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PCM Exam 2 > Normal Heart/CV Exam > Flashcards

Normal Heart/CV Exam Flashcards

1
Q

Normal Heart

-5 finger method?

A
  • History
  • Physical
  • ECG
  • X-ray
  • Lab tests
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2
Q

Physical

-6 components?

A

Inspection, jugular venous pressure (JVP), precordial palpation, percussion, auscultation-heart sounds, and grading system of murmurs

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3
Q

History

A

Fatigue, dyspnea, chest pain, palpations, syncope-non-specific

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4
Q

History

-Components of a complete cardiac diagnosis include consideration of?

A
  • Underlying etiology-hypertensive, ischemic, congenital, infections
  • Anatomic abnormalities
  • The physiologic disturbance-presence of an arrhythmia or CHF?
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5
Q

History

-Anatomic abnormalities-questions to find the answer to?

A
  • Which chamber is involved?
  • Which valve is affected?
  • Is pericardium involved?
  • Has there been an MI?
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6
Q

Family history-familial clustering

A

Familial clustering is common in patients with certain heart diseases-i.e. hypertrophic cardiomyopathy, marfan’s syndrome, prolonged QT syndrome

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7
Q

Physical-Common error when assessing cardiac function?

A

It is a common error to listen to the heart first

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8
Q

Physical

-Follow the proper sequence?

A

-Inspection, palpation, percussion, auscultation

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9
Q

Inspection

-3 components?

A
  • Shape-barrel-chested, pectus carinatum or excavatum
  • Landmarks
  • Scars/signs of trauma
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10
Q

Inspection

  • Barrel chested
    • Increased?
    • Indicative of?
A
  • Increased AP diameter

- Indicative of COPD

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11
Q

Inspection

-Pectus carinatum

A
  • Pigeon chest

- Central protrusion

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12
Q

Inspection

-Pectus excavatum

A
  • Funnel chest

- Central depression

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13
Q

Landmarks-review slide 14

A

slide 14

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14
Q

Principles of physical exam

-Inspection

A
  • Precordium
  • Scars, pacemaker, skeletal abnormalities
  • Apex-5th ICS, left, 1 cm medial to MCL
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15
Q

Principles of physical exam

-Palpation?

A
  • Apex beat; gently lifts palpating fingers

- Thrills

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16
Q

Palpation

-Thrills?

A

Turbulent blood flow causing murmurs

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17
Q

Principles of physical exam

-Percussion?

A

-Estimate cardiac size: start far left (resonance) and move medially to find cardiac dullness

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18
Q

Principles of physical exam

-Auscultation-S1?

A
  • Mitral and tricuspid closure

- Beginning of ventricular systole

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19
Q

Principles of physical exam

-Auscultation-S2?

A
  • Aortic and pulmonic closure

- Marks end of systole, beginning of diastole

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20
Q

Palpation and percussion

  • Point of maximal impulse (PMI) or apical impulse
    - Position?
    - Normally found where?
A
  • Supine or left lateral decubitus

- Normal-4th-5th intercostal space at the mid-clavicular line

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21
Q

Percussion

- Used in order to?
- How do you do it?
A
  • Used in order to estimate cardiac size when PMI not detectable
  • Start far left (“resonance”) and move medially to find cardiac dullness
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22
Q

Jugular Venous Pressure

  • Jugular veins reflect?
  • Level of JVP visibility gives an indication of?
  • Which is better-External or internal jugular?
A
  • Jugular veins reflect the activity of the right side of the heart
  • Level of JVP visibility gives an indication of the RAP
  • Internal jugular is better than external jugular
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23
Q
  • How do you obtain the JVP?
  • Normal JVP range?
  • Estimate of?
A
  • Place patient in supine position to allow veins to engorge, then raise to 30-45 degrees
  • Normal JVP is 0-9
  • Estimate of CVP
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24
Q

Most common cause of an elevated JVP?

A

Elevated RV diastolic pressure

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25
Q

A wave

-What is going on when you see this wave?

A
  • R atrial contraction
  • TV open
  • Coincides with S1
  • Precedes carotid pulsation
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26
Q

Giant A wave seen in?

A
  • Obstruction between RA and RV (T.S., right atrial myxoma)
  • Increased pressure in RV (P.S.?)
  • Pulmonary hypertension
  • Recurrent pulmonary emboli
  • A-V dissociation (complete heart block, V.T.) (cannon A waves) RA contracts against the closed TV
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27
Q

C Wave

-What is going on when you see this wave?

A

Backward push by closure of TV during isovolumetric systole and by impact of carotid artery adjacent to the JV

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28
Q

X wave- X slope

  • What is going on when you see this wave?
  • Steep X descent seen in?
A
  • Passive atrial filling and atrial relaxation
  • Blood flows into the RA from the cava and closure of TV
  • Steep X descent in cardiac tamponade and constrictive pericariditis
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29
Q

V wave

  • What is going on when you see this wave?
  • Prominent V wave in?
A
  • Atrial filling
    • Increasing volume and pressure in RA when TV closed
    • Prominent V wave in TR and pulmonary hypertension
30
Q

Y slope or Y descent

- What is going on when you see this wave?
- Deep Y descent in?
- A slow Y descent suggests?
A
  • Open TV and rapid RV filling in RV diastole
  • Deep Y descent in severe TR
  • A slow Y descent suggests obstruction to RV filling (i.e. TS or RA myxoma)
31
Q

Increased JVP in?

A
  • SVC obstruction
  • Severe heart failure
  • Constrictive pericariditis, cardiac tamponade, RV infarction
  • Restrictive cardiomyopathy
32
Q

Positive HJR in?

A
  • Poorly compliant RV, RV failure
  • Constrictive pericarditis
  • Obstructive RV filling by TS or RA tumor
33
Q

Cardiac cycle

-Systole?

A

Ventricular contraction, ejection

34
Q

Cardiac cycle

-diastole?

A

Ventricular relaxation, filling

35
Q

Abnormal heart sounds

  • S3
    • Due to?
A

-Due to high pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase

36
Q

Abnormal heart sounds

  • S3
    • Physiologic (normal) in?
A

Children or young adults

37
Q

Abnormal heart sounds

  • S3
    • Pathologic in?
A

People over 40 years old

38
Q

Abnormal heart sounds

  • S3
    • What does the rhythm sound like?
A

Ken-Tuck-Y

39
Q

Abnormal heart sounds

  • S4
    • What is it?
A

-Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle

40
Q

Abnormal heart sounds

  • S4
    • Can be normal in?
A

Trained athletes

41
Q

Abnormal heart sounds

  • S4
    • What does the rhythm sound like?
A

Ten-Nes-See

42
Q

S1

-2 components?

A

MV and TV closure

43
Q

S1

-When does it occur relative to the cardiac cycle?

A

Occurs at the beginning of systole

44
Q

S1

-At which part of the heart is it loudest?

A

Apex of the heart

45
Q

S2

-1st component?

A

Aortic valve closure

46
Q

S2

-2nd component?

A

-Pulmonic valve closure

47
Q

S2

-At which part of the heart is it loudest?

A

-Loudest at the base of the heart

48
Q

S2

-When does it occur relative to the cardiac cycle?

A

Occurs at the end of systole

49
Q

Slide 31?

50
Q

Heart sounds-location

-mitral?

A
  • Apex of heart

- 5th left ICS at mid-clavicular line

51
Q

Heart sounds-location

-tricuspid?

A

-4th left ICS at LSB

52
Q

Heart sounds-location

-Aortic valve?

A

2nd ICS to the right of the sternum

53
Q

Heart sounds-location

-pulmonary valve?

A

2nd ICS to the left of the sternum

54
Q

Murmurs grading system

-Grade 1

A

Barely audible

55
Q

Murmurs grading system

-Grade 2?

A

Soft but easily heard

56
Q

Murmurs grading system

-Grade 3?

A

Loud without a thrill

57
Q

Murmurs grading system

-Grade 4?

A

Loud with a thrill

58
Q

Murmurs grading system

-Grade 5?

A

Loud with minimal contact between stethoscope and chest-thrill

59
Q

Murmurs grading system

-Grade 6?

A

Loud can be heard without a stethoscope-thrill

60
Q

Palpation of peripheral arteries (Rate-Rhythm-Amplitude)

-Grading peripheral pulses-scale?

A 
0-4/4 Bil.
0-absent
1-barely palpable
2-average intensity
3-strong
4-bounding
61
Q

Should probably know the upper and lower palpable pulses

A

Slides 36-39

62
Q

Capillary refill time

-Used to assess?

A

Digital perfusion

63
Q

Capillary refill time

-How do you do it?

A
  • Patient’s hands at heart level
  • Palms down
  • Doc presses on nail bed until it turns pale then lets go
64
Q

Capillary refill time

  • Normal?
  • Should also check?
A
  • Less than 2 seconds

- Should also check skin color and turgor

65
Q

Edema-3 places to examine?

A

dorsum of foot, behind medial malleolus, anterior tibia (shin)

66
Q

Stethoscope

-Bell (small part)-used to hear what types of sounds?

A

Low pitched sounds (S3, S4, MS, carotid bruit)

67
Q

Stethoscope

-Diaphragm (large part)-used to hear what types of sounds?

A

High pitched sounds (S1, S2, AR, MR, friction rubs)

68
Q

Normal characteristics of the PMI?

A
  • Should be a small, brisk beat and measure less than 2.5 cm
  • Should last through the first 2/3 of the systolic period (or less)
  • It should not be felt through the second heart sound
69
Q

Systolic murmurs fall between which heart sounds?

70
Q

Diastolic murmurs fall between which heart sounds?

71
Q

Assessment of carotid pulse

  • Where do you feel for this?
  • Assess for?
  • What should you not do?
A
  • Medial to the SCM
  • Assess for thrills and bruits
  • DO NOT assess both carotid pulses simultaneously (could cause the patient to faint)
72
Q

Edema

-Graded on 4 point scale

A 
0-absent
1-barely detectable, slight or non-pitting-2mm
2-slight indentation-4mm
3-deeper indentation-6mm
4-very marked indentation-pitting-8mm

PCM Exam 2 (3 decks)

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