week 4 module 12 cardiac exam

Question 1

dyspnea questions

Answer 1

how long?
occur suddenly or gradually?
wake up at night feeling SOB?
how many pillows do you use? 
how far can you walk before SOB?
swelling in legs? 
chest pain with SOB?

Question 2

causes of dyspnea

Answer 2

HF
pulmonary edema
acute MI
arrhythmia 
pericarditis
pericardial effusion

Question 3

orthopnea

Answer 3

dyspnea while flat, relieved with sitting or standing

- have to sleep on pillows

Question 4

paroxymal nocturnal dyspnea

Answer 4

breathlessness at rest
starts 1-2hrs into sleep 
accompanied by: 
- wheezing, sweating, distress, cough, frothy/bloody sputum 
Relieved: sitting up/out of bed 
Commonly called cardiac asthma

Question 5

cheyne stokes

Answer 5

periodic breathing, like OSA
seen with: chronic pulmonary edema, poor CO
snoring? 
tired after sleep?
sleepy during day?
sleep study?

Question 6

edema questions

Answer 6

when did you notice the swelling?
suddenly or gradually?
worse in morning or night?
decrease after a night sleep?
SOB associated?
change in wt? 
elevating feet dec. swelling?
pain in legs? 
both legs swell equally?

Question 7

peripheral edema

Answer 7

HF
worsens during the day, better at night
-tight clothes? 
- let out belt
- shoes tight
- socks leave marks?
- wt gain?
- rings stuck?
- develop quick or overtime?
- resolve quickly or overnight?

Question 8

Palpitation questions

Answer 8

how long have you had this?
when did you first notice it? 
how long did it last? 
what did it feel like?
anything you do stop the irreg. heartbeats? 
did they stop abruptly?
noticed during exercise?
any sweating, flushing, or headaches assoc. ?
- SOB, dizzy, fainting, N/V
any problems with thyroid gland?
any recreational drugs? how much, how often?
how much caffeine per day?

Question 9

paroxysmal tachycardia

Answer 9

sudden short bursts

longer durations suggest atrial dysrhythmia

Question 10

cardioversion

Answer 10

48-72 hours from onset to perform sync-cardioversion

without needed anticoagulants

Question 11

cardiac related syncopy

Answer 11

CAD
severe chest pain
LV dysfunction
cardiomyopathy
rhythm change

Question 12

syncope questions

Answer 12

how often do you faint, or feel like you will?
what are you doing when this happens?
ever lost consciousness?
occur suddenly?
what position were you when you fainted?
anything associated
- chest pain, irreg. heartbeat, nausea, confusion, hunger, tingling, or numbness?
black, tarry BM?
heavy periods? bleeding disorders?

Question 13

assess JVD

Answer 13

pt supine at 45 degrees

• stand to the right of patient
• pt head to the left
• • vein aligned with R. atrium
• look for external jugular vein
• sternal angle
• locate pulsation of internal jugular vein; inward pulsation
• cm ruler, measure vertical distance from sternal angle to pulsation point.

> 4cm is r/t RSHF

• inc. R. atrial pressure
• constrictive pericarditis
• tricuspid sterosis
• active valsalva phenomenon

Question 14

hepatojugular reflux

Answer 14

apply pressure to abd. for 30 sec.

JVD rises >4cm for > 10sec = HF

Question 15

inspect apical impulse

Answer 15

visible about midclavicular line, 5th L. intercostal space

Question 16

xanthelsma

Answer 16

yellowish deposit of fat under skin

Question 17

precordial palpation sequence

Answer 17

apex
up the left sternal border
base
down the right sternal border
into the epigastrium or axillae

Question 18

palpation of apical impulse

Answer 18

PMI
usually 5th intercostal, midclavicular
children: 4th intercostal, medial to nipple
If more vigorus than expected: heave or lift
Thrill: a fine, palpable, rushing vibration; palpable murmur

Question 19

pectus carinatum

Answer 19

pigeon chest

- protrusion of sternum and ribs

Question 20

pectus excavatum

Answer 20

sunken chest

• restricts chest volume
• keeps lungs from fully expanding
• > dec. exercise tolerance
• > restricted heart
• -> dec. blood flow and heart function, flow murmur

Question 21

aortic area auscultation

Answer 21

2nd R. intercostal space at sternal border

Question 22

pulmonic area auscultation

Answer 22

2nd L. intercostal space at sternal border

Question 23

second pulmonic area or erbs point auscultation

Answer 23

3rd L. intercostal space at sternal border

Question 24

Tricuspid auscultation

Answer 24

4th L. intercostal space, along lower L. sternal border

Question 25

Mitral area auscultation

Answer 25

5th L. intercostal space, at the apex, mid-clavicular.

Question 26

bell of stethoscope

Answer 26

low frequency sounds

• mitral valve
• light pressure

Question 27

diaphragm of stethoscope

Answer 27

higher frequency sounds

firm pressure

Question 28

levine scale

Answer 28

grades murmurs using roman numerals

I-VI/VI

Question 29

S4 found with

Answer 29

ventricular hypertrophy 
CAD
dilated cardiomyopathy 
hyperdynamic circulation 
arrhythmia 
heart blocks

Question 30

adventitious sounds

Answer 30

gallops
mitral snaps
ejection clicks
friction rub
mechanical valve

Question 31

auscultation of murmurs

Answer 31

timing/duration
pitch
intensity
pattern
quality
location/radiation
respiratory phase variation

Question 32

flow murmur

Answer 32

velocity of blood increases

• exercise
• thyrotoxicosis

Question 33

murmur due to dec. viscosity of blood

Answer 33

anemia

Question 34

structural murmurs

Answer 34

valves narrowed or incompetent

unusual opening in chamber

Question 35

systolic murmur can be innocent in

Answer 35

children

pregnancy

Question 36

diastolic murmur

Answer 36

always pathologic

• aortic regurgitation
• mitral stenosis

Question 37

systolic murmurs

Answer 37

aortic stenosis

mitral regurgitation

Question 38

pericardial friction rub

Answer 38

inflammation of pericardial sac

• > rough parietal and visceral surfaces
• > rubbing, machine-like sound occupies both systole and diastole.