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Physical Diagnosis & Assessment > Module 2: Cardiovascular Exam > Flashcards

Module 2: Cardiovascular Exam Flashcards

1
Q

What make up the atrioventricular (AV) valves & what is their purpose?

A

•Tricuspid
• mitral (bicuspid)
One way blood flow that separates atrium from the ventricles

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2
Q

What make up the semilunar valves & what is their purpose?

A

• pulmonic
• aortic
One way blood flow that separates pulmonary trunk& atrium

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3
Q

What is cardiac output & what factors affect this?

A

Volume of blood ejected from ventricles over 1 minute
Affected by:
• HR
• stroke volume

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4
Q

What is stroke volume & what does it depend on?

A

The amount (volume) of blood ejected w/ each heartbeat influenced by:
•Preload
• myocardial contractility
• after load

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5
Q

What is pre-load & at what part of the cardiac cycle does it occur?

A

Amount of blood in ventricles at the end of diastole

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6
Q

What are some factors that increase pre-load?

A

Any increased venous return to the heart such as:
• inspiration
• exercise
• dilated right ventricle in heart failure

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7
Q

What are some factors that decrease pre-load?

A

Any decreased venous return to the heart such as:
• exhalation
• Decreased ventricular output
• pooling of blood in the periphery: capillary bed or venous system

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8
Q

How does inspiration increase pre-load in the ventricles?

A

Decreased thoracic pressure allows more blood back to the heart

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9
Q

How is myocardial contractility increased & what are some examples?

A

Stimulation by sympathetic nervous system
- fight or flight
> organs are mobilized & their functions during stress and arousal
Ex) exercise, stress, fear

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10
Q

What happens when there is decreased contractility and what can influence this?

A

Blood Flow or O2 delivery to myocardium is impaired

^ age = decreased elasticity of muscles

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11
Q

What is after-load & what happens when there is an increase in after-load?

A

Amount of pressure/vascular resistance that the heart has to contract against
Increased resistance in after-load = decreased cardiac output
- left ventricle has to work harder to get the blood out

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12
Q

What factors resist contractility of the heart & increase after-load in the ventricles?

A

Tone in walls of aorta
Tone in large arteries (ex: subclavian steal)
Volume of blood in aorta

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13
Q

What factors influence Ventricular function of the heart & how can this be detected on physical exam?

A

• volume overload
• pressure overload
PE: change in palpable pulses & heart sounds

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14
Q

What happens when there is a pathological increase in pre-load?

A

Ventricular dilitation → volume overload

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15
Q

What happens when there is a pathological increase in after -load?

A

Stiffness in blood vessels making it hard to pump blood out of ventricles → atherosclerosis

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16
Q

What is being evaluated on inspection of the precordium?

A
  • evidence of trauma
  • bony abnormalities
  • Skin abnormalities
  • Vascular congestion
  • visible lifts or heaves
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17
Q

on inspection of the precordium, patient’s chest wall extrudes & looks like a pigeon. what is this bony abnormality called?

A

pectus carinatum.

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18
Q

on inspection of the precordium, patient’s chest wall has an inward depression & looks like a funnel. what is this bony abnormality called?

A

pectus excavatum

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19
Q

how/where would you palpate the precordium for lifts/heaves & what do they feel like? what can they indicate?

A

light palpation using fingertips -> R & L 2nd ICS, L 4th ICS, & 5th ICS MCL
> impulse will noticeably raise your hand from the chest wall

*indication that cardiac output is increased 
Examples: Hypertrophy, Heart failure
-anemia
-anxiety
-HTN
-fever
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20
Q

how would you palpate the precordium for thrills & what do they feel like? what can they indicate?

A 
pressure over valvular areas using the palm of your hand -> R & L 2nd ICS, L 3rd ICS, & 5th ICS MCL 
> Vibratory sensation 
Indication of: 
-Grade IV or higher murmur
-ventricular or atrial septal defects
21
Q

what is the PMI and where is it located in healthy patients?

A

Point of maximal impulse
Felt at the apex of the heart- inferior tip of heart/left lateral border
L 5th ICS MCL

22
Q

what ventricle makes up majority of the anterior cardiac surface?

A

right ventricle

23
Q

what ventricle makes up the left lateral border of the heart? what is it used to locate?

A

left ventricle

-PMI

24
Q

what abnormalities can lateral displacement of the PMI indicate?

A

LVH
ventricular dilatation
thoracic deformities

25
Q

what abnormalities can medial displacement of the PMI indicate?

A

RVH

26
Q

what abnormalities can upward displacement of the PMI indicate?

A

pregnancy

high left hemi-diaphragm (5th -> R or L 4th ICS)

27
Q

what limitations can impact palpation of the precordium & locating the PMI?

A

body habitus
• Thickened chest wall
• Increased AP diameter
• Breast tissue

28
Q

what can percussion of the precordium be used for?

A
  • estimation of approx. heart borders & configuration
  • detecting heart enlargement
  • detection of dextrocardia or situs inversus
29
Q

if percussion of the precordium reveals dextrocardia, what does this indicate?

A

the position of the heart, specifically the apex, is pointed towards the right side of the chest instead of the left

30
Q

if percussion of the precordium reveals situs inversus, what does this indicate?

A

mirror-image transposition of internal organs ( very rare condition )
-heart will be on the right side

31
Q

what diagnostics have replaced percussion?

A

CXR

echo

32
Q

what type of sounds is the bell used to auscultate for in the precordium?

A

More sensitive for low-frequency sounds

33
Q

what type of sounds is the diaphragm used to auscultate for in the precordium?

A

Used for high-frequency sounds

34
Q

what organ is associated with the RIGHT 2nd ICS and what sound is heard upon auscultation?

A

aortic area - closure of the aortic valve

35
Q

what organ is associated with the LEFT 2nd ICS and what sound is heard upon auscultation?

A

Pulmonic area - closure of the pulmonic valve

36
Q

what organ is associated with the LEFT 4th ICS and what sound is heard upon auscultation?

A

tricuspid - closure of tricuspid valve

37
Q

what organ is associated with the LEFT 5th ICS and what sound is heard upon auscultation?

A

mitral - closure of mitral valve

38
Q

where is Erb’s point located on the precordium & what abnormality is it used to detect on auscultation?

A

LEFT 3rd ICS

aortic valve regurgitation

39
Q

what valves are involved in S1 and what part of the cardiac cycle is it associated with?

A
  • Closing of mitral and tricuspid valves

* Associated with the START of systole

40
Q

what valves are involved in S2 and what part of the cardiac cycle is it associated with?

A
  • Closing of aortic and pulmonary valves

* Associated with start of diastole

41
Q

where on the precordium would you auscultate for the base of the heart & what locations in the heart does it correlate to?

A

2nd ICS

-Correlates to location of aortic and pulmonic valves

42
Q

where on the precordium would you auscultate for the apex of the heart & what locations in the heart does it correlate to?

A

L 4th & L 5th ICS

-Correlates to the location of mitral and tricuspid valves

43
Q

what irregular rhythm involves a common variation of lub, dub in which HR increases on inspiration and decreases on expiration?

A

Sinus arrhythmia

44
Q

what irregular rhythm involves a “pattern” to beats outside of standard lub, dub?

A

Regularly irregular

45
Q

what irregular rhythm involves no pattern to the sounds in which beats come rapidly and at random
intervals?

A

irregularly irregular

46
Q

which part of the stethoscope is best for detecting high pitched sounds such as S1 & S2? what abnormalities can it detect?

A

diaphragm

  • S4
  • most murmurs
47
Q

which part of the stethoscope is best for detecting low pitched sounds such as S3? what abnormalities can it detect?

A

bell

-rumble of mitral stenosis

48
Q

where can you hear a split S2 heart sound and what does it indicate?

A

base of the heart -> 2nd ICS

-aortic and pulmonic valves do not close simultaneously

49
Q

what can cause a split S2 heart sound?

A

► Physiologic (related to inspiration)
► Right ventricle overload
► Delayed closure of pulmonary valve
► Delayed closure of aortic valve

Physical Diagnosis & Assessment (7 decks)

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