Cardiovascular Special Tests Study Worksheet – PCM III

1.     How do you palpate for a heave and what does a positive finding suggest?

1.     Place palm or fingertips on the chest wall to feel for a heave. A positive heave suggests ventricular hypertrophy.

1.     How do you palpate for a thrill and what does it indicate if present? Where do you palpate and why?

1.     Use the base of fingers or side of hand to feel for a thrill—a buzzing vibration over the precordium, indicating a high-grade murmur (grade 4 or higher). Palpate over the valvular area where the murmur is heard.

1.     Describe how to palpate and interpret the point of maximal impulse (PMI).

1.     PMI is palpated in the 5th intercostal space, midclavicular line. A displaced or enlarged PMI may suggest cardiomyopathy or LV enlargement.

1.     How is jugular venous pressure (JVP) estimated and what does an elevated JVP suggest?

1.     JVP is measured with the patient at 30-45° angle. Elevation >3-4 cm above the sternal angle suggests volume overload or right-sided heart failure.

1.     What is a normal way to document a pulse and what does it mean?

1.     Normal pulse is documented as 2+/4. This grading means normal amplitude; 0 = absent, 1+ = weak, 3+ = bounding, 4+ = full and bounding.

1.     How does squatting or performing the Valsalva maneuver help distinguish types of murmurs? Provide one example.

1.     Squatting increases preload and decreases murmurs of MVP and HOCM. Valsalva decreases preload. Example: HOCM murmur decreases with squatting.

1.     If you hear a friction rub, how can you tell whether it is pericardial or pleural in origin?

1.     A pericardial rub persists when the patient holds their breath; a pleural rub disappears with breath-holding.

1.     Which of the following is most consistent with a thrill?
A. A soft vibration suggesting a grade I murmur
B. A palpable vibration from a high-grade murmur
C. A tap felt over the carotid artery
D. A finding associated with only diastolic murmurs

1.     Answer: B – A thrill is a palpable vibration associated with high-grade (grade 4-6) murmurs.

1.     In which of the following conditions does squatting typically decrease murmur intensity?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic obstructive cardiomyopathy (HOCM)
D. Tricuspid regurgitation

1.     Answer: C – Squatting increases preload, which decreases murmur intensity in HOCM.

1.     A high JVP may be seen in congestive heart failure or volume overload. (T/F)

1.     True – High JVP indicates elevated right atrial pressure as seen in CHF or volume overload.

1.     A pericardial rub typically disappears with breath-holding. (T/F)

1.     False – A pericardial rub persists through the respiratory cycle; a pleural rub disappears with breath-holding.

1.     Matching

a. PMI displacement
b. Heaves
c. JVP estimation
d. Thrills
1. Indicates left ventricular enlargement
2. Suggests right or left ventricular hypertrophy
3. Palpable vibration from high-grade murmur
4. Evaluates volume status or right heart pressure

1.     Match:
a → 1
b → 2
c → 4
d → 3