Module 2: Cardiovascular Exam Flashcards
What make up the atrioventricular (AV) valves & what is their purpose?
•Tricuspid
• mitral (bicuspid)
One way blood flow that separates atrium from the ventricles
What make up the semilunar valves & what is their purpose?
• pulmonic
• aortic
One way blood flow that separates pulmonary trunk& atrium
What is cardiac output & what factors affect this?
Volume of blood ejected from ventricles over 1 minute
Affected by:
• HR
• stroke volume
What is stroke volume & what does it depend on?
The amount (volume) of blood ejected w/ each heartbeat influenced by:
•Preload
• myocardial contractility
• after load
What is pre-load & at what part of the cardiac cycle does it occur?
Amount of blood in ventricles at the end of diastole
What are some factors that increase pre-load?
Any increased venous return to the heart such as:
• inspiration
• exercise
• dilated right ventricle in heart failure
What are some factors that decrease pre-load?
Any decreased venous return to the heart such as:
• exhalation
• Decreased ventricular output
• pooling of blood in the periphery: capillary bed or venous system
How does inspiration increase pre-load in the ventricles?
Decreased thoracic pressure allows more blood back to the heart
How is myocardial contractility increased & what are some examples?
Stimulation by sympathetic nervous system
- fight or flight
> organs are mobilized & their functions during stress and arousal
Ex) exercise, stress, fear
What happens when there is decreased contractility and what can influence this?
Blood Flow or O2 delivery to myocardium is impaired
^ age = decreased elasticity of muscles
What is after-load & what happens when there is an increase in after-load?
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
What factors resist contractility of the heart & increase after-load in the ventricles?
Tone in walls of aorta
Tone in large arteries (ex: subclavian steal)
Volume of blood in aorta
What factors influence Ventricular function of the heart & how can this be detected on physical exam?
• volume overload
• pressure overload
PE: change in palpable pulses & heart sounds
What happens when there is a pathological increase in pre-load?
Ventricular dilitation → volume overload
What happens when there is a pathological increase in after -load?
Stiffness in blood vessels making it hard to pump blood out of ventricles → atherosclerosis
What is being evaluated on inspection of the precordium?
- evidence of trauma
- bony abnormalities
- Skin abnormalities
- Vascular congestion
- visible lifts or heaves
on inspection of the precordium, patient’s chest wall extrudes & looks like a pigeon. what is this bony abnormality called?
pectus carinatum.
on inspection of the precordium, patient’s chest wall has an inward depression & looks like a funnel. what is this bony abnormality called?
pectus excavatum
how/where would you palpate the precordium for lifts/heaves & what do they feel like? what can they indicate?
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
how would you palpate the precordium for thrills & what do they feel like? what can they indicate?
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
what is the PMI and where is it located in healthy patients?
Point of maximal impulse
Felt at the apex of the heart- inferior tip of heart/left lateral border
L 5th ICS MCL
what ventricle makes up majority of the anterior cardiac surface?
right ventricle
what ventricle makes up the left lateral border of the heart? what is it used to locate?
left ventricle
-PMI
what abnormalities can lateral displacement of the PMI indicate?
LVH
ventricular dilatation
thoracic deformities
what abnormalities can medial displacement of the PMI indicate?
RVH
what abnormalities can upward displacement of the PMI indicate?
pregnancy
high left hemi-diaphragm (5th -> R or L 4th ICS)
what limitations can impact palpation of the precordium & locating the PMI?
body habitus
• Thickened chest wall
• Increased AP diameter
• Breast tissue
what can percussion of the precordium be used for?
- estimation of approx. heart borders & configuration
- detecting heart enlargement
- detection of dextrocardia or situs inversus
if percussion of the precordium reveals dextrocardia, what does this indicate?
the position of the heart, specifically the apex, is pointed towards the right side of the chest instead of the left
if percussion of the precordium reveals situs inversus, what does this indicate?
mirror-image transposition of internal organs ( very rare condition )
-heart will be on the right side
what diagnostics have replaced percussion?
CXR
echo
what type of sounds is the bell used to auscultate for in the precordium?
More sensitive for low-frequency sounds
what type of sounds is the diaphragm used to auscultate for in the precordium?
Used for high-frequency sounds
what organ is associated with the RIGHT 2nd ICS and what sound is heard upon auscultation?
aortic area - closure of the aortic valve
what organ is associated with the LEFT 2nd ICS and what sound is heard upon auscultation?
Pulmonic area - closure of the pulmonic valve
what organ is associated with the LEFT 4th ICS and what sound is heard upon auscultation?
tricuspid - closure of tricuspid valve
what organ is associated with the LEFT 5th ICS and what sound is heard upon auscultation?
mitral - closure of mitral valve
where is Erb’s point located on the precordium & what abnormality is it used to detect on auscultation?
LEFT 3rd ICS
aortic valve regurgitation
what valves are involved in S1 and what part of the cardiac cycle is it associated with?
- Closing of mitral and tricuspid valves
* Associated with the START of systole
what valves are involved in S2 and what part of the cardiac cycle is it associated with?
- Closing of aortic and pulmonary valves
* Associated with start of diastole
where on the precordium would you auscultate for the base of the heart & what locations in the heart does it correlate to?
2nd ICS
-Correlates to location of aortic and pulmonic valves
where on the precordium would you auscultate for the apex of the heart & what locations in the heart does it correlate to?
L 4th & L 5th ICS
-Correlates to the location of mitral and tricuspid valves
what irregular rhythm involves a common variation of lub, dub in which HR increases on inspiration and decreases on expiration?
Sinus arrhythmia
what irregular rhythm involves a “pattern” to beats outside of standard lub, dub?
Regularly irregular
what irregular rhythm involves no pattern to the sounds in which beats come rapidly and at random
intervals?
irregularly irregular
which part of the stethoscope is best for detecting high pitched sounds such as S1 & S2? what abnormalities can it detect?
diaphragm
- S4
- most murmurs
which part of the stethoscope is best for detecting low pitched sounds such as S3? what abnormalities can it detect?
bell
-rumble of mitral stenosis
where can you hear a split S2 heart sound and what does it indicate?
base of the heart -> 2nd ICS
-aortic and pulmonic valves do not close simultaneously
what can cause a split S2 heart sound?
► Physiologic (related to inspiration)
► Right ventricle overload
► Delayed closure of pulmonary valve
► Delayed closure of aortic valve
