Cardiac

Question 1

What happens when you hear the ‘dub’ of the heart valves on S2?

Answer 1

The mitral and tricuspid valves open, the aortic and pulmonary valves close

Question 2

Describe the normal electrical pathway for impulses through the heart

Answer 2

SA node - to AV node - to Bundle of His - to Left and Right Bundle branches - to Purkinje Fibres

Question 3

What are the 5 main vessels that transport blood to and from the heart?

Answer 3

Aorta
Pulmonary artery
Pulmonary vein
Inferior vena cava
superior vena cava

Question 4

Name 3 things you may consider as part of your general inspection

Answer 4

Pallor
Equipment
Mobility

Question 5

What 7 things could cause an absent, palpable apex beat?

Answer 5

Obesity
Muscle
Emphysema
Left ventricular dilation
Chest Deformity
Dextocardia
Death

Question 6

Why is calf palpation included within a CVS examination?

Answer 6

To assess for oedema or signs of a DVT

Question 7

What are 3 symptoms of the hands that can be caused by endocarditis?

Answer 7

Splinter haemmorhage
Janeway lesions
Osler nodes

Question 8

What are palpable heaves associated with?

Answer 8

Right ventricular hypertrophy

Question 9

True or False: Is malar flush associated with mitral valve stenosis or CO2 retention?

Answer 9

True

Question 10

What 4 things are you including when conducting a specific examination of the neck?

Answer 10

Position of the trachea
Nodes
Surgical Emphysema
JVP

Question 11

List 3 causes of palpitations

Answer 11

Thickening of heart muscle
Amphetamines
Anxiety

Question 12

What could cause a decreased or absent tactile fremitus?

Answer 12

Pleural Effusion
Pneumothorax

Question 13

Name 6 causes for a raised JVP

Answer 13

Heart Failure
PE
Pericardial Effusion
Pericardial Constriction
Superior Vena Cava Obstruction
Pulmonary Hypertension

Question 14

What is happening to the heart valves when you hear the lub on S1?

Answer 14

The mitral and tricuspid valves are closing

The aortic and pulmonary valves are opening

Question 15

Describe the blood flow from the lungs through the CVS system and back out.
Start with the blood arriving in the left atrium.

Answer 15

Blood arrives in the left atrium via the pulmonary vein

Goes through the mitral valve

To the left ventricle

Through the aortic valve/aorta

Round the body/head - gases exchanged from organs and tissues

Back to the heart via the super vena cava/inferior vena cava

Into the right atrium

Through the tricuspid valve

Into the right ventricle

Through the pulmonary valve

Into the pulmonary artery to the lungs - gas exchange

Question 16

What are you listening to when you listen for cardiac sounds?

Answer 16

Lub (S1): Aorta and Pulmonary opening
Mitral and Tricuspid closing

Dub (S2): Aorta and Pulmonary closing
Mitral and Tricuspid opening

Question 17

What is the difference between regurgitation and stenosis?

Answer 17

Regurgitation: valve failing to close

Stenosis: valve failing to open

Question 18

How does MI cardiac chest pain present?
Pain - location, quality, radiation, associations, risk factors

Answer 18

Chest pain: pressure, tight, heavy, often diffuse
Radiation: neck, jaw, shoulders
PMH: cardiac risk factors, possible recent episodes of chest pain
Possible FH of heart disease
Associations: palpitations, nausea, sweating, SoB

Question 19

List 10 cardiac clinical signs in the hands

Answer 19

Clubbing: Chronic Heart Disease
Nicotine Staining: smoking = increased risk of cardiorespiratory disease
Splinter haemorrhage: endocarditis
Janeway Lesions: endocarditis
Oslar Nodes: endocarditis
Cyanosis: poor perfusion
Temperature: hot = pyrexia/infection, cold = peripherally shut down, warm = CO2 retention
Beau’s Lines: chronic disease
Xanthomata: high cholesterol
Palmer Creases: anemia

Question 20

List 8 cardiac clinical signs in the face

Answer 20

Corneal Arcus: high cholesterol
Xanthalasma: high cholesterol
Pale conjunctiva: anaemia
Atrophic glossitis: anaemia
Angular chelitis: anaemia
Central Cyanosis: hypoxia
Pursed lips: respiratory distress
Malar Flush: mitral valve stenosis, CO2 retention

Question 21

When assessing a JVP - what could you do it you weren’t sure it was a JVP?

Answer 21

Palpate it - JVP does not have a pulse

It connects to the right atrium without any valves

Question 22

What are the 6 possible causes of a raised JVP?

Answer 22

Heart Failure
Pulmonary Embolism
Pulmonary Hypertension
Pericardial Effusion
Pericardial Constriction
Supervena Cava Obstruction

Question 23

List 7 reasons why you may not be able to palpate the apex beat

Answer 23

Obesity
Muscle
Death
Emphysema
Chest Deformity
Dextrocardia
Left Ventricular dilation

Question 24

What would identifying heaves tell you?

Answer 24

Right ventricular hypertrophy

Question 25

When assessing a pulse, what 4 things are you considering?

Answer 25

Rate Rhythm (regularity) Character (bounding/thready) Volume (strong/weak)

Question 26

Name 9 things you would look for when conducting a general cardiac inspection

Answer 26

General Demeanour Colour Odour Gait Breathless Posture Carers Agitation Peripheral Oedema

Question 27

How do you assess the JVP?

Answer 27

30-45 degree angle Look at height of JVP from sternum/angle of Louis Should be less than 4cm

Question 28

What do you look for in a specific cardiac inspection?

Answer 28

Scars (e.g. sternotomy) Visible implanted devices (pacemaker) Oedema Oxygen Therapy Chest Drains Arm span greater than height (Marfans) Obvious chest deformity (scoliosis/barrel chest/pectusexcavatum) Abnormal Pulsations Obvious distended chest wall vessels = low central venous oxygen

Question 29

Name the 8 pulses

Answer 29

Radial Ulnar Brachial Carotid Femoral Popliteal Dorsalis Pedis Posterior Tibial

Question 30

What 6 things might you assess for in the pulses?

Answer 30

Rate Character Rhythm Radial-Radial Delay: aorta issue Radial-Femoral Delay: aorta issue Collapsing Pulse: aorta issue

Question 31

How do you palpate the apex beat?

Answer 31

Left mid-clavicular line, 5th intercostal space

Question 32

Where do you listen for the aortic, pulmonary, tricuspid and mitral valves?

Answer 32

Aortic - right sternal edge, 2nd intercostal space Pulmonary - left sternal edge, 2nd intercostal space Tricuspid - left sternal edge, 4-5th intercostal space Mitral valve - left mid-clavicular, 5th intercostal space

Question 33

Where might you check for radiation when listening to the heart valves?

Answer 33

Carotid and axilla - can help localise heart murmur

Question 34

What should you do before using stethoscope?

Answer 34

Check turned on , check using correct side

Question 35

Name 3 signs in the hands of endocarditis

Answer 35

Janeway Lesions Oslar Nodes Splinter Haemorrhage

Question 36

When assessing the calves, what are you looking for?

Answer 36

Swelling of leg/calf Pain - worse on standing/walking Warmth and redness Pitting oedema and where it extends to May measure calves/consider WELLS

Question 37

If you hear a whoosh when listening to the heart sounds - what could this mean?

Answer 37

A heart murmur - regurgitation or stenosis = faulty valve Patent ductus arterioles (little ones)

Question 38

What should you do if you cannot hear the apex beat?

Answer 38

Get the patient to sit up, turn to the right and lean forward

Question 39

What should you do if you cannot hear heart sounds?

Answer 39

Get the patient to lean forward Palpate the carotid or radial pulse to ignore breath sounds

Question 40

Which valves are the semilunar valves?

Answer 40

Aortic and pulmonary

Question 42

Which valves are the atrioventricular valves?

Answer 42

Mitral and tricuspid