Physical Examination - Cardiovascular Flashcards
Clinical Skills
What are the major steps of the cardiovascular exam?
- Observation
- Palpation
- Auscultation
(*no percussion*)
Clinical Skills
What are the major points of the observation/inspection portion of the cardiovascular exam?
1. Jugular venous pulsations/pressure
2. Point of maximal impulse
(*NOTE: both are often not visible*)
Clinical Skills
Describe the assessment of jugular venous pressure in the cardiovascular exam.
1. Position table at ___°.
2. Look for visible pulse in jugular vein (normally, pulse should not be visible). If pulse is visible, approximate the distance of the pulse point to the _______ angle, add ___ cm to this to get your JVP.
1. Position table at 30°.
2. Look for visible pulse in jugular vein (normally, pulse should not be visible). If pulse is visible, approximate the distance of the pulse point to the sternal angle, add 5 cm to this to get your JVP.
Clinical Skills
Describe the assessment of point of maximal impulse in the cardiovascular exam.
1. Position table at ___°.
2. PMI normally should be at ___th intercostal space at the __________ line, about the size of a quarter. PMIs are commonly not visible, so confirm its location by palpation.
3. Move patient to _____________ position, using the whole hand to feel for PMI.
1. Position table at 30°.
2. PMI normally should be at 5th intercostal space at the mid-clavicular line, about the size of a quarter. PMIs are commonly not visible, so confirm its location by palpation.
3. Move patient to left lateral decubitus position, using the whole hand to feel for PMI.
Clinical Skills
What are the major points assessed for during the palpation portion of the cardiovascular exam?
1. PMI
2. Lifts/heaves
3. Edema (at ankles/feet)
4. Abdominojugular reflex (only if right ventricular failure is expected)
Clinical Skills
What is a cardiovascular heave/lift?
Being able to feel the ventricular contraction through the chest wall
(indicates right ventricular hypertrophy)
Clinical Skills
What is a cardiovascular thrill?
A palpable murmur
Clinical Skills
The PMI is palpable in ____% of patients in the left lateral decubitus position.
Clinical Skills
The PMI is palpable in 50% of patients in the left lateral decubitus position (25-40% in the supine position).
Clinical Skills
During the palpation portion of the cardiovascular exam, where should one check for heaves/lifts?
With the whole hand at the left sternal border
Clinical Skills
The PMI should normally not be larger than what?
A quarter
Clinical Skills
True/False.
The more abnormal the heart, the more the PMI is visible.
True.
Clinical Skills
When should hepatojugular reflex be assessed?
(How?)
If right ventricular failure is suspected.
(Patient at 30°;
place the heel of the hand under the right costal margin;
press firmly for 30-60 seconds;
ventricular failure leads to a rise in JVP exceeding 3-4 cm)
Clinical Skills
A PMI that is diffuse or displaced laterally is indicative of what?
Ventricular enlargement
Clinical Skills
What are the six points of the auscultation portion of the cardiovascular exam?
1. Right carotid artery (BELL)
2. Aortic space (DIAPHRAGM)
3. Pulmonic space (DIAPHRAGM)
4. Erb’s point (DIAPHRAGM)
5. Tricuspid area (DIAPHRAGM)
6. Mitral area (DIAPHRAGM)
Clinical Skills
Which two peripheral vascular pulses should always be assessed in the cardiovascular exam (Tier I)?
- Radial
- Dorsalis pedis
(compare both sides)
Clinical Skills
Which peripheral vascular pulses can be assessed in the cardiovascular exam in addition to the radial and dorsalis pedis?
Carotid,
brachial,
femoral,
popliteal,
posterior tibial
Clinical Skills
In assessing murmur intensity, what would consitute a 1?
A murmur faintly heard with a stethoscope
Clinical Skills
In assessing murmur intensity, what would consitute a 4?
A palpable thrill
Clinical Skills
In assessing murmur intensity, what would consitute a 6?
A murmur heard with the stethoscope off the chest
Clinical Skills
How can you determine which beat is the S1 during a cardiovascular exam?
The S1 occurs simultaneously with the carotid pulse
Clinical Skills
Which Tier 1 auscultation point(s) of the cardiovascular exam is(are) done with the bell?
The carotid arteries
Clinical Skills
The stethoscope bell is useful for hearing ______ frequencies.
The stethoscope diaphragm is useful for hearing ______ frequencies.
Clinical Skills
The stethoscope bell is useful for hearing lower frequencies.
The stethoscope diaphragm is useful for hearing higher frequencies.
