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PCM 1 Final > Normal Heart and Cardiovascular Exam > Flashcards

Normal Heart and Cardiovascular Exam Flashcards

1
Q

What is the five finger method?

A 
History
Physical
ECG
Imaging
Lab
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2
Q

What symptoms indicate that you should do a cardiac exam?

A

fatigue, dyspnea, chest pain, palpitations, syncope - non specific

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3
Q

What may be listed in family history indicating that you should do a cardiac exam?

A
  • hypertrophic cardiomyopathy
  • Marfan’s syndrome
  • prolonged QT syndrome
  • CAD
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4
Q

In what order should a cardiac exam be done?

A
  • inspection
  • palpation
  • percussion
  • auscultation
  • grading of murmurs
  • JVP
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5
Q

What should you look for during inspection during a cardiac exam?

A 
general appearance, chest shape, landmarks, scars and signs of trauma
• Face – acromegalic, cushnoid, Down’s Syndrome, hyperthyroid, hypothyroid
• Neck - JVD
• Skin - jaundice, cyanosis, pallor
• Body/chest wall shape
• Breathing – fast or slow, labored or not
• Extremities
– Edema?
– Nails
– Clubbing? Hemorrhages?
• Position of patient
• Overall Appearance
– Distress or not
• Body Habitus
• Hydration
• Vitals
– temperature, HR, RR, BP, pulse oximetry
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6
Q

What do you palpate for in a cardiac exam?

A

point of maximal intensity

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7
Q

What is Grave’s disease associated with for a cardiac exam?

A

tachycardia and palpitations

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8
Q

What are Osler’s nodes, Janeway lesions, and splinter hemorrhages indicative of?

A

Endocarditis

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9
Q

Pale skin indicates ___ hemoglobin. Pale conjuctiva indicates a hemoglobin of ____.

A

low;

8 or less

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10
Q

Cyanosis is a sign of ____

A

cystic fibrosis or congenital heart problem

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11
Q

What does clubbing indicate?

A

chronic hypoxia

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12
Q

What are the chest shapes?

A
  • barrel chested
  • pectus carinatum
  • pectus excavatum
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13
Q

What do barrel chested people normally have?

A

COPD

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14
Q

What is the ratio of a normal chest?

A

1:2

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15
Q

What is the ratio for barrel chest?

A

1:1

increased AP diameter

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16
Q

What is pectus carinatum?

A

pigeon chest

central protrusion

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17
Q

What is pectus excavatum?

A

funnel chest

central depression

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18
Q

What is the midclavicular line important for?

A

pneumothorax thoracentesis at the 2nd rib on top (neurovascular bundle runs underneath)

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19
Q

Where do you put in a chest tube?

A

anterior axillary line 4-5th ICS

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20
Q

Where is the apex beat/PMI palpated when the pt is sitting?

A

mid clavicular line left 5th ICS 1 cm medial

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21
Q

Where is the apex beat/PMI when pt is supine?

A

supine at 45 degrees at 4-5th ICS at mid clavicular line

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22
Q

What are thrills?

A

turbulent blood flow causing murmurs. A murmur you feel.

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23
Q

When do you percuss in a cardiac exam?

A

when PMI is not detectable.

Start far left “resonance” and move medially to “dullness”

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24
Q

How do you check for bruits in the carotids?

A

have pt hold breath and place stethoscope over carotid

25
What does S1 mark? | Where is it loudest?
beginning of ventricular systole mitral and tricuspid closure loudest at apex
26
What does S2 mark? | Where is it loudest?
end of systole, beginning of diastole aortic and pulmonic closure loudest toward the base
27
Which valve closes first: tricuspid or mitral?
Mitral valve THEN tricuspid valve
28
Which valve closes first: aortic or pulmonary?
AORTIC then PULMONARY
29
What is physiologic splitting of S2?
occurs during inspiration because increased venous return during inspiration and more time for RV to deliver blood to the lung
30
What causes S3? What does it sound like? Who is it physiologic in? Pathologic?
due to high pressures and abrupt deceleration of inflow across the MITRAL valve at end of rapid filling phase "ken-tuck-y" physiologic: children/young adults pathologic: >40 yo
31
What causes S4? What does it sound like? Who is it physiologic in? Pathologic?
atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle "ten-nes-see" normal in trained athletes pathologic: everyone else
32
What side of the heart do jugular veins reflect?
right pressure indicating a "bad pump" = heart failure
33
What does the level of JVP visibility indicate?
CVP and RAP
34
Which is a better estimate: internal jugular or external jugular?
internal jugular (IJ)
35
How do you measure JVP? What is normal? What is the most common cause of elevated JVP?
Pt supine to allow veins to engorge, then raise to 30-45 degrees. Measure from RV to sternal notch + height from sternal notch. Normal JVP is 0-9. Most common cause of elevated JVP is elevated RV diastolic pressure.
36
What are the normal venous waves?
a, c, v
37
What are the normal venous descents?
x, y
38
What is the a wave?
atrium contracting and tricuspid valve open
39
What is the x descent?
atrium relaxing then filling, tricuspid closed
40
What is the v wave?
atrium tense, full; tricuspid closed
41
What is the y descent?
atrium emptying, tricuspid open
42
What are the differences between veins and arteries?
veins: diffuse, biphasic, varies with position, height falls on inspiration, non-palpable, can be occluded arteries: single, sharp waveform, no variation with position, no respiration variation, palpable not compressible
43
What causes increased JVP/JVD?
- SVC obstruction - severe heart failure - constrictive pericarditis - cardiac tamponade - RV infarction - restrictive cardiomyopathy
44
What causes hepatojugular reflux (HJR)? pushing on liver and JVD elevates. stays elevated when released.
- poorly compliant RV, RV failure - constrictive pericarditis - obstructive RV filling by TS or RA tumor
45
Documenting pulses:
0 absent 2 average 4 bounding
46
What is normal capillary refill time?
<2s
47
Where do you check for edema?
dorsum of foot, behind medial malleolus, anterior tibia
48
How do you grade 2 mm edema non pitting?
1+
49
What is 2+ edema?
4 mm 10-15 seconds
50
What is 3+ edema?
6 mm >1 min
51
What is 4+ edema?
very marked indention 8 mm 2-5 min
52
What is normal right atrial pressure (RAP)?
0-8 mm Hg
53
What is normal right ventricle pressure (RV)?
25/6 mm Hg
54
What is normal pulmonary artery pressure (PAP)?
systolic 15-30 mm Hg diastolic 5-12 mm Hg mean 10-20 mm Hg
55
What is the normal pulmonary capillary wedge pressure?
8-15 mm Hg
56
What is normal cardiac output?
3.5-7 liters/min
57
What is normal cardiac index (CI)?
2.5-4 liter/min^2
58
What is normal systolic vascular resistance (SVR)?
900-1500 dynes/s/cm
59
What is normal pulmonary vascular resistance (PVR)?
155-255 dynes/s/cm

PCM 1 Final (6 decks)

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