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N507 Exam 1 > (9) Cardio > Flashcards

(9) Cardio Flashcards

1
Q

Systole

A

ventricles contract

  • right ventricle pumps blood into pulmonary arteries (pulmonic valve open)
  • left ventricle pumps blood into aorta (aortic valve open)
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2
Q

Diastole

A

ventricles relax

  • blood flows from right atrium to right ventricle (tricuspid valve open)
  • blood flows from left atrium to left ventricle (mitral valve open)
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3
Q

blood flow through heart

A

superior and inferior vena cavas - right atrium and right ventricle - pulmonary arteries - left atrium and left ventricle - aorta and aortic arch

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4
Q

preload

A

volume overload

load that stretches the cardiac muscle before contraction

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5
Q

contractility

A

ventricles contract during systole

ability of cardiac muscle to shorten when given. load

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6
Q

afterload

A

pressure overload

degrees of vascular resistance to ventricular contraction

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7
Q

cardiac output

A

stroke volume x heart rate

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8
Q

blood pressure

A

cardiac output x systemic vascular resistance

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9
Q

systolic blood pressure

A

pressure generated by left ventricle during systole when the LV ejects blood into the aorta and the arterial tree
(pressure waves in the arteries create pulses)

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10
Q

diastolic blood pressure

A

pressure generated by blood remaining in the arterial tree during diastole, when the ventricles are relaxed

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11
Q

carotid pulse: brisk upstroke

A

normal

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12
Q

carotid pulse: delayed upstroke

A

suggests aortic stenosis

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13
Q

carotid pulse: bounding upstroke

A

suggests aortic insufficiency

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14
Q

Apex (PMI) pulse: tapping

A

normal

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15
Q

Apex (PMI) pulse: sustained

A

suggests LV hypertrophy from HTN or aortic stenosis

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16
Q

Apex (PMI) pulse: diffuse

A

suggests a dilated ventricle from CHF or cardiomyopathy

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17
Q

what to assess at apical pulse?

A

location, amplitude, duration, diameter

rhythm least important

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18
Q

heart auscultation: diaphragm

A

best for high-pitched sounds like S1,S2,S4, most murmurs

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19
Q

heart auscultation: bell

A

best for low-pitched sounds like S3 and rumble of mitral stenosis

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20
Q

how to ID if murmur is systolic or diastolic

A

murmur coincides w/ carotid upstroke = systolic

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21
Q

PMI

A

may not be palpable even in healthy pt

left border of heart normally 5th intercostal space at or just medial to left midclavicular line

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22
Q

PMI > 2.5 cm - abnormal dx?

A

left ventricular hypertrophy from HTN, aortic stenosis

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23
Q

PMI displacement lateral to midclavicular line of >10cm lateral to mistrial line - abnormal dx?

A

LVH

ventricular dilation from MI or heart failure

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24
Q

hear S3 or S4 - abnormal dx?

A

heart failure
acute myocardial ischemia

S3 abrupt deceleration of inflow across the mitral valve
s4 increased L ventricular end diastolic stiffness which decreases compliance

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25
Q

S1

A

closure of mitral valve

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26
Q

S2

A

closure of aortic valve

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27
Q

chest wall location & typical rising of sound/murmur

A

R 2nd interspace to apex: aortic valve

L 2nd/3rd interspaces close to sternum but also higher/lower levels: pulmonic valve

@/near lower left sternal border: tricuspid valve

@/near cardiac apex: mitral valve

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28
Q

P wave

A

atrial depolarization

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29
Q

QRS

A

ventricular depolarization

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30
Q

T wave

A

ventricular depolarization or recovery

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31
Q

factors affecting BP

A

L ventricular stroke volume
distensibility of the aorta and large arteries
peripheral vascular resistance, particularly @ arteriolar level
volume of blood in arterial sysem

32
Q

JVP (jugular venous pressure)

A

reflects right atrial pressure (which equals CVP and R ventricular end-diastolic pressure)

best estimated from RIJ which has most direct channel into the R atrium

33
Q

Cardiac: common/concerning symptoms

A 
chest pain
palpitations
shortness of breath
swelling
fainting
34
Q

anterior chest pain “tearing, ripping” radiating to back - abnormal dx?

A

acute aortic dissection

35
Q

sudden dyspnea - abnormal dx?

A

pulmonary embolism
spontaneous pneumothorax
anxiety

36
Q

PND

A

episodes of sudden dyspnea and orthopnea that awaken pt from sleep 1-2 hrs after going to bed, prompting pt to get up, may have wheezing coughing

37
Q

orthopnea and PND - abnormal dx?

A

L ventricular heart failure
mitral stenosis
obstructive lung disease

38
Q

edema - abnormal dx?

A

cardiac
nutritional
positional

can be dependent or anasarca (whole body)
periorbital - nephrotic syndrome
waist - liver ascites

39
Q

healthy fats

A

high monounsaturated fats: nuts
high in polyunsaturated fat: corn, cottonseed, soybean oils, walnuts, pumpkin/sunflower seeds, soft margarine, mayo, salad dressings
high in omega-3s: flaxseed, walnuts, tuna, anchovies, herring, mackerel, rainbow trout, salmon, sardines, shrimp

40
Q

unhealthy fats

A

high in saturated fats: high fat dairy, bacon, chocolate, coconut oil, lard, meat gravy, ground meat, bologna, hot dogs, sausage
high in trans fats: hydrogenated oil, stick margin, fried food

41
Q

JVP

A

pg 375 if have time

42
Q

elevated JVP

A

1 heart failure

tricuspid stenos
chronic pulmonary HTN
superior vena cave obstruction
cardiac tampondae
constrictive perocarditis
43
Q

IJ vs carotid pulsations

A

IJ

  • rarely palpable
  • biphasic
  • eliminated by light pressure
  • height changes w/ position
  • height falls w/ inspiration

Carotid

  • palpable
  • single outward thrust component
  • not eliminated by pressure
  • height unchanged by position or inspiration
44
Q

assessment characteristics of carotid pulse

A
  • amplitude
  • contour of pulse wave
  • variations in amplitude
  • timing of upstroke in relation to S1 and S2
45
Q

unilateral carotid pulsatile bulge -abnormal dx?

A

torturous or kinked carotid artery

46
Q

decreased carotid pulsations - abnormal dx?

A

decreased stroke volume from shock or MI and atherosclerotic narrowing or occlusion

47
Q

carotid pulse small, thready weak vs bounding - abnormal dx?

A

small - cardiogenic shock

bounding - aortic regurgitation

48
Q

pulses alternans

A

rhythms of pulse remains regular but the force of the arterial pulse alternates b/c of alternating strong and weak ventricular contractions

almost always indicates severe L ventricular dysfunction

49
Q

Paradoxical pulse

A

greater than normal drop in SBP during inspiration

signaled by alternately loud and soft Korotkoff sounds of sudden doubling of apparent HR as cuff pressure declines (upright position may accentuate this finding)

seen in: acute asthma
COPD
pericardial tamponade
constrictive pericarditis
acute pulmonary embolism
50
Q

carotid thrill - abnormal dx?

A

aortic stenosis

51
Q

carotid bruit - abnormal dx?

A 
torturous carotid artery
external carotid artery disease
aortic stenosis
hypervascularity of hyperthyroid
external compression from thoracic outlet syndrome
52
Q

thrill vs bruit

A

thrill - vibration

bruit - murmur like sound, stop breathing 15 sec to listen

53
Q

sequence of cardiac exam by pt position

A

supine, HOB 30: JVP, carotid, inspect/palpate precordium, 2nd R&L interspaces, RV, LV, apical impulse

left lateral decubitus: palpate apical impulse for diameter, listen

supine, HOB 30: listen 2nd R&L interspace, down L sternal border to 4th/5th interspaces, across to apex the 6 listening areas w/ both sides of stethoscope

sitting, leaning forward after full exhalation: listen L sternal border and apex w/ diaphragm

54
Q

diminished S1 or S2 - abnormal dx?

A

S1 - 1st degree heart block

S2 - aortic stenosis

55
Q

S1 vs S2 intensity

A

S1 louder at apex

S2 louder at base

56
Q

palpation of carotid artery during auscultation is valuable for?

A

coming of sounds and murmurs b/c carotid upstroke always occurs in systole immediately after S1 sounds or murmurs coinciding w. upstroke are systolic, sounds/murmurs following carotid upstroke are diastolic

57
Q

heaves and lifts

A

sustained impulses that rhythmically lift your fingers produced by an enlarged R or L ventricle or atrium and occasionally by ventricular aneurysms

(use palm or finger pads firmly on chest)

58
Q

apical pulse shifted upward and to left - abnormal dx?

A

pregnancy

high left diaphragm

59
Q

apical pulse lateral displacement from axillary line - abnormal dx?

A 
heart failure
cardiomyopathy
ischemic heart disease
thoracic deformities
mediastinal shift
60
Q

apical pulse lateral displacement from midclavicular line - abnormal dx?

A

increased L ventricular volume and low left ventricular EF more likely

61
Q

hyperkinetic apical pulse - abnormal dx?

A

hyperthyroid
severe anemia
pressure overload of L ventricle from HTN or aortic stenosis
volume overload of L ventricle from aortic regurgitation

62
Q

sustained high-amplitude apical impulse - abnormal dx?

A

significantly increases LVH from pressure overload seen in HTN
- if displaced laterally consider value overload

63
Q

diffuse sustained low amplitude apical impulse - abnormal dx?

A

heart failure

dilated cardiomyopathy

64
Q

pulmonic area (L 2nd interspace) prominent pulsation or palpable S2 - abnormals?

A

prominent pulsation: dilation or increased flow in pulmonary artery

palpable S2: pulmonary HTN

65
Q

aortic area (R 2nd interspace) pulsation - abnormal?

A

systemic HTN

dilated of aneurysmal aorta

66
Q

stethoscope: diaphragm v bell

A

diaphragm: high pitched sounds of S1 S2, murmurs of aortic and mitral regurgitation, pericardial friction rubs
bell: low pitched sounds of S3 S4 and murmur of mitral stenosis

67
Q

important maneuver to enhance mitral stenosis detection

A

pt on left lateral decubitus position (brings L ventricle closer to chest wall)
use bell on apical impulse
hear mitral murmur

68
Q

importnat maneuver to enhance aortic regurgitation detection

A

pt sits up, leans forward, exhales completely, briefly stop breathing after expiration
diaphragm on chest along L sternal border at apex - have pt periodically breath
hear soft diastolic decrescendo murmur

69
Q

Systolic Murmurs

A

coincide w/ carotid upstrike

begins S1

often heard in healthy pts and not pathologic

70
Q

Diastolic Murmurs

A

usually represent valvular heart disease

begins S2

early = regurgitant flow across incompetent semilunar valves

71
Q

Continuous Murmurs

A

begin in systole and extends in all or part of diastole

congenital: PDA, AV fistulas

72
Q

Mitral Stenosis type of murmur?

A

pre systolic murmur

-cresendo

73
Q

Aortic Regurgitation type of murmur?

A

early diastolic

- descrendo

74
Q

Aortic Stenosis type of murmur?

A

mid systolic murmur
-crescendo-decrescendo

often radiates to neck in direction of arterial flow especially on R

75
Q

Mitral Regurgitation type of murmur?

A

Pansystolic murmur
- plateau

radiates to axilla (bone conduction)

76
Q

Murmur Grades

A

1: faint, not heard all positions
2. quite but heard immediately after placing stethoscope
3: moderately loud
4: loud w/ thrill
5: very loud w/ thrill, maybe heard w/ stethoscope partly off chest
6: very loud w/ thrill, maybe heard w/ stethoscope entirely off chest

77
Q

squatting and assessing murmurs

A

help to ID prolapsed mitral valve and distinguish hypertrophic cardiomyopathy from aortic stenosis

N507 Exam 1 (10 decks)

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