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Physical Assessment > Cardiac exam > Flashcards

Cardiac exam Flashcards

(96 cards)

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1
Q

Which splitting heart sound is louder?

A

A2

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2
Q

why is A2 usually louder?

A

because of the high pressure of the aorta - heard throughout the precordium

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3
Q

Why is P2 usually soft?

A

it reflects the low pressure of the pulmonary artery

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4
Q

Where is the splitting of S2 heard the best ?

A

2nd and 3rd intercostal spaces close to the sternum

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5
Q

What are the 2 components of S1?

A

early mitral and late tricuspid

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6
Q

Where do you hear the mitral part of S1?

A

through precordium and loudest at the apex

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7
Q

Where do you hear the tricuspid part of S1?

A

lower left sternal border

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8
Q

What heart sound is louder with inspiration?

A

S2 - this is what potentially causes the splitting of the sounds into A2 and P2

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9
Q

What is a heart murmur distinguished by?

A

pitch and duration

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10
Q

what does a heart murmur usually diagnostic of?

A

turbulent blood flow usually indicating valvular heart disease

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11
Q

What is a stenotic valve?

A

an abnormally narrowed valvular orifice that obstructs blood blow as in aortic stenosis

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12
Q

What is a valve that fails to close fully create?

A

aortic regurgitation

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13
Q

order of cardiac exam?

A

inspect, palpate, auscultate

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14
Q

what are you inspecting on the skin for the cardiac exam?

A

malar flush (redness/flushness of skin due to mitral stenosis) , pallor, cyanosis, edema

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15
Q

what are you inspecting the cornea for?

A

Cornea arcus

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16
Q

What is cornea arcus?

A

gray- white discoloration around the cornea that is indicative of hyperlipidemia

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17
Q

what are you inspecting around the eyes for

A

xanthelasma - yellowish cholesterol deposits around the eye

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18
Q

why do you perform a fundoscopic exam for cardiovascular?

A

look for retinopathy and roth’s spots

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19
Q

What are roth’s spots ?

A

pale - centered hemorrhages that occur in bacterial endocarditis

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20
Q

what are you checking on inspection of nails?

A

clubbing, color, capillary refill, lesions

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21
Q

what is the examination of the jugular veins meauring?

A

indirect measure of volume status

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22
Q

What are you checking for while inspecting the carotids?

A

pulsations, amplitude,timing

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23
Q

What is CVP (central venous pressure)?

A

Pressure in the venae cavae (near the R atrium)

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24
Q

What can you observe to monitor a patient’s CVP?

A

the external jugulars

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25
At what position can you visualize a healthy persons jugular pulsation?
semirecumbent at 7cm above the atrium
26
When could you notice a abnormally high CVP?
when a patient is sitting upright
27
what is a normal JVP?
6-8 cm/H20
28
What are the abnormalities of JVP?
jugular venous distention, flattened neck veins
29
What is jugular venous distention (JVD) caused by?
Right HF, Chronic L HF, Constrictive pericarditis, tricuspid stenosis, cardiac tamponade
30
if a patient presents with flattened jugular veins what would you be concerned by?
hypovolemia
31
What is the first step to a carotid exam ?
auscultate
32
What do you need to be aware of while palpating the carotids?
carotid sinuses
33
If a person is palpating the carotids and they palpate both at the same time is that okay?
no, do not palpate at the same time
34
Why do we check the carotid pulses?
this is a clue for vascular occlusion, indication of hemodynamics of L heart, indication of aortic valve disease, helps to evaluate severity of aortic stenosis
35
what is the best way to evaluate the severity of aortic stenosis?
evaluation of the carotids
36
What is the phenomenon "pulsus parvus et tardus" refer to?
Weak (parvus) and delayed (tardus) carotid upstroke
37
when should we feel the carotid pulse?
at S2
38
when is timing delayed and amplitude decreased?
aortic stenosis
39
What side of the heart does the CVP evaluate?
right side - because its chekcing the jugular
40
What side of the heart does the JVP evaluate?
right side
41
When would you feel pulsus parvus et tardus ?
with aortic stenosis
42
What causes a bruit?
it is a swishing sound caused by blood flow through a partially obstructed blood vessel or a localized increased rate of blood flow in an unobstructed vessel
43
What is a carotid bruit usually indicative of?
carotid artery disease - blood flowing through the stenotic vessel making a swishing sound
44
What is a good estimate of fluid volume in the body?
CVP / JVP
45
What is JVP?
estimate of CVP (central venous pressure)
46
When palpating the precordium what part of the hand do you use?
the palmar surface
47
What do you palpate with your palmar surface when palpating the precordium ?
Aortic, pulmonic, parasternal (accessory aortic), apical area (tricuspid and mitral)
48
What sounds are you looking for at the parasternal area?
heaves, thrills, lifts
49
where is the PMI usually located
the point of maximal impulse is usually located at the apex
50
What does the PMI (located at the apex) usually correlate with ?
LV
51
If you feel a thrill- what is this caused by?
turbulent blood flow that causes a vibiratory senstion
52
If you heard a heave / thrill where would this be located?
3rd and 4th parasternal space
53
if you heard a heave/thrill in an older adult thoughout systole, what would this be indicative of?
right ventricular hypertrophy or heart failure
54
when is hearing a heave/thrill normal?
in small children or thin adults
55
WHat is the most common cause of RV failure?
LV failure
56
What could chronic LV failure cause?
jugular distention
57
Where is a normal PMI heard?
4th and 5th intercostal space + midclavicualr line
58
How many intercostal spaces would a normal PMI be heard at ?
1 intercostal space
59
What is a normal amplitude of PMI?
brisk/ tapping
60
What position would you hear a normal PMI best at?
supine but also heard good at LL decubitus
61
Why would you hear an abnormal PMI location?
LV hypertrophy, pregnancy, thoracic abnormalities
62
Where do you hear the aortic area?
right upper sternal border - 2nd intercostal space
63
Where do you hear the pulmonic area?
2nd intercostal space at the Left sternal border
64
Where do you hear the accessory aortic area?
3rd and 4th left sternal border
65
Where do you hear the tricuspid area?
Left lower sternal border at the 4th and 5th intercostal space
66
Where do you hear the mitral area?
the apex!! the 5th intercostal space at the midclavicular line
67
What should the head of bed be angled at for supine auscultation?
30-45 deg
68
WHat heart sounds can you hear better at LL decubitus ?
S3, S4, mitral murmurs
69
What heart sounds can you hear best supine?
aortic murmurs, pericardial rubs
70
What part of the stethoscope do you use to hear high pitched heart sounds (S1,S2)?
diaphragm
71
What part of the stethoscope do you use to hear aortic regurgitation?
Diaphragm
72
What part of the stethoscope do you use to hear mitral regurgitation?
diaphragm
73
what part of the stethoscope do you use to hear the opening of mitral stenosis?
diaphragm
74
What part of the stethoscope do you use to hear a pericardial friction rub?
diaphragm
75
What part of the stethoscope do you use to hear mitral stenosis?
bell
76
what part of the stethoscope do you use to hear low pitched sounds (S3,S4) ?
bell
77
Where is S1 sound heard the best?
LLSB and Apex
78
Where is the S2 sound heard the best ?
base of the heart
79
When should you hear the splitting of S2?
inspiration
80
is a S4 sound normal?
no, usually pathologic
81
in S2 does the aortic valve or pulmonic valve close first?
the aortic valve - due to the higher pressure
82
What are the 2 abnormal splittign sounds of S2?
Fixed splitting, reversed (paradoxical splitting)
83
What causes fixed splitting?
no alteration between inspiration and expiration - due to RVF (right ventricle leads out to the pulmonic valve ) and septal defect
84
What is a reversed (paradoxical) splitting sound caused by?
splitting on expiration - caused by L BBB
85
What usually causes S3?
When blood rushes quickly into the ventricles
86
When is S3 usually heard in children and young adults?
early diastole
87
When is S3 usually pathalogic?
in older adults - usually due to blood rushing into an already filled ventricle due to a decrease in EF or result of CHF
88
What is referred to as a ventricular gallop?
pathologic S3 with tachycardia
89
When do you see S3?
in volume overload states
90
If a person has S3- what could you consider the ddx to be?
CHF, advanced MR or TR, VSD, Dilated cardiomyopathy
91
When is a ventricular gallop heard?
in volume overloaded states
92
When is a atrial gallop heard?
in pressure overloaded states
93
What causes an S4 sound?
when the atria contract- they are contracting against a stiffened ventricle which causes an increase in the force of contraction so it can overcome resistance.
94
When would you see a S4 sound?
in pressure overload states - hypertrophic cardiomyopathy, aortic stenosis, HTN
95
What sound can be a sign of systolic CHF?
S3
96
What sound could be a sign of diastolic CHF?
S4

Physical Assessment (3 decks)

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