OSCE Heart Flashcards
pulse grading scale (0-4)
0
Absent, Not Palpable
1
Diminished, barely palpable
2
Expected
3
Full, increased
4
Bounding
what are the listening posts of the heart?
- Aortic Area: right upper sternal border, 2nd ICS
- Pulmonic Area: left upper sternal border, 2nd ICS
- Tricuspid Area: lower left sternal border, 3rd-5<strong>t</strong>h ICS
- Mitral Area: PMI, 5th ICS, @ mid-sternal line
normal and abnormal carotic pulse
NL: sharp knock
Abnormal: weak nudge, then slight pulsation or pulse
Alternating strong and weak pulses palpable at radial or femoral arteries
Pulsus alternans:
Pulse due to large stroke volume and backflow of blood from the aorta into LV; indicative of aortic regurgitation
water hammer pulse
how do you find water-hammer pulse?
- Palpate radial pulse while the patient lies on the exam table, applying pressure until pulse is obscured. Raise arm straight over patient’s head, perpendicular to the table, and palpate pulse for a sudden rise and collapse of radial pulse that feels “jumpy”
- Harsh quality
- RIGHT 2nd ICS/3rd ICS
- Radiates to suprasternal notch and carotids
- Delayed pulses (pulsus tardus et parvus
aortic stenosis
- Blowing quality, holosystolic
- Prominent at apex, radiates to LEFT axilla
- Loudness correlates with degree of valve insufficiency
mitral regurg
- Harsh, loud, ejection click
- LEFT 2nd ICS/3rd ICS
- Radiates to the LEFT shoulder
- Increases with ____
pulmonary stenosis
inspiration
- Blowing quality, increases with inspiration
- Holosystolic
- Lower LEFT sternal border
triscuspud insuff
- Blowing, decrescendo murmur
- LEFT 2nd ICS to the 4th ICS
- Auscultate with diaphragm
aortic regurg (diastolic murmr)
- Rumbling, low pitched
- Best heard at apex
- Auscultate with bell
mitral stenosis (diastolic
- Pulmonary Insufficiency (diastolic) sounds likes
blowing quality
-
Tricuspid Stenosis
- Increases in intensity with ____
- Decreases in intensity with _______
- Tricuspid Stenosis
- Increases in intensity with inspiration
- Decreases in intensity with expiration and valsalva
murmur grading
1/6
Very faint; not heard in all positions
No
2/6
Soft, but heard immediately after placing stethoscope on chest
No
3/6
Moderately loud
No
4/6
Loud, with palpable thrill
Yes
5/6
Very loud, with thrill. May be heard with stethoscope partly off chest
Yes
6/6
Very loud, with thrill. May be heard with stethoscope entirely off chest
Yes
In the left lateral decubitus position,
- a diffuse PMI with a diameter < 3cm signals ____________;
- a diameter of >4 cm makes __________ almost 5x more likely.
- left ventricular enlargement
- left ventricular overload
what can cause a hypekinetic high-amplitude impulse?
- hyperthyroidism
- severe anemia
- pressure overload of LV d/t HTN or aortic stenosis
- Volume overload of LV due to aortic regugr
what increases chances of hearting aortic regurg
sitt and lean forward
what increases chances of hearing mitral regurg
straining/valsalva
what increases chances of hearing mitral stenosis and extra heart sounds
left lateral recumabt
A hypovolemic or septic patient may have to________ before you see the neck veins.
In contrast, when there is volume overload, you may need to ______________________to locate the oscillation point.
- lie flat
- elevate the patient’s head to 60° or even 90°
elevated JVP is correlated with what?
- 1. acute and chronic HF
- 2. Triscupid stenosis
- 3. Chronic pulmary HTN
- 4. SVC
- 5. Cardiac tapon and constrictive pericaridits
In patients with obstructive lung disease, JVP can appear __________ on expiration, but the veins _________ on inspiration.
This finding does/does not indicate heart failure.
JVP: elevated on expiration
Veins: collapse on inspiration
does not
An elevated JVP is 95% specific for an _______________________, although its role as a predictor of hospitalization and death from heart failure is less clear.
- increased left ventricular end diastolic pressure
- low left ventricular EF
