Lab Refresher: Normal Cardiac/Vascular exam Flashcards
When do you use the Diaphragm vs. Bell, what does each help you listen to?
Diaphragm - high pitched sounds (S1, S2, AR, MR, Friction Rubs)
Bell - low pitched (S3, S4, MS, carotid bruit)
A central protrusion of pt’s chest indicates what; while a central depression indicates?
Protrusion - Pectus carinatum
Depression - Pectus excavatum
What are thrills?
Turbulent blood flow causing murmurs (humming vibrations)
Point of maximal impulse (PMI) is usually palpated where, position of the patient can be?
- Near 4th-5th intercostal space in MCL
- Supine or left lateral decubitus
When percussing for estimation of heart size what is proper procedure?
Start far left (resonance) and move medially to find cardiac dullness
Criteria (size) when palpating for impulse?
Small, brisk beat measuring less than 2.5 cm, should last the first 2/3 of systolic period (or less).
Where is Erb’s point listening post and what is heard there?
L 3rd ICS at SB; point at which S1 and S2 heard equally
What is an S3 sound?
- Dull, low pitch (heard w/ bell)
- Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of rapid filling phase
When is S3 normal and abnromal, what does it sound like (name that state!)?
- Normal in children/young adults
- Pathologic >40 y/o
(Kent-Tuck-Y)
What is the S4 sound?
- Dull, low pitch (heard w/ bell)
- Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle
When is an S4 normal and what is the sound (state)?
Normal in trained athletes (Ten-Nes-See)
Jugular veins reflect the activity of which side of the heart, indicates which pressure?
Right side - gives indication of the RAP
Most common cause of an elevated JVP?
Elevated RV diastolic pressue
Systolic murmurs are heard between?
S1 and S2
Systolic murmurs may indicate which pathologies?
- Aortic stenosis
- Pulmonic stenosis
- Mitral regurgitation
- Tricuspid regurgitation
Diastolic murmurs are heard between?
S2 and S1
Diastolic murmurs may indicate which pathologies?
- Aortic regurgitation
- Pulmonic regurgitation
- Mitral stenosis
- Tricuspid stenosis
How is JVP measured and what is normal?
- Pt placed supine to allow veins to engorge, then raise to 30-45 degrees
Normal: 0-9
Where is carotid pulse felt, and how do you assess both?
- Medial to the SCM
- Only assess ONE AT A TIME!!!
How are pulses graded?
4+ Bounding 3+ Strong, full, increases 2+ Normal, average intensity 1+ Diminished, barely palpable 0 Absent, not palpable
What is the normal capillary refill time?
2 seconds or less
Examining for pitting edema is done by pressing firmly for 5 seconds in which 3 locations?
1) Dorsum of foot
2) Anterior tibia
3) Behind medial malleolus
What is the 4 point grading for edema?
- Absent
- 1+ Barely detectable, slight pitting (2mm); disappears rapidly
2+ Slight indentation (4mm); 10-15 secs
3+ Deeper indentation (6mm); may be >1 min
4+ Very marked indentation (8mm); 2-5 minutes
Increased JVP in?
- SVC obstruction
- Severe heart failure
- Constrictive pericarditis, cardiac tamponade, RV infarction
- Restrictive cardiomyopathy
What is the normal ejection fraction %?
50-60%
Steps to CV exam in order
- Inspection
- Palpation
- Percussion
- Auscultation
When palpating PMI what are the normal characteristics that should be felt and should last how long?
- Small, brisk beat and measure <2.5 cm
- Should last the first 2/3 of systolic period (or less)
