sternal border
Erb’s point ( aortic and pulmonic sounds)
Name this location of auscultation:
5th left intercostal space at the midclavicular line
mitral
Name this location of auscultation:
2nd right intercostal space at the right sternal border
aortic
Name this location of auscultation:
2nd left intercostal space at the left sternal border
pulmonic
Name this location of auscultation:
4th left intercostal space at the left lower sternal border
tricuspid
What are the 4 characteristics of heart sounds?
1) rate
2) rhythm
3) intensity
4) splitting
What do you assess when listening to the heart?
character of the heart sounds (rate, rhythm, intensity, splitting)
presence or absence and quality of S1, S2, S3, and S4 sounds
presence or absence and quality of murmurs, rubs or clicks
How should the patient be positioned in order to listen to high-pitched murmurs? What part of the stethoscope should be used?
seated, leaning slightly forward
diaphragm
How should the patient be positioned in order to listen to low pitch filling sounds in diastole? What part of the stethoscope should be used?
left lateral recumbent
bell
Which of 4 S sounds are normal?
S1 and S2
Is splitting of S1 and S2 normal?
It can be a false positive, physiological splitting of S2 during inspiration is normal and particularly common in younger patients
Is this a normal heart sound: variations to the spacing and intensity of S1 and S2?
no, this is not normal
Ejection clicks and opening snaps are normal or abnormal heart sounds?
abnormal
How should murmurs be documented?
cardiac cycle duration pitch intensity quality pattern location where it is loudest does it radiate change during respiration
Grade this murmur:
very loud, with thrill. may be heard when the stethoscope is partly off the chest
Grade V
Grade this murmur:
very faint, heard only after listener has “tuned in”; may not be heard in all positions
Grade I
Grade this murmur:
moderately loud
Grade III
Grade this murmur:
quiet, but hear immediately after placing the stethoscope on the chest
Grade II
Grade this murmur:
loud, with palpable thrill
Grade IV
Grade this murmur:
very loud, with thrill. may be heard with stethoscope entirely off the chest
Grade VI
Are all systolic murmurs pathologic?
no, murmurs found in the 2nd to 4th left intercostal spaces between the left sternal border and the apex during systole are very common in children and young adults
***ALL diastolic murmurs are pathologic!!
