Normal Cardiovascular Exam

Question 1

Pectus carinatum

Answer 1

Pigeon Shaped Chest

Question 2

Pectus excavatum

Answer 2

Concave chested

Question 3

Increased A-P diameter in chest

Answer 3

Barrel Chest (think COPD)

Question 4

4th-5th intercostal space at the Mid-clavicular line

Answer 4

Point of Maximal Impulse (PMI)

Question 5

Percussion

Answer 5

 Estimate cardiac size when PMI not detectable

 Start far left (“resonance”) and move medially to find cardiac “dullness”

Question 6

Places to check heart sounds

Question 7

Listening post -

Right 2nd intercostal
space at sternal border

Answer 7

Aortic

Question 8

Pulmonary listening post

Answer 8

Left 2nd intercostal space at sternal border

Question 9

Tricuspid listening post

Answer 9

Left 4th intercostal
space at sternal border

Question 10

Left 5th intercostal
space at mid-clavicular line

Answer 10

Mitral listening post

Question 11

What does R/R/A mean?

Answer 11

Rate/Rhythm/Amplitude

Question 12

What are the Upper Extremity Palpable Pulses?

Answer 12

Brachial Pulse

Radial Pulse

Question 13

What are the lower extremity palpable pulses?

Answer 13

Popliteal Pulse

Posterior Tibial Pulse

Dorsalis Pedis Pulse

Question 14

How to assess capillary refill time?

Answer 14

• Pt’s hands at heart level, fingers pointing up. Doc presses on nail bed till it turns pale, then lets go. Normal refill time <2sec.

Question 15

How to grade peripheral pulse?

Answer 15

O = absent
1 = barely palpable
2 = average intensity
3 = strong
4 = bounding

 Example documentation:
Radial Pulses: 2/4 bil.

Question 16

How to check for Edema?

Answer 16

• *1.) Dorsum of Foot
  2. ) Behind M. malleolus
  3. ) Anterior Tibia (shin)**

Graded on Four point scale:
0 Absent
1+ Barely detectable,
nonpitting (2mm down)
2+ Slight indentation (4mm);
10-15 sec
3+ Deeper indentation (6mm);
can be >1 min
4+ Very marked
indentation (8mm);
2-5 min

Question 17

Cardiac Structures on Chest X-Ray

Question 18

Auscultation – Heart Sounds (Normal)

Answer 18

 S1 – closing of mitral and
tricuspid valves

 S2 – closing of aortic and
pulmonary valves

Question 19

Auscultation – Heart Sounds (abnormal)

Answer 19

 S3 – Due to high pressures
and abrupt deceleration of
inflow across the mitral
valve at the end of the rapid
filling phase. Physiologic in
children/young adults,
pathologic >40 y/o
 “Ken-Tuck-Y”

 S4 – Atrial gallop from
forceful contraction of atria
against a stiffened (low
compliant) ventricle. Can be
normal in trained athletes.
 “Ten-Nes-See”

Question 20

Grade of heart murmurs

Answer 20

 Grade 1 – very faint
 Grade 2 – Quiet, but heard easily with stethoscope
 Grade 3 – Moderately loud, no thrill
 Grade 4 – Loud with palpable thrill
 Grade 5 – Very loud with stethoscope partially off chest
 Grade 6 – Heard with stethoscope entirely off chest

Question 21

Steps to percuss for cardiac size?

Answer 21

When PMI is no detectable and you want to estimate the cardiac size…

Start far left (“resonance” sounds”) and move medially to find cardiac “dullness”