Precordium Abnormal findings

Question 1

what is a heave?

Answer 1

a heave is abnormal thrusting of the ventricle during systole

Question 2

what does a heave occur with?

Answer 2

hypertrophy of the ventricle due to increased workload

Question 3

where is a right heave seen? what about a left heave?

Answer 3

• right is seen at the right sternal border
• left is seen at the apex

Question 4

what is considered cardiac enlargement?

Answer 4

when ventricular dilation (volume overload) moves the apical impulse down more than one space

Question 5

what causes cardiac enlargment?

Answer 5

heart failure or cardiomyopathy

Question 6

what will the apical pulse feel like with left ventricular hypertrophy? what is it an overload of?

Answer 6

• sustained
• greater force
• longer duration
• pressure overload

Question 7

if the apical pulse is not palpable in any position, what does this indicate?

Answer 7

pulmonary emphysema because of the overriding lungs

Question 8

what is a thrill?

Answer 8

a palpable vibration

Question 9

what does a thrill feel like?

Answer 9

it feels like the throat of a purring cat

Question 10

what does a thrill indicate?

Answer 10

• turbulent blood flow

Question 11

what other factors cause abnormal pulsations?

Answer 11

• extra heart sounds
• accentuated heart sounds

Question 12

what does a pulse deficit indicate?

Answer 12

• weak contraction of the ventricles

Question 13

what does a pulse deficit occur with?

Answer 13

atrial fibrillation, premature beats and heart failure

Question 14

when are heart sounds diminished?

Answer 14

any time there is extra tissue or fluid between the heart and stethescope

Question 15

what is a fixed split?

Answer 15

a split that is unaffected by respiration

Question 16

what is a paradoxical split?

Answer 16

the sounds fuse on inspiration and split on expiration

Question 17

what does a pathologic S3 occur with?

Answer 17

heart failure and volume overload

Question 18

what does S4 occur with ?

Answer 18

it occurs with CAD

Question 19

what can murmurs be caused by?

Answer 19

congenital and acquired valvular defects

Question 20

what is the difference between a systolic and diastolic murmur?

Answer 20

• a systolic murmur may occur with a healthy heart or heart disease
• a diastolic murmur always indicate heart disease

Question 21

what is the difference between the murmur of mitral and aortic stenosis?

Answer 21

• mitral is low pitched and rumbling
• aortic is harsh

Question 22

where can the aortic stenosis murmur radiate to?

Answer 22

it can radiate to the neck

Question 23

why is auscultating with the person on their left side important?

Answer 23

S3, S4 and mitral stenosis murmurs sometimes can only be heard when patient is on the left

Question 24

why ask the person to lean forward for auscultation?

Answer 24

the soft diastolic murmur of aortic regurgitation may only be heart when person is in this position

Question 25

what is HCM?

Answer 25

• hypertrophic cardiomyopathy is the inherited thickening of the myocardium

Question 26

what is the standing-squatting screening measure?

Answer 26

• used to screen for HCM
• murmur grows softer for sitting
• murmur grows louder for standing