Cardiovascular

Question 1

What is the 5 finger method of the heart?

Answer 1

history, physical, ECG, imaging, and labs

Question 2

What are the 4 parts of cardiovascular exam?

Answer 2

inspection, palpation, percussion, and auscultation

Question 3

What is the PMI? Where is it normally palpated?

Answer 3

Point of maximal impulse/apex beat -> lower border of heart at LV

• if pt is upright, 5th left ICS, slightly medial to midclavicular line
• if pt is supine at 45 degrees, 4-5th ICS at midclavicular line

Question 4

When is percussion done?

Answer 4

When PMI not detectable -> start far left (resonance) and move medially to find cardiac “dullness”

Question 5

What are the 4 listening posts for the heart? Where are they located?

Answer 5

Aortic - 2nd ICS at RSB
Pulmonic - 2nd ICS at LSB
Tricuspid - 4th ICS at LSB
Mitral - 5th ICS at left mid central lobe

Question 6

What causes S1?

Answer 6

mitral and tricuspid closure; beginning of ventricular systole

Question 7

What causes S2?

Answer 7

aortic and pulmonic closure; marks end of ventricular systole and beginning of diastole

Question 8

What is physiologic splitting of S2?

Answer 8

occurs during inspiration b/c of increased venous return during inspiration and more time for RV to deliver blood to lung (delayed P2)

Question 9

What causes S3?

Answer 9

due to high pressures and abrupt deceleration of inflow across mitral valve at end of rapid filling phase; heard just after S2; normal in children and young adults

Question 10

What causes S4?

Answer 10

atrial gallop from forceful contraction of atria against a stiffened ventricle; heard just before S1; can be normal in trained athletes

Question 11

What is the grading system (I-VI) for murmurs?

Answer 11

I - barely audible
II - soft but easily heard
III - loud w/o thrill
IV - loud w/ thrill
V - loud w/ minimal contact between stethoscope and chest (thrill)
VI - loud and can be heard w/o stethoscope (thrill)

Question 12

What do the jugular veins reflect?

Answer 12

reflect activity of right side of heart

Question 13

What is normal value for JVP? What is most common cause of elevated JVP?

Answer 13

Normal = 0-9
Elevated = elevated RB diastolic pressure; SVC obstruction; severe heart failure; RV infarction; cardiac tamponade

Question 14

What is HJR? What can cause it?

Answer 14

RV failure; constrictive pericarditis; obstructive RV filling by RA tumor

Question 15

How do you document pulses?

Answer 15

0/4 = absent
1/4 = barely palpable
2/4 = normal
3/4 = stronger than average
4/4 = bounding

Question 16

What side of the stethoscope do you use to auscultate carotid arteries, S3, and S4?

Answer 16

Bell

Question 17

What is normal capillary refill time?

Answer 17

< 2 seconds

Question 18

Where do you check for edema (3)?

Answer 18

dorsal of foot; behind medial malleolus; anterior tibia (shin)

Question 19

Define regurgitation

Answer 19

turbulent flow sound when blood is moving in opposite direction from what it should

Question 20

Define stenosis

Answer 20

turbulent flow when blood is moving through a stiff, damaged valve

Question 21

What valves are opened/closed during ventricular systole?

Answer 21

Aortic and pulmonic open

Tricuspid and mitral closed

Question 22

What valves are opened/closed during ventricular diastole?

Answer 22

Aortic and pulmonic are closed

Tricuspid and mitral open

Question 23

What makes right heart murmurs (tricuspid and pulmonic) louder?

Answer 23

inspiration

Question 24

What makes left heart murmurs (aortic and mitral) louder?

Answer 24

expiration

Question 25

How does preload affect murmur sounds?

Answer 25

increased preload = louder murmur | decreased preload = softer murmur

Question 26

What occurs to murmur sounds in pts w/ hypertrophic cardiomyopathy (HOCM)?

Answer 26

increased preload improves aortic murmur by pushing septum away from aortic outflow and allowing blood to be ejected more easily; decreased preload worsens murmur

Question 27

What occurs to murmur sounds in pts w/ mitral valve prolapse (MVP)?

Answer 27

leaflets of mitral valve prolapse into LA under normal pressure; increasing preload improves mid-systolic click by allowing prolapsed leaflets to return to normal orientation

Question 28

How does afterload affect murmurs? What are the exceptions?

Answer 28

Increased afterload = louder murmur Decreased afterload = softer murmur Exceptions = HOCM and MVP (increased afterload = softer murmur)

Question 29

What type of murmur is caused by aortic stenosis? Most likely presentation?

Answer 29

crescendo-decrescendo murmur; calcified aortic valve; radiates up to the carotids

Question 30

What type of murmur is caused by mitral regurgitation? Most likely presentation?

Answer 30

holosystolic murmur -> plateau shaped loud blowing murmur; decreased S1; best heard at apex; radiates to axilla; usually caused by rheumatic fever

Question 31

What type of murmur is caused by tricuspid regurgitation? Most likely presentation?

Answer 31

holosystolic murmur; history of IVDA (IV drug abuse)

Question 32

What type of murmur is caused by aortic regurgitation? Most likely presentation?

Answer 32

early blowing diastolic murmur; found in pts w/ connective tissue disorders, marfan's syndrome, "head-bobbing", water hammer pulse and femoral bruits

Question 33

What type of murmur is caused by mitral stenosis? Most likely presentation?

Answer 33

opening "snap" murmur; found in pt's w/ history of rheumatic fever

Question 34

What is seen in FHx for hypertrophic cardiomyopathy (HOCM)?

Answer 34

FHx of sudden cardiac death at young age

Question 35

What is heard in pt's w/ MVP? What is a common clinical presentation?

Answer 35

midsystolic "click" | commonly seen in young women w/ psychiatric history

Question 36

What is another name for MVP?

Answer 36

myxomatous valvular disease

Question 37

What does the Allen test evaluate?

Answer 37

function of radial and ulnar arteries