10 Questions
What is the main characteristic of a murmur?
Blowing swooshing sound
What causes a murmur according to the text?
Over flow of blood through normal valves
How is a Grade 1 murmur characterized?
Quiet, heard only after listener has 'tuned in'
What defines a systolic murmur?
Occurs between S1 and S2
Which type of murmur is related to demand-supply disharmonization?
Physiologic murmur
What is the classification of a pathologic murmur?
Result of tangible cardiac disorder
How would you describe the location characteristic of a murmur?
'Area of maximum intensity' by noting the valve area or intercostal space
What makes a Grade 4 murmur different from other grades?
'Loud', with palpable thrill
When is a Grade 5 murmur most likely to be heard?
'Very loud', with thrill when stethoscope is partly off the chest
What defines a diastolic murmur?
Occurs during diastole
Study Notes
Assessment of the Cardiovascular System
- The cardiovascular system consists of the heart, blood, and blood vessels, which function to deliver oxygen and nutrients to the body's cells and remove waste products.
Common Symptoms of Cardiac Disease
- Chest pain
- Cough
- Dyspnea (shortness of breath on exertion and/or rest)
- Paroxysmal Nocturnal Dyspnea (shortness of breath during sleep)
- Orthopnea (shortness of breath in the recumbent position)
- Palpitation (unpleasant perception of one's own heartbeat)
Heart Examination
- Patient should be supine with the upper body raised to about 30°
- Two other positions needed: left lateral decubitus and sitting, leaning forward
- Examiner should stand at the patient's right side
Inspection and Palpation
- Inspect any deformity of the chest (kyphosis, lordosis, scoliosis)
- Identify the location of apical impulse (Point of maximal impulse)
- Normally, the apex beat is felt 9cm from the mid-sternal line or 1cm internal to the mid-clavicular line in the 5th intercostal space to the left of the sternum
- Apical impulse should occupy only one inter-space, the fourth or fifth, and be at or medial to the mid-clavicular line
- Size: normally 1cm x 2cm
Aortic, Pulmonic, Tricuspid, and Mitral Areas
- Four important landmarks to examine the chest wall:
- Aortic area: 2nd intercostal space to the right of the sternum
- Pulmonic area: 2nd intercostal space to the left of the sternum
- Tricuspid area: 4th and 5th intercostal spaces to the left of the sternum
- Mitral (apical) area: left 5th intercostal space at the mid-clavicular line
Heart Percussion
- Estimates heart borders and configuration
- Used to detect heart enlargement due to increased ventricular volume or thickening of heart wall
Heart Auscultation
- Purpose: determine heart rate and rhythm, and evaluate heart sounds
- Normal heart sounds: S1 and S2
- S1 (First Heart Sound): closure of tricuspid and mitral valves, heard loudest at the apical area
- S2 (Second Heart Sound): closure of pulmonic and aortic valves, heard loudest over the aortic and pulmonic areas
Abnormal Heart Sounds
- Gallop sounds: S3 and S4
- S3 sound: heard immediately after S2, due to ventricular hypertrophy
- S4 sound: heard just before S1, due to atrial contraction and non-compliant ventricle
- Murmurs: created by turbulent flow of blood in the heart
Test your knowledge on the systematic approach used to examine the chest wall and detect the apex beat. Learn about important landmarks such as the aortic area, pulmonic area, tricuspid area, and mitral (apical) area.
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