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PCM > Cardiac Exam > Flashcards

Cardiac Exam Flashcards

1
Q

History

A

Fatigue, dyspnea, chest pain, palpation said, syncope

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2
Q

Family History

A

Familial clustering is common in patients with certain heart diseases
i.e: hypertrophic cardiomyopathy, Marfan’s syndrome, prolonged QT syndrome

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3
Q

Physical

A

Inspection
Palpation
Percussion
Auscultation

Quiet room
Gown patient
Sitting, supine, left lateral decubitus, leaning forward, standing

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4
Q

Inspect

A 
Face - acromegaly, cushnoid, Down's syndrome, hyperthyroid, myxedema
Jaundice - yellow
Cyanosis - blue
Pallor - pale, anemia, shock
Nails - clubbing, hemorrhages
Body habitus - tall, short
Hydration - blood pressure ,weight
Temperature: 1 degree fever above normal => increase HR by 10 beats

Precordium
Scars, pacemaker, skeletal abnormalities

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5
Q

PMI

A

Precordial Palpation
Point of maximum intensity
Note location, amplitude, duration, direction
Apicial impulse, visible at midclavicular line in. 5th ICS
1-2.5 cm diameter
Vigorous, heave, lift
Systolic outward thrust

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6
Q

Heart Sounds

A

Aortic valve - 2nd ICS to the R of sternum
Pulmonic valve - 2nd ICS to the L of the sternum
Tricuspid valve - 4th ICS to the L of the sternum
Mitral valve - apex of heart, 5th ICS left midclavicular line

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7
Q

S1

A

MV closure 1st component
TV closure 2nd component
Beginning of systole
Loudest at apex

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8
Q

S2

A

Aortic valve closure 1st component
Pulmonic valve closure 2nd component
Loudest at the base
End of systole

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9
Q

Heart Sounds Inspiration vs Expiration

A

Expiration - single sound

Inspiration - splitting of S2, because of increased venous return during inspiration and more time for right ventricle to deliver blood to the lung

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10
Q

Murmurs Grading System

A 
1 = barely audible, faint
2 = soft, but easily heard, quiet
3 = loud, without a thrill
4 = loud with a thrill
5 = loud with minimal contact between stethoscope and chest - thrill
6 = loud, can be heard without a stethoscope - thrill
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11
Q

Midsystolic Murmur

A

Begins after S1
Stops before S2
Brief gaps are audible between the murmur and the heart sounds

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12
Q

Pansystolic (Holosystolic) Murmur

A

Starts with S1
Stops at S2
No gap between murmur and heart sound

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13
Q

Late Systolic Murmur

A

Starts in mid or late systole

Persists up to S2

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14
Q

Early Diastolic Murmur

A

Starts immediately after S2
No discernible gap
Fades into silence before next S1

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15
Q

Middiastolic Murmur

A

Starts a short time after S2

May fade away or merge into a later diastolic murmur

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16
Q

Preload

A

Stretching of myocytes prior to contraction

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17
Q

After load

A

Load on heart during ejection of blood from ventricle

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18
Q

Contractility

A

Capacity to produce active force at a specific preload

19
Q

Rate

A

Heart rate number of cardiac cycles per minute

20
Q

Stroke Volume (SV)

A

Blood ejected from ventricle per beat

EDV - ESV

21
Q

End Diastolic Volume (EDV)

A

Volume of blood in ventricle at end of diastole

Preload

22
Q

End Systolic Volume (ESV)

A

Volume of blood remaining in ventricle at end of systole

23
Q

Cardiac Output (CO)

A

Volume of blood per minute pumped by the heart

SV x HR

24
Q

Ejection Fraction (EF)

A

Measures contractility

SV/EDV

25
Q

Kussmauls Sign

A

Venous column (JVP) rises during inspiration rather than falls

Seen in R heart failure, constrictive pericarditis, or RV infarction

26
Q

Barrel Chest

A

Think COPD

Increased A-P diameter

27
Q

Pectus Carinatum

A

Pigeon chest

Central protrusion

28
Q

Pectus Excavatum

A

Funnel chest

Central depression

29
Q

Jugular Venous Pulse (JVP)

A

Jugular veins reflect the activity of the right side of the heart
Level of JVP visibility gives an indication of the right atrial pressure
Internal jugular is better than external jugular

Place patient in supine position to allow veins to engorge, then raise 30-45 degrees
Normal JVP = 0-9
Most common cause of elevated JVP = elevated RV diastolic pressure

30
Q

A Wave

A

Right atrial contraction
Tricuspid valve opens
Coincides with S1
Precedes carotid pulsation

Giant wave:

  • obstruction between RA and RV (tricuspid stenosis, right atrial myxoma)
  • increased pressure in RV (pulmonary stenosis)
  • pulmonary hypertension
  • recurrent pulmonary emboli
  • A-V dissociation (complete heart block, VT) RA contracts against the closed TV
31
Q

C Wave

A

Backward push by closure of TV during isovolumetic systole and by impact of carotid artery adjacent to the JV

32
Q

X Wave - X Slope

A

Passive atrial filling and atrial relaxation
Blood flows into RA from cava and closure of TV

Steep X decent in cardiac tamponade and constrictive pericarditis

33
Q

V Wave

A

Atrial filling
Increased volume and pressure in RA when TV closed
Prominent V wave in tricuspid regurgitation and pulmonary hypertension

34
Q

Y Slope or Y Descent

A

Open TV and rapid RV filling in RV diastole
Deep Y descent in severe Tricuspid regurgitation
A slow Y descent suggests obstruction to RV filling (tricuspid stenosis, RA myxoma)

35
Q

Increased JVP

A 
SVC obstruction
Sever heart failure
Constrictive pericarditis
Cardiac tamponade
RV infarction
Restrictive cardiomyopathy
36
Q

Five Finger Method

A 
History
Physical
ECG
X-Ray
Lab Tests
37
Q

Hepatojugular Reflex (HJR)

A

Liver engorged
Poorly compliant RV, RV failure
Constrictive pericarditis
Obstructive RV filling by tricuspid stenosis or RA tumor

38
Q

Systole

A

Ventricular contraction

Ejection

39
Q

Diastole

A

Ventricular relaxation

Filling

40
Q

S3

A

High pressures and abrupt deceleration of inflow across the mitral valve at the end of the rapid filling phase
Physiologic in children/young adults
Pathological >40 yo

Ken-Tuck-Y

41
Q

S4

A

Atrial gallop from forceful contraction of atria against a stiffened (low compliant) ventricle
Can be normal in trained athletes

Ten-Nes-See

42
Q

Grading Peripheral Pulses

A 
0 = absent
1 = barely palpable
2 = average intensity
3 = strong
4 = bounding

R/R/A = rate/rhythm/amplitude

43
Q

Edema

A

Dorsum of foot
Behind medial malleolus
Anterior tibia (shin)

0 = absent
1+ = barely detectable, nonpitting (2mm)
2+ = slight indentation (4mm) 10-15 sec
3+ = deeper indentation (6mm) >1 min
4+ = very marked indentation (8mm) 2-5 min

PCM (26 decks)

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