Lecture 5: Approach to Cardiac Exam Flashcards
When obtaining a cardiac history, what should you consider asking?
1) Underlying etiologies
2) Anatomic abnormalities
3) Physiological disturbances
4) Family history
What is a normal JVP?
What is the most common cause of elevated JVP?
0-9
elevated RV diastolic pressure
In a jugular venous pressure recording, what do these represent? a wave v wave c wave x descent y descent
JVP Mnemonic: a - atrial contraction v - venous filling c - tricuspid valve closure x descent - atrial relaxation y descent - atrial emptying
Under what circumstances will you see a giant “a wave?”
1) Obstruction b/t right atria and ventricle
2) Increased pressure in right ventricle
3) Pulmonary hypertension
4) Recurrent pulmonary emboli
5) AV dissociation (A and V not synced)
Under what circumstances will you see a steep “x descent?”
Tamponade
Constrictive pericarditis
Under what circumstances will you see a prominent “v wave?”
Pulmonary hypertension
Tricuspid regurgitation
Where is increased jugular venous pressure seen?
Superior Vena Cava obstruction Severe heart failure Constrictive pericarditis Cardiac tamponade Right Ventricle infarction Restrictive cardiomyopathy
Does S1 or S1 have a splitting sound in inspiration?
S2
What is the five finger method of the cardiovascular exam?
High Pixel
Hx Physical ECG XR Labs
How id family hx pertinent when getting cardiac hx?
clustering common in certain heart diseases, particularly if family member is affected at an early age
What does S1 represent? Where is it heard loudest?
What does S2 represent? Where is it heard loudest?
- mitral and tricuspid closure > beginning of ventricular systole; apex
- aortic and pulmonic closure > beginning of ventricular diastole; base
What does S3 represent?
What does S4 represent?
- rapid inflow into a compliant left ventricle (splashy)
- forceful contraction of the atria into a stiff left ventricle
