Cardiovascular Physical Therapy Evaluation: Heart Auscultation

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Questions and Answers

What is the primary purpose of auscultation in a cardiovascular and pulmonary physical therapy evaluation?

To assess joint integrity and mobility

To identify abnormal heart sounds and diagnose cardiovascular conditions (correct)

To measure aerobic capacity and endurance

To evaluate mental functions and neuromotor development

Which of the following heart sounds occurs during ventricular systole?

S1 (correct)

What is the underlying cause of an S3 heart sound?

Mitral valve stenosis

Enlarged atrial chamber

Enlarged ventricle chamber that is weak and overly compliant (correct)

Aortic valve regurgitation

What type of heart muscle is associated with diastolic dysfunction?

Thick and overly stiff Signup and view all the answers

What is the primary function of the diaphragm on a stethoscope?

To detect high frequency sounds Signup and view all the answers

Which of the following is NOT a component of a complete cardiovascular and pulmonary physical therapy evaluation?

Pharmacological interventions Signup and view all the answers

What is the primary difference between an S3 and an S4 heart sound?

S3 occurs after S2, while S4 occurs before S1 Signup and view all the answers

During heart auscultation, what is the correct position of the patient?

Supine and breathing normally Signup and view all the answers

What is the location of the mitral valve sound during heart auscultation?

Left, 5th intercostal space, midclavicular Signup and view all the answers

What is the objective of the 7250.8 evaluation?

To demonstrate a complete and safe cardiovascular and pulmonary physical therapy evaluation Signup and view all the answers

What is the term for the vibration from turbulent flow that creates a blowing, whooshing, or rasping sound heard during a heartbeat?

Murmur Signup and view all the answers

What is the abbreviation used to remember the locations of heart auscultation?

APTM Signup and view all the answers

Which type of normal lung sound is characterized by a soft, low-pitched inspiration sound that is greater than expiration sound?

Vesicular Signup and view all the answers

In which location are bronchovesicular lung sounds typically auscultated?

Manubrium, right and left main bronchus Signup and view all the answers

What is the characteristic of bronchial lung sounds?

Harsh, high-pitched expiration sound Signup and view all the answers

What is the common cause of decreased or absent bronchial lung sounds in peripheral lung fields?

Elderly, obese, emphysema, or pleural dysfunction Signup and view all the answers

What is the characteristic of fine crackles?

High-pitched, similar to fire popping or Velcro Signup and view all the answers

What is the characteristic of rhonchi?

Low-pitched, continuous sound Signup and view all the answers

What should the patient be positioned in during lung auscultation?

Sitting Signup and view all the answers

What should be avoided during lung auscultation?

All of the above Signup and view all the answers

Study Notes

Heart Auscultation

Objective 7250.8: Demonstrate a complete and safe cardiovascular and pulmonary physical therapy evaluation in a simulated environment.
Normal heart sounds:
- S1: AV valves closing, ventricular systole
- S2: SL valves closing, ventricular diastole
Abnormal heart sounds:
- S3 (Ventricular gallop): occurs after S2, blood sloshing in, creating turbulence, systole dysfunction, enlarged ventricle chamber
- S4 (Atrial gallop): occurs before S1, blood hits resistance, creating turbulence, diastolic dysfunction, thick and stiff heart muscle
- Murmur: vibration from turbulent flow, blowing, whooshing, or rasping sound heard during a heartbeat, common causes are valve dysfunctions or septal defects
- Pericardial friction rub
Stethoscope:
- Diaphragm is better for high frequency (S1, S2)
- Bell is better for low frequency (S3, S4)
Heart auscultation procedure:
- Patient is supine, breathing normally (or seated)
- Explain the procedure
- Place the diaphragm on the skin over 4 locations (APTM)
- Repeat with the bell at all four locations
Auscultation locations:
- Aortic: Right, 2nd intercostal space, parasternal
- Pulmonary: Left, 2nd intercostal space, parasternal
- Tricuspid: Left, 5th intercostal space, parasternal
- Mitral (apex): Left, 5th intercostal space, midclavicular
Heart auscultation documentation:
- “Normal S1 and S2, with regular rate and rhythm. No splitting of the heart sounds heard. No murmur. No S3 or S4, no friction rub.”

Lung Auscultation

Normal lung sounds:
- Vesicular: peripheral lung fields, soft, low-pitched, inspiration sound > expiration
- Bronchovesicular: manubrium, right and left main bronchus, inspiration sound = expiration
- Bronchial: trachea, harsh, high-pitched, expiration sound ≥ inspiration
Abnormal lung sounds:
- Bronchial in peripheral lung fields: consolidation due to pneumonia
- Decreased or absent sounds: elderly, obese, emphysema, pleural dysfunction
Adventitious lung sounds:
- Crackles (rales): discontinuous sounds, high-pitched (fine) or low-pitched (coarse)
- Wheezes (rhonchi): continuous sounds, high-pitched (fine) or low-pitched (coarse)
- Pleural friction rub: leather on leather sound, inflamed pleural
Lung auscultation procedure:
- Ideally, patient is positioned in sitting
- Explain the procedure
- Instruct patient to take deep breaths
- Let the patient rest after 5-6 breaths
- Auscultate over each area shown
- Listen during the entire breathing cycle
Lung auscultation charting:
- “Vesicular breath sounds in all peripheral lung fields; no rales, wheezes, or friction rub.”
- “High-pitched inspiratory crackles heard over bilateral lower lobes.”

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Description

Heart auscultation is a crucial part of physical therapy evaluation. This quiz covers normal and abnormal heart sounds, including S1, S2, S3, and S4, and their significance in cardiovascular health.