1 cardio lecture Flashcards
Angina
- the main manifestation of the coronary artery disease (CAD)
-
Typical angina (definite):
1) Substernal chest discomfort with a characteristic quality and duration that is2) provoked by exertion or emotional stress and 3) relieved by rest or NTG. - Atypical angina (probable): meets 2 of the above characteristics.
- Noncardiac chest pain: meets one or none of the typical anginal characteristics. (AHA 2009
CAD
discrepancy between the amount of oxygen supplied to the cardiac tissue and the needs;
- other cause of angina: inflam.involving the coronary art.(syphilis, vasculitis); angina“with normal coronary arteries“
Typical angina
- S:Precordial area
- R:left uper limb cubital side to last 2 fingers
- C:Constriction ppressure squeezing
- T:no more than 15 minutes
- E:Extra demand on the heart exercise, an emotional upset, exposure to cold, a heavy meal
- rest nitroglycerine
- S:Aanxiety dyspnea
Atypical angina
- S:Interscapular, upper part of the body, epigastrium; sometimes: just in areas of radiation
- R: jaw Posterior limbs posterior Thorax
- C: weakness discomfort
[*] Prinzmetal angina (variant angina):
- Coronarian spasm – hyperactivity of sympathetic nervous system
- During sleeping (REM phase- rapid eye movement)
- Severe pain, anxiety, dyspnea
- Same hour of the night (or day)
- Elevation of the ST segment (diff.dg. with acute myocardial infarction)- occurs only during the crisis !!!
Non-ischaemic pain:
Pericarditis
Pericarditis
- Substernal pain, like a “knife”(dry p.) or pressure (p.effusion) or absent
- Left border of the sternum or epigastrium radiating to the neck and arms
- increases: pressure over the thorax, respiratory movements
- decreases: leaning forward – antalgic position in dry pericarditis and against dyspnea in pericardial effusion !
Pain due to aortic causes
- Aortitis (syphilis)
- Aortic aneurysm
- Acute dissection of aorta:
–suddenly and maximal intensity onset;
–anterior thoracic pain is associated with anterior arch or aortic root dissection
Forms of dyspnea in cardiac patients:
–Exertional d. – progressive: the intensity of the effort leading to dyspnea declines progressively
–Dyspnea at rest with orthopnea
–Paroxysmal d.: ACUTE LVF- 3 types:
–Paroxysmal dyspnea
Nocturnal paroxysmal dyspnea
- a sudden awakening of the patient, after a couple hours of sleep, with a feeling of severe anxiety, breathlessness, and suffocation- orthopnea
- the manifestations are relieved spontaneously
- Episodes of this may be so frightening that the patient may be afraid to resume sleeping
Cardiac Asthma
- Bronchial obstruction is associated
Acute pulmonary Edema
- Transsudate al alveoli level
- Severe dyspnea and cough- frothy pink sputum
Exertional d. – progressive: the intensity of the effort leading to dyspnea declines progressively
- the degree of activity necessary to induce this symptom: difference between healthy-cardiac subjects
- CHRONIC LVF (CAD, hypertensive cardiopathy, valvular heart diseases etc)
- The severity of d. decreases when RIGHT cardiac failure occurs !!! – pulmonary stasis decreases when peripheral (sistemic) stasis develops
–Dyspnea at rest with orthopnea
[*] LV advances
[*] is relieved with elevation of the head - “how many pillows do you need?”
[*] develops when the patient is awake, within min.after the recumbency
[*] Cough- nonproductive, during recumbency- an “orthopnea equivalent.”
Palpitations:
- An unpleasent sensation in which a person is aware of an irregular, hard, or rapid heartbeat.
- Due to hyperexcitability of the central nervous system or abnormal cardiac function (rhythm, the force of contraction)
- A very common symptom
- Physiological cond. (coffee, smoking, effort, stress)
- Cardiac diseases- arrhythmias (any cardiopathy)
Palitations
The correlation with a cardiopathy is supposed when:
- Palpitations- persistent and frequent
- Associatedwith chest pain,dyspnea
- history of a cardiac disease
Orthopnea
Acute LVF
Immobile
during crisis off angina
Agitation, no specific position to relieve the pain
AMI
Squatting
congenital cardiopathy (redistribution of the blood to the brain)
Leaning forward-
pericarditis
corvisart face
cyanosis
–Central: congenital cardiopathy (R L shunt)
–Periph.: RCF
–Mixed: cor pulmonale
Palor
Low cardiac output
- CF
- Arrythmias
- acute myocardial infarction
- crisis of angina
Cafe au lait : pallor+ cyanosis –> infectios endocarditis
Jaundice
Chronic liver stasis
RCF
Chronic Pericarditis
clubbing finger
- congenital cardiopathies
- endocarditis
- cor pulmonale
Meynet nodules
reuhmatic fever
(on the back of the wrist, the outside elbow, and the front of the knees), erytema marginatum (well-demarcated edge and clearing central portion)
signs for infectious endocarditis
[*] Osler nodes:
–Septic embolisation- fingers, toes
[*] Janeway lesions:
–Haemorrage the thenar and hypothenar eminences
[*] splinter haemorrhages on fingernail
Fever (37-38 Celsius):
infective endocaditis
Systolic epigastric pulsations:
- right ventricle dilatation= Harzer sign,
- abd.aortic aneurysm,
- tricuspid regurgitation
- thin people: N.!- abdominal aorta
- -Emphysema: low position of the diaphragm allows the transmission of the normal activity of the RV
- -Hepatomegaly-stasis: the normal abd.aortic pulsations are transmitted to the enlarged liver
apex impulse
= the point of maximum outward movement of the left ventricle during systole
- corresponds to the onset of ventricular ejection or systole
- one third of the systole
- *-IVth – VI th intercostal space** on the midclavicular line
- Dorsal, lateral decubitus (! A correction of 2cm.to the right)
- Area of 2 cm2
- Location, amplitude, size
Apex impulses
Displacement
With normal position of trachea:
–Left ventricular enlargement - the apex is displaced downwards and laterally.
–Right ventricular enlargement - the apex will displaced laterally.
–Cardiomegaly
–Pectus excavatum (unusual location)
–Situs inversus/ dextrocardia
With shifted trachea
–Away from the hemithorax in case of: pleural effusion, pneumothorax
–Towards the hemithorax: atelectasis, fibrosis (Pressure differrence)
increased intenity of apex impulses
–LV hypertrophy,
–Pressure overload: aortic stenosis, systemic hypertension- forceful sustained (a dome-shaped impulse)
–Volume overload: aortic, mitral regurgitation- produces a less sustained impulse- hyperdynamic apex impulse
decreased intenity of apex impulse
–Dextrocardia
–apex behind a Rib
–Pericarditis (left)
–Obesity and thick chest wall
–Pericardial effusion
–Emphysema
Double apex beat
[*] atrial contraction (atrial hypertrophy) or late outward movement of a ventricular aneurysm
Tapping apex beat-
the first sound is loud and may be felt
- Thrill
= a palpable murmur- a vibration produced by the physical energy of a loud sound
-“le fremissement cataire” = purring of a cat
- diastolic thrill, Vth left intercostal space, increased in left lateral decubitus- mitral stenosis
- Systolic thrill, 2nd right intercostal space- aortic stenosis
Pericardial rub
- pericarditis (dry)
- During diastole and systole
- Increased when leaning forward
murmur grading
I/VI Barely audible
II/VI Audible after a few seconds of auscultation, low intensity
III/VI Immediately audible, moderate intensity
IV/VI Loud intensity without a precordial thrill
V/VI Loud intensity with a precordial thrill
VI/VI Loudest intensity, precordial thrill, audible with stethoscope slightly away from thoracic wall
murmur
–Described according to their timing in the cardiac cycle; duration
–Location
–Radiation
–quality- tonal effect (rumbling)
–Pattern-shape
–Frequency (pitch)- relates to the velocity of the blood; high pitched murmurs occur when the blood flow from a high pressure chamber to a lower
–Grade (degree of intensity)– I-VI
–Increased- decreased intensity
