Part 1

Question 1

What is the typical patient profile for people who are heart patients?

Answer 1

overweight
middle aged or older
sedentary with little regular exercise
smoker or exposed to smoke
high strong
compulsive or hostile personality
poor stress coping skills
history of bad cholesterol
high BP, diabetes
previous heart or vessle problems

Question 2

what are some classic presentations of acute heart failure?

Answer 2

substernal chest pain
pressure radiating to the jaw, neck, arms, back, gastrointestinal discomfort
exertional dyspnea
pain, pressure and discomfort aggravated by physical or emotional stress, heavy meals or cold weather

Question 3

general observations of acute heart failure

Answer 3

pale
perspiring
apprehensive

Question 4

what are classic presentations of chronic right sided heart failure?

Answer 4

fatigue
dyspnea
ankle edema
jugular distention
ascites

Question 5

What are the classic presentations of chronic left sided heart failure?

Answer 5

fatigue
exertional dyspnea
cough
orthopnea
pink frothy sputum

Question 6

most common cause of right sided heart failure

Answer 6

high blood pressure

Question 7

what is a common atrial gallop in MI?

Answer 7

S4

Question 8

what is the number 1 cause of acute heart failure?

Answer 8

coronary artery disease

Question 9

what is the traditional cardiac physical assessment procedures in classic sequence?

Answer 9

inspection of precordium
palpation of precordium and peripheral pulses
percussion of the heart borders
auscultation of normal and abnormal heart sounds

Question 10

what do you look for when inspection?

Answer 10

pitting edema of the ankles
cyanosis
clubbing of fingers
apical impulse
engorgement and accentuated waves of the jugular veins
veins of the back of the hand don’t collapse when brought to heart level

Question 11

what do you do during palpation?

Answer 11

estimate heart size and placement, should only be felt in 5th left ICS, medial to midclavicular line
feel for precordial thrills
palpation of peripheral pulses are a logical extension of the cardiac exam

Question 12

what do you do during percussion?

Answer 12

percuss left and right heart borders moving lateral medial in iCS 5-2

Question 13

what are the traditional auscultation sites?

Answer 13

aortic- R2ICS
pulmonic- L2ICS
tricuspid- L3ICS
mitral- L5ICS just inside midclavicular line

Question 14

what are audible characteristics of heart sounds?

Answer 14

quality
pitch
intensity
duration
timing
location
respiratory variation
pattern
position

Question 15

describe the first heartbeat

Answer 15

S1/Lubb sound
mitral and tricuspid close
relatively longer and lower pitched than dup
loudest at mitral valve site
having patient in the left lateral recumbent position
lubb should be in sync with the apical and carotid impulse

Question 16

describe the second heartbeat

Answer 16

aortic and pulmonic close
shorter and higher than lubb
loudest at the aortic site
having patient sitting up and leaning forward

Question 17

what are the 4 types of unexpected heartbeats?

Answer 17

splits, gallops, clicks and snaps

Question 18

split S1

Answer 18

mitral and tricuspid valves aren’t closing together
heard best at tricuspid site following diastolic pause
may represent delayed tricuspid closure or RBBB

Question 19

physiologic S2 split

Answer 19

takes longer for the right heart to propel the extra blood to the lungs, which causes the pulmonic valve to close delayed
apparent in children and some adults

Question 20

paradoxical S2 split

Answer 20

aortic valve is pathologically delayed (LBBB)

on inspiration and expiration

Question 21

fixed S2 split

Answer 21

pulmonic valve delayed even more than usual (septal defect)

blood from left heart is shunted to the right heart, making it harder on the right heart

Question 22

ventricular gallop (third heartbeat)

Answer 22

early diastole
subtle, low pitched, early diastolic sound, heart best at apex with bell
implies acute or chronic heart failure in those over 40
may be functional in children, teens, young adults, late-stage pregnancy

Question 23

atrial gallop (presysteolic gallop, or 4th heartbeat)

Answer 23

late diastole
implies acute or chronic heart failure in people 40 years old
also in functional, well conditioned athletes

Question 24

how is an added early diastolic beat produced? (opening snaps of the mitral and tricuspid valves)

Answer 24

strep throat and scarlet fever

cadence is like a fixed S2 split

Question 25

ejection clicks of the aortic and pulmonic valve

Answer 25

like split S1 | higher pitched than atrial gallop

Question 26

murmur

Answer 26

abnormal heart sounds due to turbulent blood flow, usually due to faulty valves or septal defects

Question 27

what are the characteristics of murmurs?

Answer 27

quality- often a blowing or rumbling sound usually due to valve problems sometimes by septal defects or increased velocity or viscosity of blood better heard with diaphragm intensity can be faint, or loud

Question 28

grade I murmur

Answer 28

faint in a quiet room

Question 29

grade II murmur

Answer 29

quiet, but clearly audible

Question 30

grade III murmur

Answer 30

moderately loud (same intensity as S1 and S2)

Question 31

grade IV murmur

Answer 31

loud with a thrill

Question 32

grade V murmur

Answer 32

loud with a thrill with only the edge of the stethoscope touching the patient

Question 33

grade VI murmur

Answer 33

loud with a thrill with the stethoscope not touching the chest

Question 34

presystolic murmur

Answer 34

short, late diastolic murmur

Question 35

protosystolic murmur

Answer 35

short, early systolic murmur

Question 36

pansystolic murmur

Answer 36

extends through all of systole

Question 37

holosystolic murmur

Answer 37

extends through all of systole

Question 38

continuous murmur

Answer 38

present through all of systole and some of diastole

Question 39

where is a murmur heard best if it is because of the aortic valve?

Answer 39

2nd right ICS

Question 40

where is a murmur heard best if it is because of the pulmonic valve?

Answer 40

2nd left ICS

Question 41

where is a murmur heard best if it is because of the tricuspid valve?

Answer 41

4th left ICS

Question 42

where is a murmur heard best if it is because of a mitral valve?

Answer 42

5th left ICS, midclavicular line

Question 43

when are right sided heart valve murmurs heard best?

Answer 43

during inspiration

Question 44

what is the pattern a murmur can take on?

Answer 44

crescendo or decrescendo

Question 45

are all murmurs bad?

Answer 45

no, they can occur in children and young athletes

Question 46

if the murmur is heard between S1 and S2...

Answer 46

it is systolic in timing

Question 47

if the murmur is heard between S2 and S1..

Answer 47

it is diastolic in timing

Question 48

machinery murmur

Answer 48

a continuous, rough murmur in the 2nd ICS due to a patent ductus arteriosis, that should have closed after birth

Question 49

Still's murmur

Answer 49

a benign, functional midsystolic murmur heard in children

Question 50

Austin Flint murmur

Answer 50

late diastolic murmur associated with aortic insufficiency; the regurgitant blood is through to vibrate the mitral valve causing a murmur

Question 51

pneumonic to remember the murmurs

Answer 51

he Died in her ARMS & PRTS

Question 52

pericardial friction rub

Answer 52

inflammation of the pericardial sac with or without fluid can result in a high pitched, grating, scratching noise heard during systole and diastole best heard with patient leaning forward in deep expiration

Question 53

cardiovascular red flags

Answer 53

``` angina or intermittent claudation racing heart or palpitations persistent dyspena, fatigue or cough light headed or fainting spells ankle edema ```