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Questions and Answers
What is considered a normal heart rate for adults?
Which type of pulse upstroke suggests aortic stenosis?
Which examination finding is associated with congestive heart failure?
During diastole, blood flows from which chamber to which chamber through the tricuspid valve?
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What symptom may indicate aortic insufficiency during a cardiovascular examination?
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Which physiological process occurs during systole?
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What is the primary purpose of assessing the abdominal aorta during a cardiovascular examination?
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What does a gallop rhythm typically indicate during a heart examination?
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Which area corresponds to the location of the Aortic valve during auscultation?
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What is the best tool for detecting high-pitched heart sounds?
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If a murmur coincides with the carotid upstroke, it is classified as which type?
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What type of murmur is indicated by 'crescendo-decrescendo'?
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Which pitch is characteristic of S3 heart sounds?
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Where should you auscultate to identify the Mitral valve?
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What quality descriptor would best fit a sound resembling 'whispering' during auscultation?
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How is the murmur described if it lasts throughout ventricular systole?
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What is the correct location for auscultating the Pulmonic area?
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Which stethoscope method is preferred for detecting low-pitched sounds like S3?
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What timing classification is appropriate for a murmur that occurs during diastole?
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How would you describe a 'crescendo-decrescendo' murmur?
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Which quality descriptor would best match a murmur that is soft and smooth?
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What interspace should be identified for auscultating the Mitral area?
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Which type of murmur is described as 'holosystolic'?
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What is the ancillarity of palpating the carotid upstroke during auscultation?
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What finding in a cardiovascular examination suggests congestive heart failure?
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What abnormality is indicated by a delayed carotid pulse upstroke?
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Which of the following findings would indicate bradycardia?
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What condition is most commonly associated with an elevated JVP?
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During which phase of the cardiac cycle is the tricuspid valve open?
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Which term describes the condition when the JVP falls?
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An important aspect of clinical decision-making in cardiovascular examination is to form a differential diagnosis based on which elements?
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Which pulse characteristic suggests a normal finding?
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Study Notes
Vital Signs
- Normal Heart Rate: 60-100 bpm
- Tachycardia: >100 bpm
- Bradycardia: <60 bpm
- Normal blood pressure: Varies based on age, race, and other factors
- Elevated Jugular Venous Pressure (JVP): > 3 cm (or possibly 4cm) above the sternal angle
- Elevated JVP can be caused by congestive heart failure (CHF), Pulmonary hypertension, tricuspid stenosis, or pericardial compression/tamponade
- Decreased JVP can be caused by hypovolemia or loss of blood
- Carotid Upstroke: Brisk = normal, Delayed = possible aortic stenosis, Bounding = possible aortic insufficiency
- Auscultate carotid arteries to assess for bruits
The Cardiac Cycle
- Systole: Ventricles contract, right ventricle pumps blood into pulmonary arteries (pulmonic valve open), Left ventricle pumps blood into the aorta (aortic valve open)
- Diastole: Ventricles relax, blood flows from the right atrium to the right ventricle (tricuspid valve open), blood flows from the left atrium to the left ventricle (mitral valve open)
Physical Exam - Auscultation
- Aortic Area: 2nd ICS, right sternal border
- Pulmonic Area: 2nd ICS, left sternal border
- Tricuspid Area: 3rd/4th ICS, left sternal border
- Mitral Area: 5th ICS, left midclavicular line
Cardiac Auscultation
- Auscultate all listening areas for S1 and S2 using the diaphragm of the stethoscope, then auscultate the apex with the bell
- Diaphragm is best for high-pitched sounds: S1, S2, S4, most murmurs
- Bell is best for low-pitched sounds: S3, mitral stenosis
Describing Heart Murmurs
- Timing: Systolic or diastolic? Palpate carotid upstroke (occurs in systole) while auscultating
- Duration: Early/mid/late systolic (or holosystolic), Early/mid/late diastolic
-
Shape: Crescendo, decrescendo, or both (“diamond-shaped”)
- Crescendo-decrescendo systolic murmur: Aortic stenosis
- Holosystolic murmur: Mitral regurgitation
- Quality: Harsh, musical, soft, blowing, rumbling
- Pitch: High, medium, or low pitched
- Location: Area where best heard
Cardiovascular Examination
- The examination includes vital signs, neck, chest, abdomen, lower extremities, and special tests.
Vital Signs: Heart Rate and Blood Pressure
- Normal Heart Rate: 60-100 beats per minute (bpm)
- Tachycardia: >100 bpm
- Bradycardia: < 60 bpm
- Normal blood pressure: < 120/80 mmHg
Neck: Jugular Venous Pressure (JVP)
- JVP is best assessed with the patient lying at 30-45 degrees
- Normal JVP: 2 cm or less above the sternal angle
- Elevated JVP: 3 cm or more above the sternal angle
- Causes of elevated JVP include: Congestive Heart Failure (CHF), Pulmonary hypertension, tricuspid stenosis, pericardial compression/tamponade.
- Decreased JVP can occur with hypovolemia and/or blood loss.
Neck: Carotid Arteries
- Carotid upstroke can be:
- Brisk - normal
- Delayed - suggests aortic stenosis
- Bounding - suggests aortic insufficiency
- Auscultate the carotid arteries for bruits (abnormal sounds).
Cardiac Cycle
-
Systole: Ventricles contract, blood is pumped out.
- Right ventricle pumps to pulmonary arteries (pulmonic valve open)
- Left ventricle pumps to aorta (aortic valve open)
-
Diastole: Ventricles relax, blood fills the ventricles.
- Blood flows from right atrium to right ventricle (tricuspid valve open)
- Blood flows from left atrium to left ventricle (mitral valve open)
Physical Exam: Auscultation
- Aortic area: 2nd intercostal space (ICS), right sternal border
- Pulmonic area: 2nd ICS, left sternl boarder
- Tricuspid area: 3rd/4th ICS, left sternal border
- Mitral area: 5th ICS, left midclavicular line
Cardiac Auscultation
- Auscultate all listening areas for S1 and S2 heart sounds using the diaphragm of the stethoscope.
- Auscultate at the apex with the bell of the stethoscope.
- Diaphragm is better for detecting high-pitched sounds (S1, S2, S4, and most murmurs).
- Bell is better for detecting low-pitched sounds (S3 and mitral stenosis).
Heart Murmurs
-
Timing: Systolic or diastolic?
- Palpate carotid upstroke (occurs in systole) to help determine timing.
- If the murmur coincides with carotid upstroke, it is systolic.
-
Duration:
- Early/mid/late systolic (or holosystolic)
- Early/mid/or late diastolic
-
Shape:
- Crescendo: Increases in intensity
- Decrescendo: Decreases in intensity
- Both: Starts softly, increases then decreases ("diamond-shaped")
- Quality: Harsh, musical, soft, blowing, or rumbling?
- Pitch: High, medium, or low pitched?
- Location: Where on the chest is the murmur loudest?
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Description
This quiz covers the essential aspects of vital signs and the cardiac cycle, including definitions of normal and abnormal heart rates, blood pressure, and the stages of the cardiac cycle. It's designed for students and professionals looking to refresh their knowledge in cardiovascular health. Test your understanding of these crucial concepts in cardiovascular physiology.
