Normal Heart and Cardiovascular Exam

Question 1

• Steps to cardiovascular exam

Answer 1

• Inspection
• Palpation
• Percussion
• Ascultation

Question 2

• Where is the PMI (Point of Maximal Impulse) or Apical Impulse Located?

Answer 2

• Upright person; 5th ICS 1 cm medial to MCL
• Normal: 4th-5th intercostal space at MCL

MCL=Mid-clavicular line

Question 3

What should you use to estimate cardiac size when the PMI is not detectable?

How do you do this?

Answer 3

• Percuss from far left and move medially until you find cardiac “dullness”

Question 4

• 4 Positions for Heart Auscultation

Answer 4

• Aortic: Right 2nd intercostal space at sternal border
• Pulmonary: Left 2nd intercostal space at sternal border
• Tricuspid: 4th intercostal space at sternal border
• Mitral: 5th intercostal space at mid clavicular line
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Question 5

• When are systolic murmurs heard

Answer 5

Between S1 and S2

Question 6

• When are diastolic murmurs heard?

Answer 6

• Between S2 and S1

Question 7

Grade 1 murmur

Grade 2 murmur

Grade 3 murmur

Grade 4 murmur

Grade 5 murmur

Grade 6 murmur

Answer 7

Very faint

Quiet, but heard easy with steth

Moderately loud, no thrill

Loud with palpable thrill

Very loud with steth off chest

Heard with steth off chest

Question 8

Use _ of stethoscope to listen for bruits on carotids

Answer 8

• Bell

Question 9

• What heart sound splits with inspiration?

Answer 9

S1

Question 10

• Which heart sounds are best heard with the diaphragm of the stethescope?

Answer 10

• S1
• S2
• High pitched sounds
• Aortic and mitral regurgitation
• Friction rubs

Question 11

• What sounds are best heard using the bell of the stethoscope?

Answer 11

• S3 and S4
• Mitral stenosis
• Carotid bruits
• Low pitched sounds

Question 12

• How do you perform the Allen Test?
• What is it used for?

Answer 12

• Occlude radial and ulnar arteries while patient makes a closed fist
• Have patient open and close fist
• Release pressure on ulnar artery and wiat for color to return (should take 5-10 sec)
• Repeat with radial artery
• Used to test blood supply to hand

Question 13

• What are the palpable pulses?

Answer 13

• Carotid
• Brachial
• Radial
• Femoral
• Popliteal
• Posterior Tibial
• Dorsalis Pedis

Question 14

• How do you rate edema on 4 point scale

Answer 14

• 0=absent
• 1+=barely detectable (2mm), nonpitting
• 2+=slight indentation (4mm), 10-15 sec
• 3+=Deeper Indentation (6 mm); can be > 1 min
• 4+=Very marked indentatino (8mm); 2-5 min

Question 15

• What is a normal RAP?
• What is a normal RVP?

Answer 15

• 0-8 mm Hg
• 25/6 mm Hg

Question 16

• What is hepatojugular reflux?

Answer 16

• Distension of neck veins when liver is pressed on

Question 17

• What causes hepatojugular reflux?

Answer 17

• Poorly compliant RV
• Right ventricular failure
• Constrictive pericarditis
• Obstrutctive RV filling by tricuspid stenosis or right atrial tumor

Question 18

• Level of JVP visibility gives an indication of _ pressure and _ pressure
• _ jugular is a better estimate

Answer 18

• Right atrial
• Central venous
• Internal

Question 19

• How do you measure JVP?

Answer 19

• Place pt in supine position then raise 30-45 deg
• Normal is 0-9 (3 cm from sternal notch, _+5 cm from RV to sternal notch)
• If elevated, most commonly indicative of elevated RV diastolic pressure

Question 20

• How do you evaluate pulses?

Answer 20

• 0=absent
• +1/4= Barely palpable
• +2/4= Normal intensity
• +3/4=Strong, full, increased
• +4/4=Bounding