Cardiovascular Examination Flashcards by Jasmine Watts

What is the mediastinum?

Connective tissue-lined compartment located centrally in the thoracic cavity
*Houses the heart and the vessels
*Aorta, pulmonary arteries
* Superior and inferior vena cava

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Which ventricle is the most anterior structure of the heart?

Right ventricle

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What are the atrioventricular valves/

Mitral and tricuspid valves

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What are the semilunar valves?

Aortic and pulmonic valves

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What are the heart sounds produced when the heart valves close/

S1 and s2

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During systole what valves are open and closed?

Open: Pulmonic and aortic
Closed: Mitral and tricuspid
*To prevent backwards blood flow

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During diastole which valves are open and closed?

Open: Mitral and tricuspid
Closed: Pulmonic and aortic

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What is the cardiac cycle/=?

The complete movement of the heart
*One heartbeat to the beginning of the next heartbeat

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Describe systole

Period of ventricular contraction
*When the left ventricle ejects blood into the aorta

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Describe diastole

ventricular relaxation
*once the ventricle ejects much of the blood into the aorta, the pressure levels start to fall off

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During systole what valves are open and closed?

The aortic valve is open
*allowing ejection of the blood from the LV into the aorta
Mitral valve is closed
*Preventing blood from regurgitating back into the left
atrium
Tricuspid valve is closed
*When blood is ejected from the right ventricle into the pulmonary artery

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During diastole which valves are open or closed?

Aortic valve is closed (Pulmonic)
*Preventing regurgitation of the blood from the aorta back into the left ventricles
Mitral valve is open
*Allowing blood to flow from the left atrium into the relaxed left ventricle
Tricuspid valves opens
*As blood flows into the relaxed right ventricle

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What produces heart sound S1

Closure of the mitral valves and the tricuspid valve
*right side of the heart
*Systole

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What corresponds with systolic blood pressure?

Maximal Left ventricular pressure

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What produces heart sound S2?

Aortic valve closure and pulmonic valve closure
*diastole begins

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What is an opening snap?

Happens during mitral stenosis
*opening of the mitral valve
*early diastolic sound
*High pitched (diaphragm)

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What happens during systole?

Ventricles contract
*the RV pumps blood into the pulmonary arteries (Pulmonic valve is open)

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What happens during diastole?

Ventricles Relax
*Blood flows from RA to RV (Tricuspid valve is open)
Blood flows from LA to LV (Mitral valves is open)

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What is the definition of preload?

Volume overload
*Load that stretches the cardiac muscle before contraction
*volume of blood in the right ventricle at the end of diastole

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What is the definition of myocardial contractility?

Ability of cardiac muscle to contract in systole

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What is the definition of afterload?

Pressure overload
*degree of vascular resistance to ventricular contraction
*Pressure that the left ventricle is overcoming

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What is the definition of cardiac output?

Stoke volume X Heart rate
*The volume of blood ejected from each ventricle in 1 minute

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What is the definition of stoke volume?

The volume of blood ejected with each heartbeat

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What is blood pressure?

Cardiac output X systemic vascular resistance

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Where is the aortic listening post located?

Right 2nd interspace

Where is the pulmonic listening valve located?

Left 2nd interspace

Where is the right ventricular listening post located?

Left sternal border

Where is the left ventricular (mitral) listening post located?

Apex of the heart

Where is the tricuspid listening post located?

Epigastric

Which part of the physical examination is usually rarely performed in the CV exam?

Percussion

What is a cause of clubbing?

Chronic hypoxia

What is orthostatic blood pressure?

Reduction of SBP of at least 20mmHG OR DBP of at least 10mmHG

What does the jugular venous pressure represent?

Right atrial pressure

How is JVP best estimated from?

From the right internal jugular vein

What is the difference between the Internal jugular vein and carotid artery?

IJV: Not palpable, soft, 2 elevation, between 2 heads of sternocleidomastoid muscle Carotid: Palpable, vigorous thrust, height unchanged by position or inspiration

What type of lighting do you use to examine the neck vessels?

Tangential lighting

How is the carotid pulse best heard?

With the bell

What are the different types of upstroke with the carotid pulse/

Brisk: Normal Delayed: Aortic stenosis Bounding: Aortic insufficiency

What is a thrill when feeling for the carotid pulse?

Palpable vibrations with Palpation of the carotid

What is a bruits when listening to the carotid pulse?

Murmur-like sounds airing from turbulent arterial blood flow

When do you use your finger pads during Palpation of the cardiac exam/

Feeling for heaves and lifts

When do you use the palmar aspects of the MCPJ’s during Palpation of the cardiac exam?

Feeling for thrills *Grade IV or higher murmur

What is the apical pulse (point of maximal intensity)?

Brief early pulsation of the left ventricle as it moves anteriorly during contraction and contracts the chest wall

Where is the point of maximal intensity located?

Found inn the fifth intercostal space OR medial to the left mid clavicular line

When do you use the diaphragm?

For higher pitched sounds *S1 and S2 *Murmurs of aortic and mitral regurgitation *Pericardial friction rubs

When do you use the bell?

For lower pitched sounds *S3 and S4 *Mitral stenosis

What side do you use in the left lateral decubitus position?

The bell *listening over the mitral area

Which side do you use in the seated, leaning forward position?

Diaphragm *aortic, LSB, apex

What are the different types of heart sounds/

S1 (LUB) *systole S2 (DUB) *diastole

What produces S1?

Closure of the mitral and tricuspid valves *systole/contraction

What produces S2?

Closure of the aortic and pulmonic valves *diastole/ relaxation

When is S1 heard louder than S2?

At the apex

When is S2 heard best?

At the base

What are the two components of S2?

A2: Aortic (loudest) P2: Pulmonic

When is a split S2 heard best?

Heard best with inspiration (pulmonic area)

Where does fixed splitting occur?

In atrial septal defect and right ventricular failure

What is a S3 heart sound (ventricular gallop)

-Early diastolic sound -Older patients: may indicate heart failure -LUB Dub ta - best heard at LLD bell

What causes a S3 heart sound

Rapid ventricular filing -When mitral valve opens -heard best at apex in LLD with bell

What is a S4 heart sound (atrial gallop)

Late diastole (just before S1) - when atria contract to force blood into left ventricle Ta LUB Dub

What is a cause of a S4 heart sound

Increased resistance to ventricular filling

What is an opening snap?

Very early diastolic sound Caused by a stenotic mitral valve -best heard with the diaphragm (mitral area)

What grade of murmur produces a thrill?

4/6 and up

What are the most common type of systolic murmurs?

Midsystolic ejection murmurs

Where are innocent (systolic) murmurs located?

LSB -Turbulent blood flow from left ventricle to aorta

Where is aortic stenosis located (pathological systolic murmur)

Right 2nd and 3rd ICS -turbulent blood flow increases left ventricular afterload

What is a pulmonic stenosis murmur (pathological systolic)

Left 2nd and 3rd ICS Valvular stenosis impairs flow across the valve, increasing right ventricular afterload *congenital

What is a mitral regurgitation murmur/

Located at the apex -mitral valve fails to close fully in systole, blood regurgitates from left ventricle to left atrium, increasing left ventricular pre-load

What is tricuspid regurgitation? (Systolic murmur)

Location: LLSB -tricuspid valve. Fails to close fully in systole, blood regurgitates from right ventricle to right atrium

What is a ventricular septal defec?

-opening between the ventricles -will be a continuous murmur in both systole and diastole

What is aortic regurgitation murmur? (Diastolic)

-aortic valve leaflets fail to close completely during diastole -blood regurgitates from aorta back into the left ventricle

What is mitral stenosis? (Diastolic murmur)

Rapid ventricular filling over thickened, stenotic valve causes turbulent blood flow MC cause: rheumatic fever Opening snap follows S2

What is a continuous murmur?

Patent Ductus Ateriosus -opening between pulmonary artery and aorta -Machinery-like -Left 2nd ICS

When are ejection clicks heard?

Heard in systole

When are opening snap heard?

Heard in diastole -heard in mitral stenosis

What is a pericardial fricition rub/

Coarse grating sounds *left 3rd ICS

What is Ms. ARD

Mitral Stenosis and Aortic Regurgitation (Diastolic murmurs)

What is Mr. PASS

Mitral Regurgitation, Physiolgic and Aortic Stenosis (systolic murmurs)

Gradin of pitting edema

1+ 2mm 2+ 4mm 3+ 6mm 4+ 8mm

How do varicose veins happen?

Valves become incompetent

What are the 5 P’s of acute arterial occlusion

Pain Pallor Pulselessness Parenthesias Paralysis

Cardiovascular Examination Flashcards

(80 cards)