Heart Exam

Question 1

What are the five things a heart exam should include?

Answer 1

History, physical, ECG, x-ray, labs

Question 2

What are some key things you should note on an inspection portion of the physical exam?

Answer 2

face(acromegalic, cushnoid, down’s, hyperthyroid, jaundice, cyanotic, pallor, clubbing of nails, body habitus, hydration, shape of chest, landmarks

Question 3

What are some important things that should be included in a cardiac history?

Answer 3

fatigue, dyspnea, chest pain, palpations, syncope, underlying etiologies, anatomic abnormalities, family history

Question 4

What is the order of a cardiac physical exam?

Answer 4

Inspection, palpation, percussion, auscultation

Question 5

What are some key things to be palpated in the cardiac PE?

Answer 5

apex beat, thrills/turbulent blood flow, PMI over 4th or 5th intercostal space at midclavicular line

Question 6

What are some things to be percussed in a cardiac PE?

Answer 6

cardiac size, start left and move medially to note cardiac DULLNESS

Question 7

Why is it important to inspect JVP?

Answer 7

reflects the activity of the R side of the heart

Question 8

What is the “a” wave?

Answer 8

R atrial contraction, tricuspid valve open, coincides with S1 and precedes carotid pulsation

Question 9

What is the “c” wave?

Answer 9

backward push by TV closure during isovolumetric contraction

Question 10

What is the “x” wave?

Answer 10

Passive atrial filling and relaxation

Question 11

What does a steep x descent indicate?

Answer 11

cardiac tamponade, constrictive pericarditis

Question 12

What is the “V” wave?

Answer 12

atrial filling with TV closed

Question 13

What does a prominent v wave indicate?

Answer 13

pulmonary hypertension, tricuspid regurgitation

Question 14

What does a prominent a wave indicate?

Answer 14

RA/RV obstruction, increased RV pressure, pulmonary hypertension, pulmonary emboli, a-v dissociation

Question 15

What is the “y” slope?

Answer 15

opening of tricuspic valve and rapid RV filling during RV diastole

Question 16

What does an increased JVP indicate?

Answer 16

SVC obstruction, heart failure, pericarditis, cardiac tamponade, RV infarction, cardiomyopathy

Question 17

What does a positive HJR indicate?

Answer 17

Poorly compliant RV, RV failure, constrictive pericarditis, obstructive RV filling by TS

Question 18

What is the S1 sound?

Answer 18

closing of mitral and tricuspid valves

Question 19

What is the S2 sound?

Answer 19

Closing of aortic and pulmonic valves

Question 20

What is the S3 sound?

Answer 20

patho in adults over 40, due to high pressures and abrupt deceleration of inflow across mitral valve at end of filling phase

Question 21

What is the S4 sound?

Answer 21

Atrial gallop from forceful contraction of atria against stiff ventricle

Question 22

What is a split S2 sound?

Answer 22

A split S2 sound is normally heard during inspiration because of increased venous return during inspiration and more time for RV to deliver blood to the lungs

Question 23

Where do you listen for the mitral valve?

Answer 23

5th left ICS at mid clavicular line

Question 24

Where do you listen for the tricuspid valve?

Answer 24

fourth left ICS at LSB

Question 25

Where do you listen for the aortic valve?

Answer 25

second ICS to the R of the sternum

Question 26

Where do you listen for the pulmonic valve?

Answer 26

second ICS to the L of the sternum

Question 27

What is a grade 1 murmur?

Answer 27

barely audible

Question 28

What is a grade 6 murmur?

Answer 28

Loud, heard without stethoscope

Question 29

What is a grade 2 murmur?

Answer 29

Soft, easily heard

Question 30

What is a grade 5 murmur?

Answer 30

loud with minimal contact between chest and stethoscope

Question 31

What is a grade 3 murmur?

Answer 31

loud without a thrill

Question 32

What is a grade 4 murmur?

Answer 32

loud with a thrill

Question 33

What is grading system for pulses?

Answer 33

``` 0- absent 1- barely palpable 2- normal 3- strong 4- bounding ```

Question 34

What is the grading system for edema?

Answer 34

``` 0- absent 1- barely detectable, nonpitting 2- slight indentation, 10-15 sec 3- depper, >1 min 4- marked indentation, 2-5 min ```

Question 35

What is the diaphragm of the stethoscope used to listen for?

Answer 35

high pitched sounds, S1, S2, AR, MR

Question 36

What is the bell of the stethoscope used for?

Answer 36

low pitched sounds, S3, S4, MS, carotid bruit

Question 37

What are systolic murmurs?

Answer 37

between S1 and S2, aortic stenosis, pulmonic stenosis, mitral regurgitation, tricuspid regurgitation

Question 38

What are diastolic murmurs?

Answer 38

between S2 and S1, aortic or pulmonic regurgitation ,mitral or tricuspid stenosis

Question 39

What is a fixed S2 split?

Answer 39

wide split that does not vary with respiration, prolonged right ventricular systole, RV failure or ASD

Question 40

What is paradoxical splitting?

Answer 40

splitting that appears on expiration, typically due to left bundle branch block

Question 41

What is an early systolic ejection?

Answer 41

pathologic halting of aortic and pulmonic valves as they open in systole, indicates CVD

Question 42

What is a systolic click?

Answer 42

usually caused by mitral valve prolapse, squatting often delays the click due to increased venous return while standing moves the click closer to the S1

Question 43

What is an opening snap?

Answer 43

stenotic mitral valve