16- Physical Diagnosis of Cardiac System Flashcards
cardinal symptoms of cardiovascular disease
- chest pain or discomfort
- dyspnea, orthopnea, paroxysmal nocturnal dyspnea, wheezing
- palpitations, dizziness, syncope
- cough, hemoptysis
- fatigue, weakness
- pain in extremities with exertion (claudication)
chest discomfort without an immediate or obvious clinical cause points toward …
MI
define myocardial ischemia
imbalance of myocardial oxygen demand and supply
pressure, tightness, squeezing or burning that lasts 2-10 min –>
angina
associated features of angina
- precipitated by exertion, cold or stress
- S4 gallop or MR during pain
similar to angina but occurs with low exertion and at rest and lasts 10-20 min
unstable angina
chest pain unrelieved by nitroglycerin and of length greater than 30 min
acute myocardial infraction
recurrent pain similar to angina heard with a systolic murmur
aortic stenosis
sharp pain relieved by sitting up and leaning forward
pericarditis
can also hear a pericardial friction rub
tearing or ripping sensation with abrupt onset of unrelenting pain
aortic dissection
abrupt onset of pain in lateral chest wall associated with trouble breathing
pulmonary embolism
pain that worsens after laying down post-meal (post prandial decumbency)
esophageal reflux
relieved by antacids and time
burning quality
pain that radiates to the right shoulder after a meal …
could be gallbladder disease
patient can point to the pain specifically with one finger
musculoskeletal disease – can’t do that if cardiac because it is too spread out
sharp burning pain with dermatomal distribution
shingles
the pain may precede the rash
key question for orthopnea
how many pillows do you sleep with?
opposite of orthopnea
platypnea
relief when laying flat, SOB when standing. Happens with shunts ie liver disease
What is pertinent family history for cardiac issues?
coronary artery disease: first degree relative and
non modifiable risk factors for coronary artery disease
age
family history
gender
ethnicity
modifiable risk factors for CAD
HTN diabetes hyperlipidemia obesity diet tobacco physical activity type A personality
how do you take BP for a cardiac exam?
in both arms and one leg
what does a pulsating uvula indicate?
aortic insufficiency
how is jugular venous pressure measured and what is abnormal?
- 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
how would you describe the carotid pulse of someone with valvular aortic stenosis?
delayed in frequency and intensity
aortic regurgitation for example would be increased
crackles heard with lung auscultation are indicative of …
pulmonary edema, pneumonia or pleuritis
where is a normal PMI located
left midclavicular line and 5th intercostal space
should also be less than 2 cm
S1 =
mitral and tricuspid close
S2 =
aortic and pulmonic close
interval between S1 and S2 =
ventricular systole
interval between S2 and S1
ventricular diastole
when is an S3 sound abnormal?
> 40 yo indicates heart failure or mitral regurgitation
-this is the rapid filling phase of venticular diastole
systolic murmurs could be:
Atrial or pulmonic stenosis
Mitral or tricuspid regurgitation
diastolic murmurs could be:
Aortic and pulmonic regurgitation
Mitral and tricuspid stenosis
continuous murmur
patent ductus arteriosus
100% specific for diagnosis of acute pericarditis
pericardial friction rub
you would also see ST elevation in all leads
what is the hepatojugular reflux test?
pressing on liver and showing an increase in the jugular venous pressure
liver enlargement indicates HF
what might delayed pulses indicate?
coarctation/dissection of aorta
