Lecture 4: Approach to Cardiac Exam

Question 1

When obtaining a cardiac history, what should you consider asking?

Answer 1

1) Underlying etiologies
2) Anatomic abnormalities
3) Physiological disturbances
4) Family history

Question 2

What is a normal JVP?

Answer 2

0-9

Question 3

In a jugular venous pressure recording, what does the “a wave” represent?

Answer 3

Right atrial contraction

-coincides with S1

Question 4

Under what circumstances will you see a giant “a wave?”

Answer 4

1) Obstruction b/t right atria and ventricle
2) Increased pressure in right ventricle
3) Pulmonary hypertension
4) Recurrent pulmonary emboli
5) AV dissociation

Question 5

In a jugular venous pressure recording, what does the “c wave” represent?

Answer 5

Closure of tricuspid valve during isovolumetric systole

Question 6

In a jugular venous pressure recording, what does the “x wave” represent?

Answer 6

Passive atrial filling and atrial relaxation

• blood flowing into right atrium
• tricuspid valve is closed

Question 7

Under what circumstances will you see a steep “x descent?”

Answer 7

Tamponade

Constrictive pericarditis

Question 8

In a jugular venous pressure recording, what does the “v wave” represent?

Answer 8

Atrial filling

• increasing volume and pressure in right atrium
• tricuspid valve is closed

Question 9

Under what circumstances will you see a prominent “v wave?”

Answer 9

Pulmonary hypertension

Tricuspid regurgitation

Question 10

In a jugular venous pressure recording, what does the “y slope” represent?

Answer 10

Opening of tricuspid valve

• rapid filling of right ventricle
• diastole

Question 11

Where is increased jugular venous pressure seen?

Answer 11

Superior Vena Cava obstruction
Severe heart failure
Constrictive pericarditis
Cardiac tamponade
Right Ventricle infarction
Restrictive cardiomyopathy

Question 12

Does S1 or S2 have a splitting sound in inspiration?

Answer 12

S2