Normal Cardiovascular Exam Flashcards Preview

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Flashcards in Normal Cardiovascular Exam Deck (22):
1

Pectus carinatum

Pigeon Shaped Chest

 

2

Pectus excavatum

Concave chested

3

Increased A-P diameter in chest

Barrel Chest (think COPD)

 

4

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

Point of Maximal Impulse (PMI)

5

Percussion

 Estimate cardiac size when PMI not detectable

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

6

Places to check heart sounds

7

Listening post -

Right 2nd intercostal
space at sternal border

 

Aortic

8

Pulmonary listening post

Left 2nd intercostal space at sternal border

9

Tricuspid listening post

Left 4th intercostal
space at sternal border

10

Left 5th intercostal
space at mid-clavicular line

Mitral listening post

11

What does R/R/A mean?

Rate/Rhythm/Amplitude

12

What are the Upper Extremity Palpable Pulses?

Brachial Pulse

Radial Pulse

13

What are the lower extremity palpable pulses?

Popliteal Pulse 

Posterior Tibial Pulse

Dorsalis Pedis Pulse

14

How to assess capillary refill time?

• 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. 

15

How to grade peripheral pulse?

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

 

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

16

How to check for Edema?

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

17

Cardiac Structures on Chest X-Ray

 

18

Auscultation – Heart Sounds (Normal)

 S1 – closing of mitral and
tricuspid valves


 S2 – closing of aortic and
pulmonary valves

 

19

Auscultation – Heart Sounds (abnormal)

 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”

20

Grade of heart murmurs

 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

21

Steps to percuss for cardiac size?

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"

22