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 stenosis
    2. functional (innocent) murmur
    3. mitral insufficiency/regurgitation/prolapse
    4. mitral stenosis
    5. aortic insufficiency
    6. pulmonic stenosis
    7. pulmonic insufficiency
    8. mitral regurgitation
    9. tricuspid stenosis
    10. tricuspid regurgitation
  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.

(10 May 2000)
david.kaelber@case.edu-- Copyright 1999-2000 CWRU-- Unauthorized use prohibited