Cardiac Abnormal Finding

Front 1

JVD is a sign of

Back 1

Fluid overload

Front 2

What is the measurement in JVD that is a sign of elevated right heart pressure?

Back 2

angle (sternal angle is considered to be 5cm above the right atrium).

JVP higher than 4 cm above the sternal angle (9 cm above R atrium) indicates elevated right heart pressure.

Front 3

Hepatojugular reflex is a test for

Back 3

fluid overload
increase happens with everyone,
exaggeration is abnormal

Front 4

Check for Right ventricular Hypertrophy

Back 4

Palpation of the precordium at the lower left sternal border

Front 5

Precordial palpation

Back 5

pt supine or LLD
impulse lateral to midclavicular line or larger than normal suggests left ventricular enlargement

Front 6

Cardiac Percussion

Back 6

estimate heart size
5th ICS midaxillary line
more useful and evident with cardiac pathology

Front 7

heart auscultation leaning forward

Back 7

listen at base,
best for hearing soft murmurs at the base such as:
-aortic regurgitation
-pulmonic regurgitation

Front 8

heart auscultation left latera decubitus

Back 8

best way to hear low pitched filling sounds
-gallops or murmurs

Front 9

Systole is best heard at what location of the heart?

Back 9

Apex

Front 10

What makes the normal lub sound/

Back 10

closure of the mitral and tricuspid valves

Front 11

S1 vs S2 at apex and base

Back 11

Apex S1>S2
Base S2>S1

Front 12

Louder than normal S1
Softer than normal S1

Back 12

louder- desease A-V valve or more foceful closre of A-V valve
Softer- weak contraction of heart or reduced sound transmission through thick chest wall, empysematous lungs

Front 13

What makes the "Dub"

Back 13

Closure of the aortic and pulmonic valves

Front 14

A2 and P2

Back 14

Splitting of S2
A2- Aortic valve closure
P2- pulmonic valve closure

Front 15

Split S2 pathology

Back 15

Normal split during inspiration

“Physiologic splitting of S2”
◦
Pathologic splits due to delay in closure of pulmonic valve:

Atrial septal defect

Pulmonic stenosis

Right ventricular heart failure

Right bundle branch block

Front 16

Wide S2 splitting

Back 16

delayed closure of pulmonary valve
-stenosis

Front 17

S2 "fixed" splitting

Back 17

does not vary with respiration
-Atrial septal defect, RV failure

Front 18

S2 paradoxical splitting

Back 18

occurs during expiration and gone during inspiration
A2 then P2
-delay in contraction of the LV due to a left bundle branch block

Front 19

S3

Back 19

Early diastole
Pasive rapid filling of ventricles with blood from atria
-vibration of the rapid filling of the ventricle walls
-bell at apex
= VENTRICULAR gallop rhytm

Front 20

S3 pathology

Back 20

Children, healthy young adults, and pregnant women may have a non-pathological third heart sound.

Pathologic S3 (ventricular gallop).
◦
Over age 40, usually pathologic.
◦
Due to heart failure, anemia, volume overload of ventricle, decreased myocardial contractility.

Front 21

S4

Back 21

second phase of ventricular filling as atria contract and eject blood into the ventricles- atrial kick
vibration of valves, papillary muscles, ventricular walls
= ATRIAL gallop rhythm

Front 22

S4 pathology

Back 22

Uncommon in healthy adults.

May be normal—trained athletes and some older individuals. No other heart disease.

Pathologic due to resistance to ventricular filling; stiffness of heart muscle (reduced compliance).
◦
HBP, CAD, AS, cardiomyopathy
◦
Right-sided S4 from pulm HBP or pulm. stenosis

Front 23

Cardiac conduction

Back 23

SA node RA to
AV node in Atrial Septum to
Bundle of His to
Purkinje fibers in the ventricular myocardium

Front 24

Tach, regular, Bradycardia

Back 24

>100
6-100
<60 - blocks

Front 25

Rythmically irregular

Back 25

premature atrial or nodal contractions
Premature ventricular contractions

Front 26

Irregularly Irregular

Back 26

Atrial fibrillation
Atrial flutter with varying block

Front 27

Ejection Click

Back 27

High pitched; indicates valve disease or dilated aorta or pulmonary artery, or pulmonary hypertension.
Diaphragm

Front 28

Systolic clicks from mitral valve prolapse

Back 28

due to ballooning of mitral leflets into the left atrium during systole

common condition- usually benigh

Front 29

Murmur Grades

Back 29

Grade 1/6: barely audible in quiet room.

Grade 2/6: quiet but clearly audible.

Grade 3/6: Moderately loud.

Grade 4/6: Loud, associated with thrill.

Grade 5/6: Very loud, heard with stetho- scope partially off chest; obvious thrill.

Grade 6/6: Very loud, heard with stetho- scope entirely off the chest, obvious thrill.

Front 30

Grade 1/6

Back 30

barely audible in quiet room

Front 31

Grade 2/6

Back 31

quiet but clearly audible

Front 32

Grade 3/6

Back 32

Moderately loud

Front 33

Grade 4/6

Back 33

Loud, associated with thrill

Front 34

grade 5/6

Back 34

very loud, heard with stethoscope partially off chest,
obvious thrill

Front 35

Grade 6/6

Back 35

Very loud, heard with stethoscope entirely off the chest, obvious thrill

Front 36

Systolic ejectionmurmur

Back 36

Crescendo-decrescendo
From high pressure to high pressure
due to blood flow across semilunar valves
innocent- just turbulence, no obstruction
Listen at Base both sternal borders

Front 37

Pansystolic murmer

Back 37

plateau (pan-systolic, along the entire systole)
High pressure to low pressure
regurgitation across A-V valves
-Ventricular septal defect

Front 38

late systolic murmer

Back 38

typical of mitral valve prolapse

Front 39

Atrial septal defect

Back 39

congenital anomoly
L-R shunt with RV enlargment
increased flow through pulmonic valve
- Systolic ejection murmur
-Fixed splitting of S2
LLSB thrill

Front 40

Early diastolic murmur

Back 40

Decrescendo "D"iastolic
from regurg across semilunar valve
-aortic regurg

Front 41

Mid diastolic murmur

Back 41

turbulent flow across atrioventricular valves
"D"ecrescendo
-mitral/tricuspid stenosis

Front 42

late diastolic murmur

Back 42

Decreschendo
usually continues up to S1

Front 43

Mitral stenosis

Back 43

mid diastolic murmur
-opening snap, diastolic rumble

Front 44

systolic-diastolic murmur

Back 44

Aortic stenosis and Aortic insufficiency
Creschendo decrescendo
Obstruction to outflow due to a narrowed valve and failure of complete closure of the aortic valve during diastole, with leakage of blood back into the left ventricle.
◦
Described as a “crescendo-decrescendo” murmur.

Front 45

Valsalva

Back 45

decreased LV volume
Decreased vascular tone
Decreased PB, PVR

Front 46

Squatting

Back 46

increased LV volume
increased vascular tone
increased BP, PVR

Front 47

To and Fro murmur

Back 47

Patend ductus arteriosis
Pericardial friction rub

Front 48

RRR

Back 48

regular rate and rhytm

Front 49

NSR

Back 49

normal sinus rhytm

Front 50

MRG

Back 50

murmurs, rubs, gallops

Front 51

SEM

Back 51

systolic ejection murmur

Front 52

MSC

Back 52

midsystolic click

Front 53

ICS

Back 53

intercostal space

Front 54

M with a circle around it

Back 54

murmur