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PCM II Midterm > Approach to Cardiac Exam > Flashcards

Approach to Cardiac Exam Flashcards

(60 cards)

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1
Q

What is included in a normal heart exam?

A 
History
Physical
ECG
Xray
Lab tests
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2
Q

What are some non-specific items you should ask in heart exam history?

A

fatigue, dyspnea, chest pain, palpation, syncope

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3
Q

What does a complete cardiac DDX need to consider?

A

Underlying etiology
Anatomic abnormalities
Physiologic disturbance

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4
Q

Why is family history important in a heart exam?

A

familial clustering is common in pts with certain heart diseases (hypertrophic cardiomyopathy, prolonged QT syndrome, Marfan’s syndrome)

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5
Q

What is the order of physical assessment of cardiac function?

A 
inspection
palpation
percussion
auscultation
positioning of pt
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6
Q

Normal chest shape

A

AP diameter should be 1/2 of transverse diameter of thorax

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7
Q

Pectus carinatum

A

pigeon chest

central protrusion

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8
Q

Pectus excavatum

A

funnel chest

central depression

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9
Q

What should you inspect for on a PE?

A

precordium (trauma?)

scars, pacemaker, skeletal abnormalities

apex of heart (in 5th intercostal space)

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10
Q

What is the purpose of percussion in PE?

A

estimate cardiac size by starting far left and move medially to find cardiac dullness

if can’t feel apex of heart

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11
Q

What is the purpose of auscultation in PE?

A

S1 (mitral & tricuspid closure)

S2 (aortic & pulmonic closure)

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12
Q

What is the purpose of palpation in PE?

A

palpate for thrills which indicate blood flow causing murmurs

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13
Q

Why do you palpate for jugular venous pulse?

A

because jugular veins reflect the activity of the right side of the heart

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14
Q

Which jugular vein should you measure?

A

internal jugular vein

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15
Q

What does an elevated JVP indicate?

A

elevated RV diastolic pressure

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16
Q

What may a giant A wave indicate?

A

obstruction btwn RA & RV

increased pressure in RV

pulmonary hypertension

recurrent pulmonary emboli

AV dissociation

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17
Q

What does the C wave indicate?

A

backward push by closure of TV during isovolumetric systole & by impact of carotid artery adjacent to JV

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18
Q

What does an “X” wave indicate?

A

passive atrial filling & atrial relaxation (blood flows into RA from vena cava & triscupid valve is closed)

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19
Q

When do you see a steep X descent?

A

cardiac tamponade & constrictive pericarditis

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20
Q

When do you see a prominent V wave?

A

in TR & pulmonary hypertension

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21
Q

What does a slow Y descent suggest?

A

obstruction to RV filling

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22
Q

When do you see increased JVP?

A 
SVC obstruction
severe heart failure
constrictive pericarditis
cardiac tamponade
RV infarction
restrictive cardiomyopathy
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23
Q

Which heart sounds are abnormal?

A

S3 & S4

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24
Q

S3 heart sound

A

due to high pressures & abrupt deceleration of inflow across mitral valve @ end of rapid filling phase

(normal in children)

Ken-Tuck-Y

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25
S4 heart sound
atrial gallop from forceful contraction of atria against stiffened ventricle (low compliant) diastolic sound (Ten-Nes-See)
26
Where do you listen for mitral valve?
apex of heart 5th left ICS at mid clavicular line
27
Where do you listen for tricuspid valve?
4th left ICS @ LSB
28
Where do you listen for aortic v?
2nd ICS to R of sternum
29
Where do you listen for pul v?
2nd ICS L of sternum
30
Murmur grading system
``` 1-barely audible 2-soft, but easily heard 3-loud w/o thrill 4-loud w/ thrill 5-loud w/ minimal contact of stethoscope 6-loud, can be heard w/o stethoscope ```
31
Normal right atrial pressure
0-8 mmHg
32
Normal right ventricle pressure
25 mmHg
33
Normal pulmonary artery pressure
30/12
34
Normal systolic vascular resistance
900-1500 dynes/second/cm
35
Normal vascular resistance
155-255 dynes/second/cm
36
Normal pulmonary wedge pressure
8-15 mmHG
37
normal CO
3.5-7 liters/min
38
Normal cardiac index
2.5-4 L/m
39
What is the most important part of a CV assessment?
taking a good patient history
40
What should you first inspect about your pt w/ CV cc?
need to make sure the pt is stable
41
What would distended neck veins suggest?
filling up with pressure & area of concern that needs to be addressed
42
What is Levine sign?
pt is holding chest & abdomen sign of heart attack or unstable discomfort in chest
43
What anatomic abnormalities can contribute to pt complain?
which chamber involved which valve affected is pericardium involved has there been an MI
44
What heart disease is genetically acquired?
hypertrophic cardiomyopathy assoc w/ increase in septal hypertrophy compared to rest of ventricle outlet obstruction
45
What is Marfan's syndrome?
Connective tissue disorder pts prone to aortic aneurysms & sudden death
46
What is prolonged QT syndrome?
prolonged QT interval & more prone to arrythmias
47
Acromegaly
prone to cardiac issues b/c have bi-ventricular dysfunction
48
Cushing's disease
prone to hypertension & cardiac disease b/c elevated cortisol
49
Down's syndrome
pre-disposition to congential heart disease
50
What does clubbing of nails suggest?
interstitial lung disease & congenital heart disease
51
What do hemorrhages under nails suggest?
new pulmonary emboli or endocarditis
52
How are temperature and HR related?
for every 1 degree above normal, increase HR by 10 bpm
53
Barrel chest
AP diameter is equal to transverse diameter of chest COPD
54
Inspection landmarks
Suprasternal notch Sternal angle Midclavicular line Ant axillary line
55
What is the normal PMI (point of maximal impulse)
4th-5th intercostal space @ mid-clavicular line
56
How do you determine central venous pressure?
measure distance of IJV from sternal notch & add 5cm (which is distance of RV from sternal notch) gives you jugular venous pressure
57
What does the A wave indicate?
R atrial contraction (tricuspid valve is open) coincides w/ S1
58
Why is the S2 sound split during inspiration?
because as you inhale, increase venous return to heart takes time for venous return to get up into vessel
59
What may bilateral edema indicate?
heart, lung, kidney disease
60
What is a vscan?
ultrasound to monitor valve function

PCM II Midterm (15 decks)

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