Section 5: Clinical Assessment

Question 1

4 ways to obtain objective data in cardiac physical exam

Answer 1

1. oberservation
2. palpation
3. auscultation
4. percussion

Question 2

purpose of neck vein inspection

Answer 2

estimate central venous pressure (cvp)

Question 3

jugular venous distention- sign of?

Answer 3

cardiac congestion- seen in heart failure or certain SVTs

Question 4

palpation of carotid arteries

what should be documented?

Answer 4

looks at cardiac activity such as stroke volume and aortic competency
- rate, rhythm, amplitude, and contour of pulse

Question 5

bruit

Answer 5

blowing sound, heard listening to carotid arteries with stethescope, indicates narrowing of carotid artery or radiation of aortic valve murmur

Question 6

palpation of precordium

Answer 6

useful for assessing right left and combined ventricular hypertrophy

Question 7

apical impulse (point of maximal impulse -PMI)

Answer 7

1/2 of normal adult population, visible pulsation near heart apex, normally corresponds with ventricular systole. apical may be larger or more laterally located in patients with left ventricular hypertrophy, dilation, or aneurysm

Question 8

heaves (lifts)

Answer 8

diffuse lifting impulse observed- implied an inc contact of right ventricle with chest wall as found with dilated hypertrophic disorders or valvular diseases or pulmonary hypertension

Question 9

thrills

Answer 9

abnormal turbulent blood flow causing an audible murmur of grade V or VI intensity. Best felt with cupped palm and heel of hand placed over left precordium. (similar feeling when fingers placed over larynx of purring cat) May occur as a result of severe mitral regurg or a ruptured ventricular septum

Question 10

stethescope

Answer 10

gathers and slightly amplifies sound before transmitted to ears, has both a bell and diaphragm.

Question 11

bell stethescope

Answer 11

Bell applied lightly to skim to detect low pitch sounds such as gallops and diastolic murmurs

Question 12

diaphragm of stethescope

Answer 12

placed firmly on the skin and detects high pitched sounds such as systolic murmurs

Question 13

systematic approach for auscultation of heart

Answer 13

1. begin at base of heart and slowly move towards apex

Question 14

first heart sound

Answer 14

lubb

systolic

contraction of the ventricle, closing of av valve, synchronous with apex beat and carotid pulse

Question 15

second heart sound

Answer 15

dupp

diastolic

closure of aortic and pulmonic valves

Question 16

abdomen assessment

Answer 16

should be symmetrical in contour and appear flat or slightly rounded

Question 17

ascites

Answer 17

fluid causing a distended abdomen

Question 18

tympany

Answer 18

a hollow sound heard over a gas filled bowel

Question 19

skin

Answer 19

body’s largest organ

Question 20

cyanosis

Answer 20

bluish skin color, results from increased amounts of reduced hemoglobin seen in pulmonary and cardiac imcompetence

Question 21

skin temperature- cool, clammy skin

Answer 21

lessened cardiac output, shock, and stress precipitate a catecholamine release, resulting in vasoconstriction

Question 22

clubbing (drumstick fingers)

Answer 22

chronic decrease in oxygenation

Question 23

turgor

Answer 23

measure skin elasticity
loss of turgor reflects an extracellular volume deficit or the normal changes that occur with aging, excessive weight loss, or chronic steroid use

Question 24

positive homans sign

Answer 24

may indicate deep vein thrombosis, extend patients leg and dorsiflex foot.

if patient complains of pain or aching in calf or thigh, thrombophlebitis may be present

Question 25

edema

Answer 25

abnormal fluid collection within the interstitium (fluid within tissue)

may be caused by inc in hydrostatic pressure (heart failure), insufficient venous return

Question 26

blood pressure

Answer 26

pressure exerted by plasma and cells against the arterial walls

Question 27

sounds (korotkoffs sounds)

Answer 27

arise from turbulent blood flow through an artery constricted by external pressure (bp cuff). point at which sound disappears (diastolic pressure)

Question 28

pulse pressure

Answer 28

difference between systolic and diastolic pressures

normal 30-40 mmHg

Question 29

causes of high pulse pressure

Answer 29

fever, anemia, aortic coarctation, aortic insufficiency

Question 30

causes of lower pulse pressure

Answer 30

shock, aortic and mitral stenosis, acute mi, heart failure, constrictive pericarditis, tamponade, vasoconstricting drugs

Question 31

pulsus paradoxis

Answer 31

alternation in peak systolic pressure occurring in an every other beat pattern

beat to beat variability must be at least 10 mm hg

Question 32

waterhammer oulse

Answer 32

large bounding pulse with rapid rises and falls and associated with wide pulse pressures

Question 33

pulsus tardis

Answer 33

weak pulse with slow upstroke and prolnged peak and is associated with a dec in pulse pressure

Question 34

pulsus alternans

Answer 34

pulse with normal rhythm but alternates in amplitude beat to beat

Question 35

urinary output

Answer 35

continuous reduction in urinary output in cardiac patients is an early sign of heart failure or impending shock

maintained at 20 to 30 ml/ hr

Question 36

body weight

Answer 36

1 L of fluid retention corresponds to approximately 1 kg of body weight

Question 37

signal averaged ecg

Answer 37

micro-volt level late potentials are analyzed in patients with VT, especially after MI
can identify group of patients at high risk of sudden death or sustained VT after MI

Question 38

high frequency qrs normal duration

Answer 38

<=114 ms

Question 39

most common type of syncope

Answer 39

neurally mediated (neurocardiogenic or vasovagal)

Question 40

vasovagal syncope

Answer 40

blood pressure initially drops in the standing position. body releases catecholamines to maintain BP
- peripheral vasoconstriction, inc heart rate, inc myocardial contractility

Question 41

tilt table test

Answer 41

60- 80 degrees for 30-60 mins

Question 42

2 main varieties of ambulatory monitoring

Answer 42

holter monitor and cardiac event recorder

Question 43

holter monitor

Answer 43

typically records electrocardiogram for 24 hours, ideal for assessing severity of arrythmia, gives info on frequency of occurrence

Question 44

cardiac event recorder

Answer 44

records cardiac electrogram on continuous tape, only last 30-90 seconds available for playback, when symptoms occur patient stops tape and transmit contents via telephone, worn for extended period of time and better for patients with more infrequent episodes

Question 45

stress test

Answer 45

monitors electical and mechanical cardiac response to continuous increasingly strenuous exercise

Question 46

what can stress testing be used in conjuction with

Answer 46

myocardial radionuclide testing

Question 47

what is exercise testing used to diagnose

Answer 47

ischemic heart disease (narrowed heart arteries) which can lead to heart attack

may uncover exercise induced VT

Question 48

instruments for exercise testing

Answer 48

treadmill and bicycle ergometer