Normal Cardiovascular Exam Competency

Question 1

Differentiate what types of sounds will require the Bell vs. the Diaphragm of the Stethescope.

Answer 1

Diaphragm: HIGH pitched Sounds (i.e. S1, S2, Aortic Regurg., Mitral Regurg., Friction Rubs)

BELLS: LOW pitched sounds (i.e. S3, S4, Mitral Stenosis, carotid bruit)

Question 2

List correct order of steps to a Cardiovascular Exam.

Answer 2

IPPA

Inspection - Palpation - Percussion - Auscultation

Question 3

Barrel Chested might suggest what type of Pathology?

Answer 3

COPD

Question 4

Where can you normally palpate the Point of Maximal Impulse (PMI)?

Answer 4

4th - 5th Intercostal Space in the MID-CLAVICULAR line

• Used to estimate location of apex/left border
• Impulse should be a small, brisk beat and measure less than 2.5 cm

Question 5

How would you percuss the size of the heart?

Answer 5

Start far LEFT where RESONANT and move medially to find Cardiac DULLNESS

Question 6

Differentiate between Systole and Diastole.

Answer 6

Systole: Ventricles are CONTRACTING and EJECTING

Diastole: Ventricle Relaxation and Filling

Question 7

Where do you auscultate to listen to the different valves in the heart?

Answer 7

“All Physicians Take Money”

Aortic Valve: R 2nd IC space @ Sternal Border

Pulmonic Valve: L 2nd IC space @ Sternal Border

Tricupsid Valve: L 4th IC space @ Sternal Border

Mitral Valve: L 5th IC space @ MID-CLAVICULAR line

Question 8

Describe the different heart sounds.

Answer 8

S1: Closure of the Tricuspid and Mitral Valves

S2: Closure of Aortic and Pulmonic Valves (May SPLIT with INSPIRATION)

S3: Use BELL, “Kent-Tuck-Y”; Right AFTER S2

S4: Use BELL, “Ten-Nes-See”; Before S1

Question 9

Describe the different grades of Heart Murmurs.

Answer 9

Systolic Murmurs: Fall Between S1 and S2
Diastolic Murmurs: Between S2 and S1

• Grade 1: Very Faint
• Grade 2: Quiet, but heard easily with Stethescope
• Grade 3: Moderately Loud, NO THRILL
• Grade 4: Loud with Palpable THRILL
• Grade 5: Very loud with thrill
• Grade 6: Heard with Stethoscope entirely OFF CHEST

Question 10

Why do you only assess one Carotid pulse at a time?

Answer 10

Pressure on the carotid baroreceptors may cause a hypotensive reflex and possible fainting

Question 11

Describe the Grading Scale for Peripheral Pulses.

Answer 11

0: Absent, not palpable
\+1: Diminished, barely palpable
\+2: Average Intensity, expected, NORMAL
\+3: Strong, Full, Increased
\+4: Bounding

Question 12

What is a normal capillary refill time?

Answer 12

2 Seconds or Less

Question 13

Describe the grading scale for Edema.

Answer 13

0: Absent
+1: Barely detectable, slight pitting (2 mm); disappears rapidly
+2: Slight indentation (4 mm); 10-15 seconds
+3: Deeper indentation (6 mm); may be > 1 minute
+4: Very marked indentation (8 mm); 2-5 minutes

Question 14

Where do you examine for edema?

Answer 14

1. Dorsum of foot
2. Anterior Tibia
3. Behind Medial Malleolus

• Press firmly for 5 seconds

Question 15

What is the pneumonic for remember what type of Murmur is caused in the heart?

Answer 15

Dem ARMS PITS

Diastolic: Aortic Regurgitation, Mitral Stenosis, Pulmonary Insufficiency (Same as Regurgitation), and Tricuspid Stenosis

SYSTOLIC murmurs are going to be the OPPOSITE!