HEALTH ASSESSMENT EXAM 2
QUESTIONS AND ANSWERS GRADED A+
2025/2026
Aortic Area - ANS 2nd right intercostal space at right upper sternal border (S2 is louder)
Pulmonic Area - ANS 2nd left intercostal space at left upper sternal border (S2 is louder)
Erb's point - ANS 3rd left intercostal space at left medial sternal border, (S1 S2 is equal)
Tricuspid Area - ANS left 4th intercostal space at left sternal border (S1 is louder)
Mitral (apical) Area - ANS left 5th intercostal space at midclavicular line (S1 is louder)
Describe the normal heart sounds, their relationship to the cardiac cycle, and what causes each.
S3 - ANS volume overload condition, ventricular gallop, change in blood flow in diastole or
rapid ventricular filling caused by tensing of cordon tendineae, occurs after S1S2 in early
diastole, low frequency, heard at tricuspid and mitral/apical area best in left lateral position,
normal in patients under 40 years old/athletes, abnomal in older adult and may indicate
congestive heart failure
Describe s1 and s2 - ANS S1 is the closing of the mitral and tricuspid valves, S2 aortic and
pulmonic valves closing
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Describe the normal heart sounds, their relationship to the cardiac cycle, and what causes each.
When are the third and fourth heart sounds normal? When are they abnormal?
S4 - ANS Pressure overload problem, atrial gallop, late diastolic filling when atria contracts
into stiff ventricle, happens just before S1 at end of diastole, heard at tricuspid and mitral/apical
area in left lateral position, if clearly heard= increased resistance to ventricular filling, S4 may be
normal in older adults- indicates decreased ventricular compliance found in chronically
hypertensive patients or cardiac ischemia, loud S4 suggests pathology and additional eval,
always bad news
Heart sound - Split - ANS caused by congruent valves not closing simultaneously, S1 splits
normal in younger patients, have patient take a deep breath to differentiate between splits and
S4, S1 split- mitral valve closes before the tricuspid valve, S2 split- aortic valve closes before the
pulmonary valve
Heart sound - Click - ANS caused by ejection against a non compliant or stiff valve, or
mechanical valve
Systolic Murmur Aortic stenosis - ANS occurs between s1s2, systolic ejection murmur or
ejection click, crescendo/decrescendo, heard best at the aortic area, may radiate to the
neck/carotids
Systolic Murmur Mitral Regurgitation - ANS starts right at s1, heard best in mitral area/apex,
halo/pan systolic murmur (lasts through entire systole), blood is flowing backward into right
atrium, flat murmur (no change in intensity), radiates to the axilla
Systolic Murmur Mitral Valve prolapse - ANS valve billows into the atria and causes a click,
non-ejection click, mid to late systolic click (occurs in the middle of s1s2), can be associated with
mitral regurgitation causing a mid systolic click with a late systolic murmur, heard best at the
mitral/apical area
Diastolic Murmur: Aortic Regurgitation - ANS heard best along the left sternal border, occurs
between s2 and s1, caused by backflow of blood into the aorta after s2, early diastolic murmur
decrescendo murmur
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Diastolic Murmur: Mitral Stenosis - ANS right after s2 opening snap occurs and presystolic
accentuation, heard best in mitral/apical area, snap and mid diastolic rumble
Physiologic changes to cardiac system in older adults - ANS The heart may decrease in size
with age unless hypertension or disease causes enlargement. The left ventricular wall thickens,
and the valves tend to fibrose and calcify. The endocardium thickens and the myocardium
becomes less elastic. Fibrosis and sclerosis may occur in the SA node and heart valves. Fibrosis
within the conduction system can occur. S4 is more common in older adults due to decreased
left ventricular compliance.
Hemodynamic changes to cardiac system in older adults - ANS Stroke volume decreases, and
cardiac output during exercise decreases by 30% to 40%. Recovery of myocardial contractility is
delayed. Tachycardia is poorly tolerated and after a stress response, it takes longer to return to
the expected heart rate. Common EKG changes consist of 1st degree AVB, BBB, ST-T wave
abnormalities, left ventricular hypertrophy, and A Fib
Hymodynamic and Physiologic changes in adult cardiac system - the effect they have on vitals -
ANS Elderly are more susceptible to orthostatic hypotension. This is in part due to impaired
baroceptor reflex (autotomic failure). Calcification and plaque buildup in the arteries causes
stiffness including dilation of the aorta, aortic branches, and carotids. They lose elasticity and
therefore result in hypertension, especially systolic. It will take longer for their pulse to return to
baseline after activity, but due to conduction system changes it is also common to see
bradycardia.
system-appropriate history questions for the CV system - ANS Onset and duration: sudden,
gradual, or vague onset, length of episode; cyclic nature; relation to physical exertion, rest,
emotional experience, eating, coughing, cold temperatures, trauma; awakens from sleep
Character: aching, sharp, tingling, burning, pressure, stabbing, crushing, or clenched fist (Levine)
sign
Location: radiating down arms, to neck, jaws, teeth, scapula; relief with rest or position change
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
QUESTIONS AND ANSWERS GRADED A+
2025/2026
Aortic Area - ANS 2nd right intercostal space at right upper sternal border (S2 is louder)
Pulmonic Area - ANS 2nd left intercostal space at left upper sternal border (S2 is louder)
Erb's point - ANS 3rd left intercostal space at left medial sternal border, (S1 S2 is equal)
Tricuspid Area - ANS left 4th intercostal space at left sternal border (S1 is louder)
Mitral (apical) Area - ANS left 5th intercostal space at midclavicular line (S1 is louder)
Describe the normal heart sounds, their relationship to the cardiac cycle, and what causes each.
S3 - ANS volume overload condition, ventricular gallop, change in blood flow in diastole or
rapid ventricular filling caused by tensing of cordon tendineae, occurs after S1S2 in early
diastole, low frequency, heard at tricuspid and mitral/apical area best in left lateral position,
normal in patients under 40 years old/athletes, abnomal in older adult and may indicate
congestive heart failure
Describe s1 and s2 - ANS S1 is the closing of the mitral and tricuspid valves, S2 aortic and
pulmonic valves closing
1 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
,Describe the normal heart sounds, their relationship to the cardiac cycle, and what causes each.
When are the third and fourth heart sounds normal? When are they abnormal?
S4 - ANS Pressure overload problem, atrial gallop, late diastolic filling when atria contracts
into stiff ventricle, happens just before S1 at end of diastole, heard at tricuspid and mitral/apical
area in left lateral position, if clearly heard= increased resistance to ventricular filling, S4 may be
normal in older adults- indicates decreased ventricular compliance found in chronically
hypertensive patients or cardiac ischemia, loud S4 suggests pathology and additional eval,
always bad news
Heart sound - Split - ANS caused by congruent valves not closing simultaneously, S1 splits
normal in younger patients, have patient take a deep breath to differentiate between splits and
S4, S1 split- mitral valve closes before the tricuspid valve, S2 split- aortic valve closes before the
pulmonary valve
Heart sound - Click - ANS caused by ejection against a non compliant or stiff valve, or
mechanical valve
Systolic Murmur Aortic stenosis - ANS occurs between s1s2, systolic ejection murmur or
ejection click, crescendo/decrescendo, heard best at the aortic area, may radiate to the
neck/carotids
Systolic Murmur Mitral Regurgitation - ANS starts right at s1, heard best in mitral area/apex,
halo/pan systolic murmur (lasts through entire systole), blood is flowing backward into right
atrium, flat murmur (no change in intensity), radiates to the axilla
Systolic Murmur Mitral Valve prolapse - ANS valve billows into the atria and causes a click,
non-ejection click, mid to late systolic click (occurs in the middle of s1s2), can be associated with
mitral regurgitation causing a mid systolic click with a late systolic murmur, heard best at the
mitral/apical area
Diastolic Murmur: Aortic Regurgitation - ANS heard best along the left sternal border, occurs
between s2 and s1, caused by backflow of blood into the aorta after s2, early diastolic murmur
decrescendo murmur
2 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
, Diastolic Murmur: Mitral Stenosis - ANS right after s2 opening snap occurs and presystolic
accentuation, heard best in mitral/apical area, snap and mid diastolic rumble
Physiologic changes to cardiac system in older adults - ANS The heart may decrease in size
with age unless hypertension or disease causes enlargement. The left ventricular wall thickens,
and the valves tend to fibrose and calcify. The endocardium thickens and the myocardium
becomes less elastic. Fibrosis and sclerosis may occur in the SA node and heart valves. Fibrosis
within the conduction system can occur. S4 is more common in older adults due to decreased
left ventricular compliance.
Hemodynamic changes to cardiac system in older adults - ANS Stroke volume decreases, and
cardiac output during exercise decreases by 30% to 40%. Recovery of myocardial contractility is
delayed. Tachycardia is poorly tolerated and after a stress response, it takes longer to return to
the expected heart rate. Common EKG changes consist of 1st degree AVB, BBB, ST-T wave
abnormalities, left ventricular hypertrophy, and A Fib
Hymodynamic and Physiologic changes in adult cardiac system - the effect they have on vitals -
ANS Elderly are more susceptible to orthostatic hypotension. This is in part due to impaired
baroceptor reflex (autotomic failure). Calcification and plaque buildup in the arteries causes
stiffness including dilation of the aorta, aortic branches, and carotids. They lose elasticity and
therefore result in hypertension, especially systolic. It will take longer for their pulse to return to
baseline after activity, but due to conduction system changes it is also common to see
bradycardia.
system-appropriate history questions for the CV system - ANS Onset and duration: sudden,
gradual, or vague onset, length of episode; cyclic nature; relation to physical exertion, rest,
emotional experience, eating, coughing, cold temperatures, trauma; awakens from sleep
Character: aching, sharp, tingling, burning, pressure, stabbing, crushing, or clenched fist (Levine)
sign
Location: radiating down arms, to neck, jaws, teeth, scapula; relief with rest or position change
3 @COPYRIGHT 2025/2026 ALLRIGHTS RESERVED.
