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PCM II Midterm > Normal Heart and CV Exam > Flashcards

Normal Heart and CV Exam Flashcards

1
Q

5 finger method

A

1) history
2) physical
3) eck
4) Xray
5) lab tests

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2
Q

Physical

A
  • inspection
  • JVP
  • precordial palpation
  • percussion
  • auscultation-heart sounds
  • grading system of murmurs
  • ecg
  • x rays
  • lab tests
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3
Q

Proper physical exam sequence

A

1) inspection
2) palpation
3) percussion
4) auscultation
- quiet rooms
- listen on bare skin
- sitting, supine, left lateral decubitus, leaning forward, standing

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4
Q

S1

A
  • mitral and tricuspid closure

- beginning of ventricular systole

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5
Q

S2

A
  • aortic and pulmonic closure

- marks end of systole, beginning of diastolic

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6
Q

Palpation and Percussion

A
  • point of max impulse: 4th and 5th intercostal space at mid clavicular line
  • estimate cardiac size when PMI not detectable
  • start far left and move medial to find cardiac dullness
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7
Q

JVP

A
  • reflects activity of right side of the heart
  • level of JVP visibility gives an indication of the right atrial pressure
  • internal jugular is better than external jugular
  • normal JVP: 0-9cm
  • most common cause of an elevated JVP is an elevated right ventricle diastolic pressure
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8
Q

A Wave

A
  • right atrial contraction
  • tricuspid open
  • coincides with S1
  • precedes carotid pulsation
  • giant wave seen in: obstruction between RA and RV, increased pressure in RV, pulmonary hypertension, recurrent pulmonary emboli, A-V dissociation (complete heart block)
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9
Q

C Wave

A

-backward push by closure of tricuspid during isovolumetric systole and by impact of carotid artery adjacent to the jugular vein

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10
Q

X wave

A
  • passive atrial filling and atrial relaxation
  • blood flows into the right atrium from the cava and closure of tricuspid
  • steep X descent in cardiac tamponade and constrictive pericarditis
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11
Q

V wave

A
  • atrial filling
  • increasing volume and pressure in RA when tricuspid is closed
  • prominent V wave in TR and pulm hypertension
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12
Q

Y slope

A
  • open tricuspid and rapid right ventricle filling

- deep Y in severe TR a slow Y descent suggests obstruction to RV filling

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13
Q

Increased JVP

A
  • SVC obstruction
  • severe heart failure
  • constrictive pericarditis
  • cardiac tamponade
  • RV infarction
  • restrictive cariomyopathy
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14
Q

Positive HJR (hepatojugular reflux)

A
  • poorly compliant RV (RV failure)
  • constrictive pericarditis
  • obstructive RV filling by TS or RA tumor
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15
Q

Systole

A

ventricular contraction, ejection

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16
Q

Diastole

A

ventricular relaxation, filling

17
Q

Normal Heart Sounds

A

S1- closing of mitral and tricuspid valves

S2- closing of aortic and pulmonary valves

18
Q

Abnormal Heart Sounds

A

S3- due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling stage (physiologic in children and young adults; pathologic in adults >40)
S4- atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle (can be normal in trained athletes)

19
Q

S1

A
  • mitral closure 1st component
  • tricuspid closure 2nd component
  • beginning of systole
  • loudest at apex
20
Q

S2

A
  • aortic valve closure 1st component
  • pulmonic valve closure 2nd component
  • loudest at the base
  • end of systole
21
Q

Normal inspiration and expiration

A 
Expiration = single sound for S1 and S2
Inspiration = splitting of S2 (increased venous return during inspiration and more time for RV to deliver blood to the lung)
22
Q

Heart Sound Locations

A

Mitral- apex of heart; 5th left intercostal space at mid clavicular line
Tricuspid- 4th left intercostal space
Aortic valve- 2nd intercostal space to the right of the sternum
Pulmonary valve- 2nd intercostal space left of the sternum

23
Q

Auscultation Listening Posts

A

Aortic- right 2nd intercostal space at sternal border
Pulmonary- left 2nd intercostal space at sternal border
Tricuspid- left 4th intercostal space at sternal border
Mitral- left 5th intercostal space at mid-clavicular line

24
Q

Murmur grading scale

A

1- barely audible
2- soft, but easily heard
3- loud, without a thrill
4- loud with a thrill
5- loud with minimal contact between stethoscope and chest
6- loud, can be heard without a stethoscope

25
Q

Documenting Pulse

A 
0 = absent
1 = barely palpable
2 = average
3 = strong
4 = bounding

R/R/A = rate, rhythm, amplitude

26
Q

Edema

A
  • dorsum of foot
  • behind medial malleolus
  • anterior tibia
27
Q

Edema grading scale

A

0 absent
1+ barely detectable, nonpitting (2mm)
2+ slight indentation (4mm); 10-15 seconds
3+ deeper indentation (6mm); can be >1 minute
4+ very marked indentation (8mm); 2-5 min

28
Q

Right Atrial Pressure

A

0-8 mmHg

29
Q

RV pressure

A

25/6 mmHg

30
Q

Pulmonary Artery Pressure

A

Syst 15-30 mmHg
Diastolic 5-12 mmHg
Mean 10-20 mmHg

31
Q

Pulm Capillary Wedge pressure

A

8-15 mmHg

32
Q

Cardiac Output

A

3.5-7 liters/min

33
Q

Cardiac index (CO/BSA)

A

2.5-4 liters/min^2

34
Q

Systolic Vascular Resistance (SVR)

A

900-1500 dynes/sec/cm

35
Q

Pulm Vascular Resistance (PVR)

A

155-255 dynes/sec/cm

PCM II Midterm (11 decks)

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