Sept 15 - Cardiac Exam

Question 1

Describe some common cardiac complaints found during the OLD CARTS questioning.

Answer 1

pain or SOA at rest or on exertion, edema, N/V, orthopnea, syncope, family Hx

Question 2

Differentiate use of the diaphragm from the bell when auscultating with a stethoscope.

Answer 2

Diaphragm: removes low tones
Bell: lets all sounds through

Question 3

What causes clubbing at the fingertips?

Answer 3

hypoxia

Question 4

Describe the physical exam assessment for JVD.

Answer 4

Elevate Pt’s head to 30-45 deg.
IJ and EJ should not be visible in healthy patient
Angle measurement when visible…
-place ruler at sternal angle and straight edge at level of EJ pulsation
-Concerning if > 3-4 cm

Question 5

What is the typical point of maximal impulse of the heart?

Answer 5

5th IC space just medial to midclavicular line - best palpated with Pt in left lateral decubitus position

Question 6

Describe 2 pathologies that affect the point of maximal impulse of the heart.

Answer 6

LVH shifts point to midaxillary line

Aortic stenosis prolongs pressure during palpation

Question 7

Describe how a thrill is noted on physical exam and state its clinical relevance.

Answer 7

Press firmly on different chest areas with the ball of your hand. Vibrating sensation indicates murmur.

Question 8

Describe how a heave or lift is noted on physical exam and state its clinical relevance.

Answer 8

Place lateral hand on chest just left of the sternal border. Hand rising may indicate RVH.

Question 9

Describe where the aortic and pulmonic valves may be auscultated.

Answer 9

Aortic: 2nd IC space just to right of sternum
Pulmonic: 2nd IC space just to left of sternum

Question 10

Describe where tricuspid and mitral valves may be auscultated.

Answer 10

Tricuspid: 4th IC just left of sternum
Mitral: 5th IC at midclavicular line

Question 11

What is Erb’s point?

Answer 11

Central portion of the heart heard at 3rd IC just left of sternum. Allows for evaluation of aortic insufficiency and mitral stenosis.

Question 12

At what positions will S1 be louder than S2 and vice versa?

Answer 12

S1 louder than S2 at the apex.

S2 louder than S1 at the base

Question 13

In what position(s) are heart valves auscultated?

Answer 13

Sitting upright, leaning forward (while holding an echale), supine, and left lateral decubitus

Question 14

Closure of what valves produce the heart sounds?

Answer 14

S1: closure of AV valves
S2: closure of the pulmonic and aortic valves

Question 15

Correlate auscultation of heart sounds to palpation of a pulse.

Answer 15

Order is: S1 –> pulse –> S2

Question 16

What are the four causes of an S2 split?

Answer 16

Inspiration (not pathologic)
Wide (present on inhale) - pulmonic valve stenosis
Paradoxical (present on exhale) - aortic stenosis
Fixed (throughout resp cycle) - atrial septal defect

Question 17

Describe the S3 extra heart sound and its clinical relevance.

Answer 17

“Ken Tuc KY” - ventricular gallop in early diastole. Can be normal or sign of systolic HF.

Question 18

Describe the S4 extra heart sound and its clinical relevance.

Answer 18

“TE Nuh See” - occurs in late diastole. Is never normal. It is a sign of diastolic HF.

Question 19

Describe the mid-systolic click and its clinical relevance.

Answer 19

Snap sound in the middle of the “lub-dub”. Indicates mitral valve stenosis - most common murmur.

Question 20

Describe pericardial friction rub and its clinical relevance.

Answer 20

2 diastolic sounds caused by pericarditis.

Question 21

Describe the heart sound and physical exam findings resulting from aortic stenosis.

Answer 21

“whoosh”: sound between S1 and S2. May also note prolonged apical pulse or thrill if severe.