Heart Exam

Question 1

Apical impulse/PMI

Answer 1

pulsations of LV as it moves anteriorly during contraction & touches chest wall

Located at 5th ICS mid-clavicular line

Diameter: Supine

Question 2

S1

Answer 2

Closure of AV Valves
Mital (L)
Tricuspid (R)

Question 3

S2

Answer 3

Closing of Semilunar valves
Splitting with inspiration is normal, causes pulmonic valve to open first and close last
You hear Aortic Valve then Pulmonic Valve

Question 4

S3

Answer 4

Ventricular Gallup
Heard just after S3
Normal in kids, young adult
Pathologic in older adults

Question 5

S4

Answer 5

Atrial Gallup
Heard just before S1
Always Pathologic

Question 6

Correlating cardiac & carotid sounds

Answer 6

S1 occurs just before carotid upstroke

S2 occurs just after carotid upstroke

Question 7

Jugular venous pressure (JVP)

Answer 7

Provides clinical index of right heart pressures and cardiac function

Reflects right atrial pressure

Measured distance + 5 cm = JVP

JVP >9cm above RA is abnormal

Question 8

Elevated JVP

Answer 8

Right sided CHF
Less common-constrictive pericarditis, tricuspid stenosis, superior vena cava obstruction

98% specific for low LV ejection fraction and increases risk of death from heart failure.

Question 9

JVP A-wave

Answer 9

RA Contraction

just precedes S1 and the carotid pulse.

Question 10

JVP- X decent

Answer 10

RA relaxation

seen late in systole just before S2

Question 11

JVP- V wave

Answer 11

RA filling and increasing pressure

almost coincides with S2

Question 12

JVP Y wave

Answer 12

RA emptying

follows S2 early in diastole

Question 13

Prominent a wave

Answer 13

increased resistance to RA contraction

Tricuspid stenosis, 1st degree AV bock, SVT, junctional rhythms, pulm. HTN and pulm. stenosis

Question 14

Absent a waves

Answer 14

atrial fibrillation

Question 15

Large v waves

Answer 15

tricuspid regurgitation

Question 16

Still’s murmur

Answer 16

Innocent Murmur
Mid-systolic, best left lower sternal border
Musical quality
Louder in supine position

Question 17

Venous hum

Answer 17

Innocent Murmur
Continuous humming, best right upper sternal border
Flow of venous blood from head & neck into thorax
Continuous while sitting
Disappear light pressure over the jugular vein, when the child’s head is turned or when the child is lying supine