Cardiac Exam: Learning Objectives

The Cardiac Exam: Learning Objectives

  1. Know the basic anatomy and physiology of the heart.
  2. Become familiar with the terminology related to a history and physical of the heart.
  3. Demonstrate knowledge of typical history questions associated with:
    1. Chest pain
    2. Cyanosis (turning blue)
    3. Dyspnea (shortness of breath)
    4. Edema (dependent - i.e. gravity edema)
    5. Fainting (syncope)
    6. Fatigue
    7. General
    8. Hemoptysis (coughing up blood)
    9. Irregular heart beat
  4. Demonstrate the following aspects of the physical exam:
    1. Inspection for evidence of cardiac contraction and point of maximal impact (PMI).
    2. Palpation of PMI, describing location, size, character, as well as the presence of lifts and thrills.
    3. Percussion of the heart.
    4. Be able to demonstrate correct use of the diaphragm and bell.
    5. Identify and describe rate and rhythm patterns including regular rate and rhythm (normal), regularly irregular rhythm, and irregularly irregular rhythm.
    6. Identify and describe normal S1, split S1, S2, and split S2 heart sounds.
    7. Auscultation in the recumbent of all 4 precordial areas of the heart.
    8. Auscultation in the left lateral decubitus position for S3 and S4, and in the sitting upright with forward lean for aortic insufficiency.
  5. Describe typical history and physical related to:
    1. hypertension (asymptomatic, diastolic BP >90 mmHg, systolic BP >150 mmHg)
    2. angina pectoris (chest pain)
    3. acute myocardial infarction (chest pain)
    4. congestive heart failure (dyspnea and edema)
    5. heart block (irregular heart beat)
  6. Describe the precordial location and timing of murmurs and other heard sounds due to:
    1. aortic insufficiency (regurgitation)
    2. aortic stenosis
    3. atrial fibrillation
    4. atrial septal defect
    5. bigeminy
    6. coarctation of the aorta
    7. ebstein's abnormality
    8. ejection click
    9. functional (innocent) murmur
    10. mitral insufficiency/prolapse/regurgitation
    11. mitral stenosis
    12. normal sinus rhythm (at rates of ~60, ~90, ~130, and ~180 beats per minutes)
    13. patent ductus arteriosus
    14. pericardial friction rub
    15. pulmonic insufficiency (regurgitation)
    16. pulmonary stenosis
    17. quadruple gallop (at rates of ~40, ~55, and ~100 beats per minute)
    18. s3
    19. s4
    20. split S1
    21. split S2
    22. split S1 with split S2
    23. summation gallop
    24. systolic murmur (early)
    25. systolic murmur (late)
    26. systolic murmur (pansystolic)
    27. tricuspid insufficiency (regurgitation)
    28. tricuspid stenosis
    29. ventricular septal defect
    30. venus hum
  7. Know the physiological processes and clinical correlation of an S3 and S4.

    Red indicates a basic learning objective for perclinical (1st and 2nd year) medical students.
    Blue indicates an advanced learning objective for clinical (3rd and 4th year) medical students.

(20 December 2008)
david.kaelber@case.edu-- Copyright 1999-2009 CWRU-- Unauthorized use prohibited