Module 2: Cardiovascular Exam Flashcards by Love Roa

What make up the atrioventricular (AV) valves & what is their purpose?

•Tricuspid
• mitral (bicuspid)
One way blood flow that separates atrium from the ventricles

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What make up the semilunar valves & what is their purpose?

• pulmonic
• aortic
One way blood flow that separates pulmonary trunk& atrium

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What is cardiac output & what factors affect this?

Volume of blood ejected from ventricles over 1 minute
Affected by:
• HR
• stroke volume

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What is stroke volume & what does it depend on?

The amount (volume) of blood ejected w/ each heartbeat influenced by:
•Preload
• myocardial contractility
• after load

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What is pre-load & at what part of the cardiac cycle does it occur?

Amount of blood in ventricles at the end of diastole

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What are some factors that increase pre-load?

Any increased venous return to the heart such as:
• inspiration
• exercise
• dilated right ventricle in heart failure

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What are some factors that decrease pre-load?

Any decreased venous return to the heart such as:
• exhalation
• Decreased ventricular output
• pooling of blood in the periphery: capillary bed or venous system

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How does inspiration increase pre-load in the ventricles?

Decreased thoracic pressure allows more blood back to the heart

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How is myocardial contractility increased & what are some examples?

Stimulation by sympathetic nervous system
- fight or flight
> organs are mobilized & their functions during stress and arousal
Ex) exercise, stress, fear

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What happens when there is decreased contractility and what can influence this?

Blood Flow or O2 delivery to myocardium is impaired

^ age = decreased elasticity of muscles

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What is after-load & what happens when there is an increase in after-load?

Amount of pressure/vascular resistance that the heart has to contract against
Increased resistance in after-load = decreased cardiac output
- left ventricle has to work harder to get the blood out

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What factors resist contractility of the heart & increase after-load in the ventricles?

Tone in walls of aorta
Tone in large arteries (ex: subclavian steal)
Volume of blood in aorta

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What factors influence Ventricular function of the heart & how can this be detected on physical exam?

• volume overload
• pressure overload
PE: change in palpable pulses & heart sounds

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What happens when there is a pathological increase in pre-load?

Ventricular dilitation → volume overload

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What happens when there is a pathological increase in after -load?

Stiffness in blood vessels making it hard to pump blood out of ventricles → atherosclerosis

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What is being evaluated on inspection of the precordium?

evidence of trauma
bony abnormalities
Skin abnormalities
Vascular congestion
visible lifts or heaves

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on inspection of the precordium, patient’s chest wall extrudes & looks like a pigeon. what is this bony abnormality called?

pectus carinatum.

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on inspection of the precordium, patient’s chest wall has an inward depression & looks like a funnel. what is this bony abnormality called?

pectus excavatum

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how/where would you palpate the precordium for lifts/heaves & what do they feel like? what can they indicate?

light palpation using fingertips -> R & L 2nd ICS, L 4th ICS, & 5th ICS MCL
> impulse will noticeably raise your hand from the chest wall

*indication that cardiac output is increased 
Examples: Hypertrophy, Heart failure
-anemia
-anxiety
-HTN
-fever

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how would you palpate the precordium for thrills & what do they feel like? what can they indicate?

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pressure over valvular areas using the palm of your hand -> R & L 2nd ICS, L 3rd ICS, & 5th ICS MCL 
> Vibratory sensation 
Indication of: 
-Grade IV or higher murmur
-ventricular or atrial septal defects

what is the PMI and where is it located in healthy patients?

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Point of maximal impulse
Felt at the apex of the heart- inferior tip of heart/left lateral border
L 5th ICS MCL

what ventricle makes up majority of the anterior cardiac surface?

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right ventricle

what ventricle makes up the left lateral border of the heart? what is it used to locate?

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left ventricle

-PMI

what abnormalities can lateral displacement of the PMI indicate?

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LVH
ventricular dilatation
thoracic deformities

what abnormalities can medial displacement of the PMI indicate?

RVH

what abnormalities can upward displacement of the PMI indicate?

pregnancy | high left hemi-diaphragm (5th -> R or L 4th ICS)

what limitations can impact palpation of the precordium & locating the PMI?

body habitus • Thickened chest wall • Increased AP diameter • Breast tissue

what can percussion of the precordium be used for?

- estimation of approx. heart borders & configuration - detecting heart enlargement - detection of dextrocardia or situs inversus

if percussion of the precordium reveals dextrocardia, what does this indicate?

the position of the heart, specifically the apex, is pointed towards the right side of the chest instead of the left

if percussion of the precordium reveals situs inversus, what does this indicate?

mirror-image transposition of internal organs ( very rare condition ) -heart will be on the right side

what diagnostics have replaced percussion?

CXR | echo

what type of sounds is the bell used to auscultate for in the precordium?

More sensitive for low-frequency sounds

what type of sounds is the diaphragm used to auscultate for in the precordium?

Used for high-frequency sounds

what organ is associated with the RIGHT 2nd ICS and what sound is heard upon auscultation?

aortic area - closure of the aortic valve

what organ is associated with the LEFT 2nd ICS and what sound is heard upon auscultation?

Pulmonic area - closure of the pulmonic valve

what organ is associated with the LEFT 4th ICS and what sound is heard upon auscultation?

tricuspid - closure of tricuspid valve

what organ is associated with the LEFT 5th ICS and what sound is heard upon auscultation?

mitral - closure of mitral valve

where is Erb's point located on the precordium & what abnormality is it used to detect on auscultation?

LEFT 3rd ICS | aortic valve regurgitation

what valves are involved in S1 and what part of the cardiac cycle is it associated with?

* Closing of mitral and tricuspid valves | * Associated with the START of systole

what valves are involved in S2 and what part of the cardiac cycle is it associated with?

* Closing of aortic and pulmonary valves | * Associated with start of diastole

where on the precordium would you auscultate for the base of the heart & what locations in the heart does it correlate to?

2nd ICS | -Correlates to location of aortic and pulmonic valves

where on the precordium would you auscultate for the apex of the heart & what locations in the heart does it correlate to?

L 4th & L 5th ICS | -Correlates to the location of mitral and tricuspid valves

what irregular rhythm involves a common variation of lub, dub in which HR increases on inspiration and decreases on expiration?

Sinus arrhythmia

what irregular rhythm involves a “pattern” to beats outside of standard lub, dub?

Regularly irregular

what irregular rhythm involves no pattern to the sounds in which beats come rapidly and at random intervals?

irregularly irregular

which part of the stethoscope is best for detecting high pitched sounds such as S1 & S2? what abnormalities can it detect?

diaphragm - S4 - most murmurs

which part of the stethoscope is best for detecting low pitched sounds such as S3? what abnormalities can it detect?

bell | -rumble of mitral stenosis

where can you hear a split S2 heart sound and what does it indicate?

base of the heart -> 2nd ICS | -aortic and pulmonic valves do not close simultaneously

what can cause a split S2 heart sound?

► Physiologic (related to inspiration) ► Right ventricle overload ► Delayed closure of pulmonary valve ► Delayed closure of aortic valve

Module 2: Cardiovascular Exam Flashcards

(49 cards)