Exam 2- Heart- Examination and Findings

Examination of the heart includes what?

Inspecting

Palpating

Percussing the chest

Auscultating the heart

Percussing the chest tests for?

Density of the tissues

What is the common error when it comes to assessing cardiac function?

Listen to heart first

-LISTEN LAST IS CORRECT

What is the precordial palpation sequence?

Apex (bottom)

Up the left eternal border

Base

Down the right sternal border

Into the epigastrium or axillae if the circumstance dictates

What is the point at which the apical impulse is most readily seen or felt?

Point of maximal impulse (PMI)

What is it where the left ventricle pups against the rib cage?

Apical impulse

Where is the point of maximal impulse (PMI) felt?

At mid clavicular line in 5th intercostal space

What is it when the apical impulse is more vigorous than expected?

Heave or lift

What is it when the apical impulse is a fine, palpable, rushing vibration, a palpable murmur?

Thrill

The point of ________ and __________ should palpate at basically the same time, if not then there can be some blockage

Maximum impulse and carotid artery

What is used for finding the borders of heart but has limited value?

Percussion

What is the more useful tool to define the heart borders?

Chest radiograph

Left ventricular size is better judged by the location of?

Apical impulse

The right ventricle tends to enlarge in the ___________________ rather than laterally

Anteroposterior

What are the 5 traditionally designated auscultations areas?

Aortic valve area

Pulmonic valve area

Second pulmonic area (Erb`s point)

Tricuspid area

Mitral (or apical) area

-All Palmer People Try Margaritas

Where is the aortic valve area?

Second right intercostal space at the right sternal border

Where is the pulmonic valve are?

Second left intercostal space at the sternal border

Where is the second pulmonic area (Erb`s Point)?

Third left intercostal space at the left sternal border

Where is the tricuspid area?

Fourth left intercostal space along the lower left sternal border

Where is the mitral (or apical) area?

Apex of the heart in the fifth left intercostal space at the midclavicular line

What are the things we listen to in the heart?

Assess overall rate and rhythm

Frequency

Intensity

Duration

Pathology

What are the lub-dub sounds?

S1 and S2

Where is S1 best heart?

B apex of heart

Where is S2 heard best?

Base

Splitting of which heart sound is pathological?

S1

Splitting of which heart sound is normal?

S2

Where is the intense first heart sound heard best?

Apex

Where is the split first sound heart best?

Tricuspid

What causes the split of the first sound?

Mitral closed before tricuspid

Where is the intense second sound heard?

Base

Where is the physiologic splitting of S2 during expiration and inspiration heard best?

Base

What causes the splitting of S2 during inspiration?

Pulmonic valve closes a bit later than aortic

What is the third sound called when we can hear it?

Gallop

Where is the third sound heard best?

Apex

How do you know you're hearing a gallop (S3 sound) and not a S2 splitting sound?

Cause of the location at the apex

What is the fourth heart sound called?

Atrial gallop

Where is the atrial gallop heard best?

Apex

How do you know you're hearing an atrial gallop and not an S1 splitting?

Cause you're at the apex

Where is the summation gallop heard best?

Apex

What are the basic heart sounds?

S1 or S2 most distinct

Splitting

S3 and S4 difficult to hear

What are the extra heart sounds?

Gallops

Mitral snaps

Ejection clicks

Friction rubs

What typically cause heart murmurs?

Valves not working properly

-may not open wide enough or not close all the way

Describe a Grade I murmur

Bare audible in quite room

Describe a Grade II murmur

Quiet but clearly audible

Describe a Grade III murmur

Moderately loud

Describe a Grade IV murmur

Loud, associated with a THRILL

Describe a Grade V murmur

Very loud, thrill easily palpable

Describe a Grade VI murmur

Very loud, audible with stethoscope not touching visible thrill

Irregular murmur but occurring in a repeated pattern may indicate ____________ a _________ variation of the heart

Sinus dysrhythmia

Cyclic variation

Patternless, unpredictable, irregular rhythm of a murmur may indicate?

Heart disease or condition system impairment

What is the best position to hear the heart?

Supine

What is the best position to hear the first heart sound?

Any position

What is the area of auscultation for the first heart sound?

Entire precordium (apex)

What is the cause of the first heart south?

Closure of tricuspid and mitral valves

What is the best position for hearing the second heart sound

Sitting or supine

Area for auscultation for the second heart sound

A2 at 2nd RICS

P2 at 2nd LICS

Cause of the second heart sound

Closure of pulmonic and aortic valves

Position for the third heart sound

Supine or left lateral

Area of auscultation of the third heart sound

Apex

Cause of the third heart sound

Rapid ventricular filling

Position for the 4th heart sound

Supine or left semi lateral

Area of auscultation for the fourth heart sound

Apex

Cause of the 4th heart sound

Forceful atrial ejection into distended ventricle

Position for quadruple rhythm

Supine or left lateral

Area of auscultation of the quadruple rhythm

Apex

Cause of quadruple rythym

S1, S2, S3 and S4 all heart separately

Position for summation gallop

Supine or left lateral

Area of auscultation for summation gallop

Apex

Cause of summation gallop

S3 and S4 fuse with fast heart rates

Position to hear ejection sounds

Sitting or supine

Area of auscultation of ejection sounds

2nd RICS

2nd LICS

Apex

Cause of ejection sounds

Opening of deformed semi-lunar valves

Position to hear systolic click

Sitting or supine

Area of auscultation for systolic click

Apex

Cause of systolic click

Prolapse of mitral valve leaflet

Position to hear opening snap

Any position

Area of auscultation for opening snap

Apex

Cause of opening snap

Abrupt recoil of stenotic mitral or tricuspid valve

When should you examine the heart of a newborn>

2-3 days for circulation transition signs

Heart function examination of infants includes?

Skin lungs liver

-inspect color of skin and mucous membranes

Murmurs are common until?

48 hrs of age

Hear rates in infants vary?

With eating, sleeping and waking

What happens in children with long standing heart enlargement?

Bulging precordium

Heart rates are ______ variable in children than adults

More variable

Most murmurs in infants and children are the result of?

congenital heart disease

What accounts for most acquired murmurs in infants and children?

Kawasaki disease

Child with known heart disease may present with?

Weight gain or loss

Developmental delays

Cyanosis

Clubbing of fingers or toes

Why does the heart position shift in pregnant women?

Size and position of uterus changes

Pulse in pregnant women is _____________ by end of trimester

10-30% faster

What heart sounds may change in pregnant women because of increased blood volume?

Audible splitting of S1 and S2

S3 may be heard after 20 weeks of gestation

S4 is abnormal to hear

What is important to do with the examination of the heart with older adults?

Slow down pace of examination

The heart rate is variable how in older adults?

Slower if increased fatal tone

Range from low 40-100 bpm

Ectopic beats are common

What is harder to find in older adults?

Apical impulse

Why is the apical impulse harder to find in older adults?

Increased anteroposterior chest diameter (more barrel chested)

Obesity

What heart sound is more common in older adults? Why?

S4

-decreased left ventricular compliance