Normal Heart Exam

Question 1

Standard positioning for the cardiac exam

Answer 1

The patient should be at a 30 degress angle lying down flat

Question 2

How do you check the carotid artery in a patient

Answer 2

You palpate and ascultate. When listening tell the patient to hold their breath

Question 3

How can exmining the carotid give an insight on heart deformaities

Answer 3

Aortic valve murmurs radiate to the carotids

Question 4

What do you feel when you palpate the carotid and the jugular

Answer 4

Carotid is an artery whereas jugular is a vein. When palpating an artery we feel the uptroke of the pressure whereas when palpating a vein we feel the downstroke of pressure. That’s all we need to know about the graphs of the vessels he showed us here

Question 5

What is observed when observing a vein like a jugular vein

Answer 5

Double dissent like in jugular vein pulsation

Question 6

Pitting edema scale, how does it correspond to in mm

Answer 6

1+, 2+, 3+ and 4+

2,4,6 and 8 cm

Question 7

Sustained precordial movements

Answer 7

Movements that happen after S2. This happens due to:

1. Aortic stenosis
2. Volume overload
3. Severe cardiomyopathy
4. Ventricular aneurysm

Question 8

Lub Dub sound

Answer 8

Question 9

Mitral regurgitation murmur, when does it happen

Answer 9

During systole, between S1 and S2, blood moves back into the left atrium

Question 10

When do you hear aortic stenosis murmur

Answer 10

Also during systole, since the aortic valve is calcified or something

Question 11

When do you hear aortic regurgitation

Answer 11

During diastole

Question 12

What does S3 mean

Answer 12

heart failure

Question 13

What causes S4

Answer 13

Long term hypertension

Question 14

What does S4 implies

Answer 14

Stiff heart, also common in long term athletes

Question 15

Which one are worse? Systolic or diastolic murmurs

Answer 15

Diastolic, none of the diastolic murmurs are benign, all of them are associated with disease whereas some of the systolic murmurs can be benign such as mild mitral valve regurgitation

Question 16

Aortic stenosis

Answer 16

1. Usully happens in older age due to calcification of the aortic valve
2. Common symptoms are shortness of breath and angina
3. It radiates to the carotids
4. It is slow and low, have croshenda decroshenda appearence (half diamond shaped)
5. Best heard in the Aortic area

Question 17

Mitral valve regurgitation

Answer 17

1. Lower pitched than aortic stenossi
2. Heard in systole
3. Heard best in mitral position

Question 18

Mitral stenosis

Answer 18

1. Happens in mid diastolic murmur
2. Low pitched

Question 19

Venous Hum

Answer 19

1. Continuous murmur, happens in systolic and diastolic
2. Associated with high flow state - high amount of blood flowing through the veins
3. Machine murmur

Question 20

Special Maneuvers

Answer 20

1. Hypertrophic Obstructive Cardiomyopathy Murmur (HOCM), make the patient move from a squatting position to standing position and the murmur gets louder, characteristic of HOCM - causes decrease in venous return
2. Increase in venous return by pressing on the abdomen or move from standing to squatting, the HOC murmur will get fainter