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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
Q

What does S1 mark?

Where is it loudest?

A

beginning of ventricular systole
mitral and tricuspid closure
loudest at apex

26
Q

What does S2 mark?

Where is it loudest?

A

end of systole, beginning of diastole
aortic and pulmonic closure
loudest toward the base

27
Q

Which valve closes first: tricuspid or mitral?

A

Mitral valve THEN tricuspid valve

28
Q

Which valve closes first: aortic or pulmonary?

A

AORTIC then PULMONARY

29
Q

What is physiologic splitting of S2?

A

occurs during inspiration because increased venous return during inspiration and more time for RV to deliver blood to the lung

30
Q

What causes S3? What does it sound like? Who is it physiologic in? Pathologic?

A

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
Q

What causes S4? What does it sound like? Who is it physiologic in? Pathologic?

A

atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle
“ten-nes-see”
normal in trained athletes
pathologic: everyone else

32
Q

What side of the heart do jugular veins reflect?

A

right pressure indicating a “bad pump” = heart failure

33
Q

What does the level of JVP visibility indicate?

A

CVP and RAP

34
Q

Which is a better estimate: internal jugular or external jugular?

A

internal jugular (IJ)

35
Q

How do you measure JVP? What is normal? What is the most common cause of elevated JVP?

A

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
Q

What are the normal venous waves?

A

a, c, v

37
Q

What are the normal venous descents?

A

x, y

38
Q

What is the a wave?

A

atrium contracting and tricuspid valve open

39
Q

What is the x descent?

A

atrium relaxing then filling, tricuspid closed

40
Q

What is the v wave?

A

atrium tense, full; tricuspid closed

41
Q

What is the y descent?

A

atrium emptying, tricuspid open

42
Q

What are the differences between veins and arteries?

A

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
Q

What causes increased JVP/JVD?

A
  • SVC obstruction
  • severe heart failure
  • constrictive pericarditis
  • cardiac tamponade
  • RV infarction
  • restrictive cardiomyopathy
44
Q

What causes hepatojugular reflux (HJR)? pushing on liver and JVD elevates. stays elevated when released.

A
  • poorly compliant RV, RV failure
  • constrictive pericarditis
  • obstructive RV filling by TS or RA tumor
45
Q

Documenting pulses:

A

0 absent
2 average
4 bounding

46
Q

What is normal capillary refill time?

A

<2s

47
Q

Where do you check for edema?

A

dorsum of foot, behind medial malleolus, anterior tibia

48
Q

How do you grade 2 mm edema non pitting?

A

1+

49
Q

What is 2+ edema?

A

4 mm 10-15 seconds

50
Q

What is 3+ edema?

A

6 mm >1 min

51
Q

What is 4+ edema?

A

very marked indention 8 mm 2-5 min

52
Q

What is normal right atrial pressure (RAP)?

A

0-8 mm Hg

53
Q

What is normal right ventricle pressure (RV)?

A

25/6 mm Hg

54
Q

What is normal pulmonary artery pressure (PAP)?

A

systolic 15-30 mm Hg
diastolic 5-12 mm Hg
mean 10-20 mm Hg

55
Q

What is the normal pulmonary capillary wedge pressure?

A

8-15 mm Hg

56
Q

What is normal cardiac output?

A

3.5-7 liters/min

57
Q

What is normal cardiac index (CI)?

A

2.5-4 liter/min^2

58
Q

What is normal systolic vascular resistance (SVR)?

A

900-1500 dynes/s/cm

59
Q

What is normal pulmonary vascular resistance (PVR)?

A

155-255 dynes/s/cm

PCM 1 Final (6 decks)

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