Exam of the Heart

Question 1

semilunar valves

Answer 1

aortic

pulmonic

Question 2

AV valves

Answer 2

tricuspid

mitral (bicuspid)

Question 3

2nd left intercostal?

Answer 3

pulmonic

Question 4

2nd right intercostal?

Answer 4

aortic

Question 5

4th left intercostal

Answer 5

tricuspid

Question 6

5th intercostal MCL?

Answer 6

mitral

Question 7

systole

Answer 7

contraction

Question 8

diastole

Answer 8

relaxation

final 1/3 is atrial contraction

Question 9

S1

Answer 9

“lub”
left side - closure of mitral valve
right side - closure of tricuspid valve

splitting sometimes occurs

Question 10

closure of mitral valve?

Answer 10

louder at apex

Question 11

closure of tricuspid valve?

Answer 11

softer at LLSB

Question 12

S2

Answer 12

“dub”
left side - aortic (A2)
right side - pulmonic (P2)

Question 13

closure of aortic?

Answer 13

louder

best at right 2nd intercostal

Question 14

closure of pulmonic?

Answer 14

softer

best at left 2nd intercostal

Question 15

physiologic splitting

Answer 15

of S2
-into A2 and P2

during inspiration

Question 16

S3

Answer 16

ventricular gallop

child/young adult

older adult - S3 gallop (not normal)

Question 17

S4

Answer 17

atrial gallop

marks atrial contraction

always pathologic

Question 18

murmur

Answer 18

longer duration than heart sounds

Question 19

valvular pathology?

Answer 19

stenotic - narrowing of valvular orifice

regurgitant - fails to close fully allows blood to leak

Question 20

grading of murmur

Answer 20

1 very faint
2 quiet but heart with stethoscope
3 moderately loud
4 loud with palpable thrill
5 very loud with thrill may be heart with stethoscope partially off chest
6 very loud with thrill, may be heart with stethoscope entirely off chest

Question 21

heaves/lifts

Answer 21

forceful cardiac contraction causing movement of ribs/sternum

Question 22

when can you get the PMI easier to feel?

Answer 22

left lateral decubitus position

Question 23

thrills

Answer 23

vibratory sensation of skin from turbulent flow through an abnormal valve (loud murmur)

-at least a grade 4 murmur

Question 24

PMI

Answer 24

5th intercostal space mid-clavicular line

pulsation of L as it moves anteriorly during contraction and touches chest wall

Question 25

jugular venous pressure

Answer 25

provides clinical index of right heart pressure and cardiac function

reflects right atrial pressure

Question 26

measuring JVP

Answer 26

find highest point of oscillation
-measure from sternal angle

distance + 5 is JVP

Question 27

abnormal JVP

Answer 27

greater than 9cm

indicates right heart is overloaded

• lots of fluid in lung
• problem with atrium itself

Question 28

jugular venous pulsations?

Answer 28

A wave - RA contraction
X-descent - RA relaxation
V wave - RA filling and increasing pressure
Y descent - RA emptying

Question 29

hepatojugular reflex

Answer 29

pressure over liver and observe for distention of neck veins

normal - transient distension of jugular veins 2-3 seconds

if 8-10 seconds, abnormal

assesses right ventricular function and elevated pulmonary wedge pressure

Question 30

diaphragm?

Answer 30

hears high pitched
S1 S2

firmly to skin

Question 31

bell?

Answer 31

low pitched 
S3 S4
bruits
thrills
murumrs

lightly to skin

Question 32

murmur

Answer 32

turbulent flow through valve

innocent in children

• thin chest wall
• more dynamic circulation
• angulated great vessels

Question 33

still’s murmur

Answer 33

mid-systolic
left lower sternal border
sounds musical

Question 34

venous hum

Answer 34

innocent
continuous humming
right upper sternal border
venous blood from head and neck to thorax

continuous while sitting