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JVP, murmurs, auscultation heart Flashcards

1
Q

Grade 1 murmur

A

faint, only heard after listener has tuned in; may not be heard in all positions

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2
Q

Grade 2 murmur

A

quiet, but heard immediately after placing stethoscope on chest

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3
Q

Grade 3 murmur

A

moderately loud

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4
Q

Grade 4 murmur

A

loud with palpable thrill

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5
Q

Grade 5 murmur

A

very loud with thrill, may be heard when stethoscope on chest partially

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6
Q

Grade 6 murmur

A

very loud with thrill, may be heard when stethoscope off chest completely

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7
Q

If murmur is heard on 2nd R. interspace where is it originating?

A

aortic valve

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8
Q

A murmur on which side of the heart varies with inspiration?

A

Right side

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9
Q

What does JVP reflect?

A

R. atrial pressure

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10
Q

Where is JVP best estimated and why?

A

R. internal jugular vein because it is the most direct channel into the R. atrium

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11
Q

What is the measurement from sternal angle to R. atrium, regardless of bed position?

A

5 cm

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12
Q

What amt do we add to the number we obtained to reflect the distance from R. atrium?

A

5 cm

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13
Q

What is a normal JVP?

A

less than 9cm

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14
Q

What diseases associated with increased JVP?

A

HF, tricuspid valve disease, pulmonic stenosis, pericardial disease

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15
Q

What disease associated with decreased JVP?

A

dehydration and hypovolemia

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16
Q

What do we do if patient hypovolemic and need to measure JVP?

A

Lower head of bed to as low as 0 degrees

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17
Q

What do we do if patient hypervolemic and need to measure JVP?

A

raise head of the bed to 60 or 90 degrees

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18
Q

What is a normal Kussmaul sign?

A

JVP falls with inspiration due to a decrease in pressure in expanding thorax cavity

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19
Q

What is an abnormal Kussmaul sign?

A

JVP will rise with inspiration due to impaired filling of R. ventricle because fluid in pericardial space or poorly compliant myocardium/pericardium

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20
Q

Where to find PMI?

A

5th IC space, 1cm medial to midclavicular line

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21
Q

Normal PMI diameter

A

less than 2.5cm

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22
Q

What are we looking for with PMI?

A

lift, heaves, thrills (buzzing)

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23
Q

How do we assess thrills?

A

use ball of hand to feel for it

24
Q

What grade murmur can you feel a thrill?

25
Q

What position is the patient when assessing PMI?

A

L. lateral decubitus

26
Q

What does it mean if you hear murmur and feel a thrill?

27
Q

When auscultating, when do you use diaphragm and bell?

A

Diaphragm for all places and bell for mitral and tricuspid

28
Q

General auscultation practice

A

listen from apex to base or base to apex inching from each of the 5 pts to assess S1 and S2 and notice any changes in tone

29
Q

What does a diastolic murmur indicate ?

A

Indicates a valvular heart disease

30
Q

What does a systolic murmur indicate

A

valvular disease with a normal heart

31
Q

What are the systolic murmurs?

A 
Mitral regurgitation (harsh holosystolic; medium-high)
Tricuspid regurgitation (holosystolic; medium, blowing)
Ventricular septal defect (high holosystolic)
Aortic stenosis (diamond; medium high)
Pulmonic stenosis (diamond; medium)
Hypertrophic cardiomyopathy
32
Q

What are the diastolic murmurs?

A 
Aortic regurgitation (decrescendo)
Mitral stenosis (rumble)
33
Q

When listening to the heart where to place stethoscope

A

apex or base

34
Q

When moving stethoscope, where do you want your left index finger and middle fingers

A

right carotid artery in lower third of neck to correctly ID S1, before carotid upstroke

35
Q

At the base what is louder and splits with respiration

36
Q

At apex what is louder

37
Q

i. Diastolic sound
ii. High pitch and snap that radiates to the apex and to the pulmonic area
iii. Use diaphragm

A

opening snap

38
Q

i. Diastolic sound
ii. Dull, low in pitch and heard best in apex in left lateral decubitus
iii. Use bell

A

S3-physiologic

39
Q

Who has physiologic S3

A

children, young adults, pregnant

40
Q

i. Dull, low in pitch and heard best in apex in left lateral decubitus (left) or along the lower left sternal border or below xiphoid with patient supine (Right)

A

pathologic s3

41
Q

Who has pathologic S3

A

adult over 40

42
Q

i. Occurs just before S1
ii. Dull, low in pitch
iii. Heard with bell

A

S4 (atrial gallop)

43
Q

Who has S4

A

athletes and older kids

44
Q

i. Starts in apex and radiates into left axilla
ii. Intensity: soft to loud
iii. Pitch: medium to high
iv. Quality: harsh, holosystolic

A

mitral regurgitation

45
Q

i. Starts in lower left sternal border and radiates to right of sternum to the xiphoid area
ii. Intensity: variable
iii. Pitch: medium
iv. Quality: blowing, holosystolic
v. Intensity increases with inspiration

A

Tricuspid regurgitation

46
Q

i. Starts in 3-5th left interspaces and radiates wide
ii. Intensity: very loud with thrill
iii. Pitch: high, holosystolic
iv. Quality: harsh

A

ventricle septal defect

47
Q

i. Starts in 2-4th interspaces between left sternal border and apex with little radiation
ii. Intensity: grade1-2
iii. Pitch: soft to medium
iv. Quality: variable
v. Decreases/disappears on sitting

A

innocent murmurs

48
Q

i. Starts in R. second interspace and radiates to carotids, down L. sternal borders and to the apex
ii. Intensity: loud with a thrill
iii. Pitch: medium-harsh; crescendo-decrescendo higher at apex
iv. Quality: harsh; musical at apex
v. Heard best when patient sitting and leaning forward

A

aortic stenosis

49
Q

i. Starts in 3-4th interspaces and radiates down left sternal border to the apex and possibly to the base
ii. Intensity: variable
iii. Pitch: medium
iv. Quality: harsh
v. Decreases with squatting, increases with straining down from Valsalva and standing

A

hypertrophic cardiomyopathy

50
Q

i. Starts in 2-3rd interspaces and if loud radiates toward left shoulder and neck
ii. Intensity: soft to loud (with thrill if loud)
iii. Pitch: medium; crescendo-decrescendo
iv. Quality: harsh

A

pulmonic stenosis

51
Q

i. Starts in 2-4th interspaces and if loud radiates to the apex and R. sternal border
ii. Intensity: grade1-3
iii. Pitch: high; use diaphragm
iv. Quality: blowing decrescendo
v. Heard best with patient sitting, leaning forward, with breath held after exhalation

A

aortic regurgitation

52
Q

i. Starts in apex with no radiation
ii. Intensity: grade1-4
iii. Pitch: decrescendo low pitched rumble; use bell
iv. Best heard in L. lateral decubitus, with exercise and exhalation

A

mitral stenosis

53
Q

i. Starts above the medial third of the clavicles, especially on the right and radiates into 1st-2nd interspaces
ii. Intensity: soft to moderate
iii. Pitch: low; use bell
iv. Quality: humming, roaring
v. Timing: continuous murmur without silent interval; loudest distole

A

venous hum

54
Q

i. Starts in 3rd interspace to left of sternum with little radiation
ii. Intensity: increase when patient leans forward, exhales, and holds reath
iii. Pitch: high: diaphragm
iv. Quality: scratchy, scraping
v. Timing: 3 short components: atrial systole, ventricular systole, ventricular diastole

A

pericardial friction rub

55
Q

i. Starts in left 2nd interspace and radiates toward left clavicle
ii. Intensity: loud and associated with thrill
iii. Pitch: medium
iv. Quality: harsh, machinery-like
v. Timing: continuous murmur in both systole and diastole with a silent interval late in diastole; loudest late systole, obscures S2 and fades in diastole

A

Patent ductus arteriosis

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