Physical Examination of the Cardiovascular System

Flashcards covering the physical examination of the cardiovascular system, including heart anatomy, common conditions, and auscultation techniques.

The Heart

Located under the rib cage and in between the lungs, its size varies depending on age, size, and condition. Consists of four chambers.

Atria

The upper two chambers of the heart that receive and collect blood.

Ventricles

The lower two chambers of the heart that pump blood out of the heart.

Septum

Muscle that divides the heart into right and left halves.

4 Heart Valves

Tricuspid, Pulmonary Semilunar, Mitral (Bicuspid), and Aortic (Semilunar).

Purpose of Heart Valves

Prevent backflow of blood, keep blood flowing in one direction.

Pallor of Anemia

Best seen in the mucous membranes of the conjunctivae, lips and tongue and in the nail beds. Many causes can cause sinus tachycardia, heart failure (Hyperdynamic).

Cyanosis

A blue discoloration of the skin and mucous membranes caused by increased concentration of reduced hemoglobin (5g/dl). Central may result from reduced arterial oxygen saturation caused by cardiac or pulmonary disease. Peripheral may result when cutaneous vasoconstriction slows blood flow and increases oxygen extraction.

Finger Clubbing

Painless soft-tissue swelling of the terminal phalanges; seen in congenital cyanotic heart disease and infective endocarditis.

Pectus Excavatum

A caved-in or sunken appearance of the chest.

Pectus Carinatum

Protrusion of the sternum and ribs.

Edema

Tissue swelling due to an increase in interstitial fluid, commonly assessed over bony prominences. Cardinal feature of congestive heart failure, most prominent around the ankles in ambulant patients and over the sacrum in bedridden patients.

Temperature Assessment (Palpation)

Place the dorsal aspect of your hand onto the patient’s; symmetrically warm suggests adequate perfusion. Cool hands may suggest poor peripheral perfusion.

Capillary Refill Time (CRT)

Apply five seconds of pressure to the distal phalanx of one of a patient’s fingers and then release. Normal is less than two seconds; greater suggests poor peripheral perfusion.

Heave

Left Sternal Angle.

Thrill

Palpable murmur over heart valves.

Apex Beat

Fifth intercostal space mid-clavicular line.

First Heart Sound (S1)

Corresponds to mitral and tricuspid valve closure at the onset of systole, best heard at the apex.

Second Heart Sound (S2)

Corresponds to aortic and pulmonary valve closure following ventricular ejection, best heard at the base.

Systolic Murmurs

Occur between S1 and S2.

Diastolic Murmurs

Occur after S2 and before S1.

Causes for Aortic Area Systolic Murmur

Aortic stenosis, Aortic valve sclerosis.

Causes for Erb Point Diastolic Murmur

Aortic regurgitation (valvular), Pulmonic regurgitation.

Causes for Pulmonic Area Systolic Ejection Murmur

Pulmonic stenosis, Atrial septal defect.

Causes for Tricuspid Area Holosystolic Murmur

Tricuspid regurgitation, Ventricular septal defect.

Causes for Mitral Area Holosystolic Murmur

Mitral regurgitation.

Midsystolic Murmur

Begins after S1 and stops before S2, with brief audible gaps.

Pansystolic (Holosystolic) Murmur

Starts with S1 and stops at S2, without a gap.

Early Diastolic Murmur

Starts immediately after S2, without a discernible gap.

Middiastolic Murmur

Starts a short time after S2.

Late Diastolic (Presystolic) Murmur

Starts late in diastole and continues up to S1.

Continuous Murmur

Begins in systole and extends into all or part of diastole.

Crescendo Murmur

Grows louder.

Decrescendo Murmur

Grows softer.

Crescendo-Decrescendo Murmur

First rises in intensity, then falls.

Plateau Murmur

Has the same intensity throughout.

Grade 1 Murmur

Very faint, heard only after listener has 'tuned in'.

Grade 2 Murmur

Quiet, but heard immediately after placing the stethoscope on the chest.

Grade 3 Murmur

Moderately loud.

Grade 4 Murmur

Loud, with palpable thrill.

Grade 5 Murmur

Very loud, with thrill; may be heard when the stethoscope is partly off the chest.

Grade 6 Murmur

Very loud, with thrill; may be heard with stethoscope entirely off the chest.