16- Physical Diagnosis of Cardiac System Flashcards

1
Q

cardinal symptoms of cardiovascular disease

A
  • chest pain or discomfort
  • dyspnea, orthopnea, paroxysmal nocturnal dyspnea, wheezing
  • palpitations, dizziness, syncope
  • cough, hemoptysis
  • fatigue, weakness
  • pain in extremities with exertion (claudication)
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2
Q

chest discomfort without an immediate or obvious clinical cause points toward …

A

MI

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3
Q

define myocardial ischemia

A

imbalance of myocardial oxygen demand and supply

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4
Q

pressure, tightness, squeezing or burning that lasts 2-10 min –>

A

angina

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5
Q

associated features of angina

A
  • precipitated by exertion, cold or stress

- S4 gallop or MR during pain

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6
Q

similar to angina but occurs with low exertion and at rest and lasts 10-20 min

A

unstable angina

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7
Q

chest pain unrelieved by nitroglycerin and of length greater than 30 min

A

acute myocardial infraction

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8
Q

recurrent pain similar to angina heard with a systolic murmur

A

aortic stenosis

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9
Q

sharp pain relieved by sitting up and leaning forward

A

pericarditis

can also hear a pericardial friction rub

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10
Q

tearing or ripping sensation with abrupt onset of unrelenting pain

A

aortic dissection

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11
Q

abrupt onset of pain in lateral chest wall associated with trouble breathing

A

pulmonary embolism

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12
Q

pain that worsens after laying down post-meal (post prandial decumbency)

A

esophageal reflux

relieved by antacids and time

burning quality

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13
Q

pain that radiates to the right shoulder after a meal …

A

could be gallbladder disease

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14
Q

patient can point to the pain specifically with one finger

A

musculoskeletal disease – can’t do that if cardiac because it is too spread out

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15
Q

sharp burning pain with dermatomal distribution

A

shingles

the pain may precede the rash

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16
Q

key question for orthopnea

A

how many pillows do you sleep with?

17
Q

opposite of orthopnea

A

platypnea

relief when laying flat, SOB when standing. Happens with shunts ie liver disease

18
Q

What is pertinent family history for cardiac issues?

A

coronary artery disease: first degree relative and

19
Q

non modifiable risk factors for coronary artery disease

A

age
family history
gender
ethnicity

20
Q

modifiable risk factors for CAD

A
HTN
diabetes
hyperlipidemia
obesity
diet
tobacco
physical activity
type A personality
21
Q

how do you take BP for a cardiac exam?

A

in both arms and one leg

22
Q

what does a pulsating uvula indicate?

A

aortic insufficiency

23
Q

how is jugular venous pressure measured and what is abnormal?

A
  • Measured by adding 5 cm to the height of observed distension above the sternal angle of Louis at 45 degrees
  • anything above 9 cm is abnormal
24
Q

how would you describe the carotid pulse of someone with valvular aortic stenosis?

A

delayed in frequency and intensity

aortic regurgitation for example would be increased

25
crackles heard with lung auscultation are indicative of ...
pulmonary edema, pneumonia or pleuritis
26
where is a normal PMI located
left midclavicular line and 5th intercostal space should also be less than 2 cm
27
S1 =
mitral and tricuspid close
28
S2 =
aortic and pulmonic close
29
interval between S1 and S2 =
ventricular systole
30
interval between S2 and S1
ventricular diastole
31
when is an S3 sound abnormal?
>40 yo indicates heart failure or mitral regurgitation -this is the rapid filling phase of venticular diastole
32
systolic murmurs could be:
Atrial or pulmonic stenosis Mitral or tricuspid regurgitation
33
diastolic murmurs could be:
Aortic and pulmonic regurgitation Mitral and tricuspid stenosis
34
continuous murmur
patent ductus arteriosus
35
100% specific for diagnosis of acute pericarditis
pericardial friction rub you would also see ST elevation in all leads
36
what is the hepatojugular reflux test?
pressing on liver and showing an increase in the jugular venous pressure liver enlargement indicates HF
37
what might delayed pulses indicate?
coarctation/dissection of aorta