PD EXAM 2- Cardiovascular

What occupies most of the anterior cardiac surface, 4th-6th ICS?

Right ventricle

What lies beneath and lateral to the right sternal border at the 4th and 5th ICS?

Right atrium

Where does the pulmonary artery lie?

The left 2nd ICS near sternal angle

What ICS is Erb’s point at?

3rd ICS

What is the inferior border of the heart?

Junction of the sternum and xyphoid process

What forms the lateral margin/border?

Left ventricle which is behind the right ventricle

What causes the “lub” sound or S1?

AV valves closing

What causes the “dub” sound or S2?

Semilunar valves closing

What is the period of ventricular contraction (120 mmhg)?

Systole

What is the period of ventricular relaxation (5 mmhg)?

Diastole

What causes the mitral valve to shut?

ventricular pressure exceeding atrial pressure

What causes the aortic valve to shut?

Ventricular pressure dropping below aortic pressure

Is it normal to hear a slight murmur at the 3rd sound?

Yes

What is heard at the S3 sound?

Rapid left ventricular filling of blood against the ventricular wall

Who is S3 more common in?

children and young adults

What does hearing a S3 sound mean?

ventricular failure and valvular heart disease

What is heard during S4 sound?

sound of atrial contraction- immediately proceeds S1 of the next beat

S of “script”

Site: aortic, pulmonic, Erb’s, tricuspid, mitral

C of “script”

Character: Crescendo, decrescendo, harsh, rumbling, musical

R of “script”

Radiation: Other areas heard

I of “script”

Intensity: Grade I-Iv

P of “script”

Pitch: Frequency-high, medium, low

T of “script”

Timing: When in the cardiac cycle—-systolic, diastolic

what is Grade I cardiac sound?

Barely audible w/ greatest difficulty

What is Grade II cardiac sound?

Faint but heard immediately upon listening

What is Grade III cardiac sound?

Moderately loud

What is Grade IV cardiac sound?

Loud, with palpable thrill

What is Grade V cardiac sound?

Very loud with thrill, may be heard with stethoscope partly off the chest

What is Grade VI cardiac sound?

Very loud, with thrill. Can be heard with stethoscope off chest

What is early peaking systolic murmur?

Heard closer to S1

What is late peaking systolic murmur?

Heard closer to S2

What do you auscultate the carotid arteries with?

Bell

How occluded must the carotid artery be for medical intervention?

70%

Where do you listen for the physiologic split of S2?

Erb’s point aka Left 3rd ICS

Where do you listen for aortic regurgitation?

Erb’s point (Left 3rd ICS) and patient must be leaning forward holding expired breath

What must you ask the patient to do during hypertrophic cardiomyopathy?

Valsalva or bear down

Which is easier to palpate, carotid artery or internal jugular vein?

Carotid artery

Between the carotid artery and internal jugular vein, which level of pulsation is unchanged with position?

Carotid artery

Between the carotid artery and internal jugular vein, which has 2 components to pulsation?

Internal jugular vein

Between the carotid artery and internal jugular vein, which has the level of pulsation that is not affected by respirations?

Carotid artery

Between the carotid artery and internal jugular vein, which has pulsations eliminated by pressure above clavicle?

internal jugular vein

What does the JVP estimate?

The pressure in the right atrium

At what angle must the patient be to estimate for JVP?

30 degree angle

If a patient has a slightly elevated JVP……

Cannot be measured as JVP above jawline, at 60 degrees it can be measured, barely discernable above clavicle

When is JVP considered elevated?

JVP greater than 3 cm above sternal angle, 8 cm above right atrium

What do you inspect the precordium for?

Heaves and the point of maximum impulse using tangential lighting

What part of the hand do you use to palpate the precordium?

Ball of the right hand

What ICS is the aortic area?

Right 2nd ICS

What ICS is the pulmonic area?

Left 2nd ICS

What is the PMI?

Point of maximal impulse

Do you use the bell or diaphragm to auscultate the 4 valvular areas and left 3rd ICS?

Both!

In what position do you listen for S3 and S4 gallops?

Patient must be in left lateral decubitus position

Is the posterior tibial artery medial or lateral?

Medial

Where do you looks for cyanosis and discoloration?

Nailbeds

In what type of issues would you see clubbing?

Respiratory

What are signs of peripheral vascular disease (PVD)?

Shiny, hairless skin, dystrophic nail changes and dependent rubor

what signs may you see with cellulitis?

Edema, warmth, erythema