Precordium Abnormal findings Flashcards
what is a heave?
a heave is abnormal thrusting of the ventricle during systole
what does a heave occur with?
hypertrophy of the ventricle due to increased workload
where is a right heave seen? what about a left heave?
- right is seen at the right sternal border
- left is seen at the apex
what is considered cardiac enlargement?
when ventricular dilation (volume overload) moves the apical impulse down more than one space
what causes cardiac enlargment?
heart failure or cardiomyopathy
what will the apical pulse feel like with left ventricular hypertrophy? what is it an overload of?
- sustained
- greater force
- longer duration
- pressure overload
if the apical pulse is not palpable in any position, what does this indicate?
pulmonary emphysema because of the overriding lungs
what is a thrill?
a palpable vibration
what does a thrill feel like?
it feels like the throat of a purring cat
what does a thrill indicate?
- turbulent blood flow
what other factors cause abnormal pulsations?
- extra heart sounds
- accentuated heart sounds
what does a pulse deficit indicate?
- weak contraction of the ventricles
what does a pulse deficit occur with?
atrial fibrillation, premature beats and heart failure
when are heart sounds diminished?
any time there is extra tissue or fluid between the heart and stethescope
what is a fixed split?
a split that is unaffected by respiration
what is a paradoxical split?
the sounds fuse on inspiration and split on expiration
what does a pathologic S3 occur with?
heart failure and volume overload
what does S4 occur with ?
it occurs with CAD
what can murmurs be caused by?
congenital and acquired valvular defects
what is the difference between a systolic and diastolic murmur?
- a systolic murmur may occur with a healthy heart or heart disease
- a diastolic murmur always indicate heart disease
what is the difference between the murmur of mitral and aortic stenosis?
- mitral is low pitched and rumbling
- aortic is harsh
where can the aortic stenosis murmur radiate to?
it can radiate to the neck
why is auscultating with the person on their left side important?
S3, S4 and mitral stenosis murmurs sometimes can only be heard when patient is on the left
why ask the person to lean forward for auscultation?
the soft diastolic murmur of aortic regurgitation may only be heart when person is in this position
what is HCM?
- hypertrophic cardiomyopathy is the inherited thickening of the myocardium
what is the standing-squatting screening measure?
- used to screen for HCM
- murmur grows softer for sitting
- murmur grows louder for standing
