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Physical Diagnosis II Heart Exam > Part 1 > Flashcards

Part 1 Flashcards

1
Q

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

A 
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
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2
Q

what are some classic presentations of acute heart failure?

A

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

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3
Q

general observations of acute heart failure

A

pale
perspiring
apprehensive

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4
Q

what are classic presentations of chronic right sided heart failure?

A 
fatigue
dyspnea
ankle edema
jugular distention
ascites
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5
Q

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

A 
fatigue
exertional dyspnea
cough
orthopnea
pink frothy sputum
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6
Q

most common cause of right sided heart failure

A

high blood pressure

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7
Q

what is a common atrial gallop in MI?

A

S4

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8
Q

what is the number 1 cause of acute heart failure?

A

coronary artery disease

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9
Q

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

A

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

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10
Q

what do you look for when inspection?

A

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

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11
Q

what do you do during palpation?

A

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

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12
Q

what do you do during percussion?

A

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

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13
Q

what are the traditional auscultation sites?

A

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

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14
Q

what are audible characteristics of heart sounds?

A 
quality
pitch
intensity
duration
timing
location
respiratory variation
pattern
position
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15
Q

describe the first heartbeat

A

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

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16
Q

describe the second heartbeat

A

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

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17
Q

what are the 4 types of unexpected heartbeats?

A

splits, gallops, clicks and snaps

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18
Q

split S1

A

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

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19
Q

physiologic S2 split

A

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

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20
Q

paradoxical S2 split

A

aortic valve is pathologically delayed (LBBB)

on inspiration and expiration

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21
Q

fixed S2 split

A

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

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22
Q

ventricular gallop (third heartbeat)

A

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

23
Q

atrial gallop (presysteolic gallop, or 4th heartbeat)

A

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

24
Q

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

A

strep throat and scarlet fever

cadence is like a fixed S2 split

25
Q

ejection clicks of the aortic and pulmonic valve

A

like split S1

higher pitched than atrial gallop

26
Q

murmur

A

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

27
Q

what are the characteristics of murmurs?

A

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

28
Q

grade I murmur

A

faint in a quiet room

29
Q

grade II murmur

A

quiet, but clearly audible

30
Q

grade III murmur

A

moderately loud (same intensity as S1 and S2)

31
Q

grade IV murmur

A

loud with a thrill

32
Q

grade V murmur

A

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

33
Q

grade VI murmur

A

loud with a thrill with the stethoscope not touching the chest

34
Q

presystolic murmur

A

short, late diastolic murmur

35
Q

protosystolic murmur

A

short, early systolic murmur

36
Q

pansystolic murmur

A

extends through all of systole

37
Q

holosystolic murmur

A

extends through all of systole

38
Q

continuous murmur

A

present through all of systole and some of diastole

39
Q

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

A

2nd right ICS

40
Q

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

A

2nd left ICS

41
Q

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

A

4th left ICS

42
Q

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

A

5th left ICS, midclavicular line

43
Q

when are right sided heart valve murmurs heard best?

A

during inspiration

44
Q

what is the pattern a murmur can take on?

A

crescendo or decrescendo

45
Q

are all murmurs bad?

A

no, they can occur in children and young athletes

46
Q

if the murmur is heard between S1 and S2…

A

it is systolic in timing

47
Q

if the murmur is heard between S2 and S1..

A

it is diastolic in timing

48
Q

machinery murmur

A

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

49
Q

Still’s murmur

A

a benign, functional midsystolic murmur heard in children

50
Q

Austin Flint murmur

A

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

51
Q

pneumonic to remember the murmurs

A

he Died in her ARMS & PRTS

52
Q

pericardial friction rub

A

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

53
Q

cardiovascular red flags

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

Physical Diagnosis II Heart Exam (1 decks)

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