16- Physical Diagnosis of Cardiac System

Question 1

cardinal symptoms of cardiovascular disease

Answer 1

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

Question 2

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

Answer 2

MI

Question 3

define myocardial ischemia

Answer 3

imbalance of myocardial oxygen demand and supply

Question 4

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

Answer 4

angina

Question 5

associated features of angina

Answer 5

• precipitated by exertion, cold or stress

- S4 gallop or MR during pain

Question 6

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

Answer 6

unstable angina

Question 7

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

Answer 7

acute myocardial infraction

Question 8

recurrent pain similar to angina heard with a systolic murmur

Answer 8

aortic stenosis

Question 9

sharp pain relieved by sitting up and leaning forward

Answer 9

pericarditis

can also hear a pericardial friction rub

Question 10

tearing or ripping sensation with abrupt onset of unrelenting pain

Answer 10

aortic dissection

Question 11

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

Answer 11

pulmonary embolism

Question 12

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

Answer 12

esophageal reflux

relieved by antacids and time

burning quality

Question 13

pain that radiates to the right shoulder after a meal …

Answer 13

could be gallbladder disease

Question 14

patient can point to the pain specifically with one finger

Answer 14

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

Question 15

sharp burning pain with dermatomal distribution

Answer 15

shingles

the pain may precede the rash

Question 16

key question for orthopnea

Answer 16

how many pillows do you sleep with?

Question 17

opposite of orthopnea

Answer 17

platypnea

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

Question 18

What is pertinent family history for cardiac issues?

Answer 18

coronary artery disease: first degree relative and

Question 19

non modifiable risk factors for coronary artery disease

Answer 19

age
family history
gender
ethnicity

Question 20

modifiable risk factors for CAD

Answer 20

HTN
diabetes
hyperlipidemia
obesity
diet
tobacco
physical activity
type A personality

Question 21

how do you take BP for a cardiac exam?

Answer 21

in both arms and one leg

Question 22

what does a pulsating uvula indicate?

Answer 22

aortic insufficiency

Question 23

how is jugular venous pressure measured and what is abnormal?

Answer 23

• 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

Question 24

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

Answer 24

delayed in frequency and intensity

aortic regurgitation for example would be increased

Question 25

crackles heard with lung auscultation are indicative of …

Answer 25

pulmonary edema, pneumonia or pleuritis

Question 26

where is a normal PMI located

Answer 26

left midclavicular line and 5th intercostal space

should also be less than 2 cm

Question 27

S1 =

Answer 27

mitral and tricuspid close

Question 28

S2 =

Answer 28

aortic and pulmonic close

Question 29

interval between S1 and S2 =

Answer 29

ventricular systole

Question 30

interval between S2 and S1

Answer 30

ventricular diastole

Question 31

when is an S3 sound abnormal?

Answer 31

> 40 yo indicates heart failure or mitral regurgitation

-this is the rapid filling phase of venticular diastole

Question 32

systolic murmurs could be:

Answer 32

Atrial or pulmonic stenosis

Mitral or tricuspid regurgitation

Question 33

diastolic murmurs could be:

Answer 33

Aortic and pulmonic regurgitation

Mitral and tricuspid stenosis

Question 34

continuous murmur

Answer 34

patent ductus arteriosus

Question 35

100% specific for diagnosis of acute pericarditis

Answer 35

pericardial friction rub

you would also see ST elevation in all leads

Question 36

what is the hepatojugular reflux test?

Answer 36

pressing on liver and showing an increase in the jugular venous pressure

liver enlargement indicates HF

Question 37

what might delayed pulses indicate?

Answer 37

coarctation/dissection of aorta