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PPS 939 > Block 3 Physical Exam (Cardio) > Flashcards

Block 3 Physical Exam (Cardio) Flashcards

1
Q

What is the precordium?

A

area of thorax overlying the heart

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2
Q

What is the pericardium?

A

sac surrounding the heart that contains visceral fluid

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3
Q

What is the SA node function?

A

“cardiac pacemaker”

generates and paces electrical pulse

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4
Q

What is the AV node function?

A

delays impulse before passing to bundle of His

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5
Q

What is a normal PR interval?

A

100-200 ms

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6
Q

What does PR represent?

A

time between atrial depol to ventricular depol / AV conduction delay

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7
Q

What drugs extend the PR?

A

beta blockers

– (prolonged PR is a contraindication)

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8
Q

What is the QT interval?

A

beginning of Q to end of T

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9
Q

What is a normal QT?

A

300-450 ms

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10
Q

What does the QT represent?

A

whole cycle of ventricular activity

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11
Q

Who is at risk for QT prolongation?

A

1) women
2) elderly
3) hypo-K, hypo-Mg
4) ischemic area
5) bradycardia

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12
Q

What intervals on EKG are HR-dependent?

A

PR and QT

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13
Q

What are you at risk for if you have a prolonged QT?

A

sudden cardiac death

Torsades

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14
Q

What does S2 represent?

A

beginning of diastole; A/P valve closing

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15
Q

Where is S2 loudest?

A

at base with diaphragm

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16
Q

What does S3 represent?

A

rapid filling
if over 30-40 years old…
– volume overload due to regurgitant valves or CHF

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17
Q

When is S3 normal?

A

in children/teens

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18
Q

When is an S2 split normal?

A

inhalation (P closes after A)

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19
Q

What does S1 represent?

A

beginning of systole; M/T valves closing

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20
Q

Where is S1 loudest?

A

at apex with diaphragm

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21
Q

When is S1 splitting normal?

A

in healthy young people without symptoms

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22
Q

Why does an S1 split occur?

A

because mitral valve closure slightly precedes tricuspid closure

    • increased pulmonary circulation pressure
    • pulmonary HTN or volume overload
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23
Q

What causes and S4?

A

increased resistance to filling due to noncompliant vessel or increased fluid volume
– CAD, HTN, aortic stenosis, severe anemia, hyperthyroidism

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24
Q

Where is S4 best heard?

A

at apex with bell, and in left lateral decubitus position

– low frequency sound

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25
When is S4 normal?
children, young adults, athletes | maybe in the elderly
26
When does S4 occur?
late diastole upon atrial contraction
27
Where is S3 best heard?
at apex with bell, and in left lateral decubitus position | -- low frequency sound
28
How is a murmur distinguished from heart sounds?
longer duration
29
What causes a murmur?
turbulent blood flow - - narrowed/leaky valves - - abnormal openings in cardiac chambers - - increased blood velocity (exercise) - - decreased blood velocity (anemia)
30
When are murmurs normal?
systolic murmurs in normal people
31
What type of murmur is associated with valvular pathology?
diastolic
32
What is noted when a murmur is detected?
STLPIRQ - - shape - - timing - - location of max intensity - - pitch - - intensity - - radiation - - quality
33
How is configuration of a heart murmur described?
1) plateau 2) crescendo 3) decrescendo 4) crescendo-decrescendo
34
How are murmurs graded?
``` by intensity (gradation/max grade) (?/6) ```
35
How does one listen for murmurs?
in upright and left lateral decubitus positions
36
What is a grade 1 murmur?
very faint; heard only after listener has tuned in
37
What is a grade 2 murmur
quiet, but heard immediately after placing stethoscope on chest
38
What is a grade 3 murmur?
moderately loud
39
What is a grade 4 murmur?
loud with palpable thrill
40
What is a grade 5 murmur?
very loud with thrill, heard with stethoscope partly off chest
41
What is a grade 6 murmur?
very loud with thrill, heard with stethoscope entirely off chest
42
What is the apical impulse
aka PMI
43
What is the PMI?
point where apex comes in contact with chest wall (4th or 5th LICS at MCL)
44
JVD
jugular venous distention
45
JVP
jugular venous pressure
46
HJR
hepatojugular reflex
47
preload
volume of blood in ventricle at end of diastole; degree to which myocardium is stretched
48
afterload
the vascular resistance against which a ventricle must contract
49
cardiac output
volume of blood pumped from ventricles in 1 minute (SV*HR)
50
stroke volume
volume of blood ejected in 1 full beat
51
What does stroke volume dependent on?
preload, afterload, contractility
52
contractility
ability of cardiac muscle to shorten and contract against a load
53
AI
aortic insufficiency
54
AR
aortic regurgitation
55
AS
aortic stenosis
56
5ICSMCL
5th intercostal space midclavicular line
57
CV
cardiovascular
58
LLSB
left lower sternal border
59
M
murmur
60
MAP
mean arterial pressure
61
MR
mitral regurgitation
62
MRG
murmurs, rubs, and gallops
63
What causes a gallop?
S3 or S4 presence
64
MS
mitral stenosis
65
MVP
mitral valve prolapse
66
NSR
normal sinus rhythm
67
OS
opening snap
68
RRR
regular rate and rhythm
69
How does one measure heart sounds?
supine with HOB at 30 degrees - timing, intensity, respiratory variation, any splitting, HR, irregularity SHITI RV
70
SEM
systolic ejection murmur
71
USB
upper sternal border
72
bruit
murmur-like sound of vascular origin due to arterial compression
73
thrill
humming vibration upon palpation due to arterial compression
74
How are pulses graded?
0 to 4+
75
4+ pulse grading
bounding
76
3+ pulse grading
increased
77
2+ pulse grading
brisk, expected (normal)
78
1+ pulse grading
diminished, weaker than expected
79
0 pulse grading
absent, unable to palpate
80
What are sources of chest pain?
1) cardiac 2) GI 3) musculoskeletal
81
What causes diminished pulsation?
1) low CO
82
What causes increased pulsation?
1) anxiety 2) thyrotoxicosis 3) HTN 4) aortic regurgitation 5) hypertrophic cardiomyopathy
83
What are signs of MI?
1) rapid weak HR 2) EKG changes (Q, STEMI, T-wave inversion) 3) creatinine phosphokinase elevations within 2 days 4) LDH within 24 hours
84
What are signs of CHF?
1) tachycardia 2) S3 and/or S4 3) LVH, displaced PMI 4) JVD, hepatomegaly, HJR 5) weight gain 6) EF less than 40% 7) rales, crackles on lung exam
85
What are signs of arrhythmia?
1) irregular heart rhythm 2) normal, brady, or tachycardic 3) abnormal EKG
86
What are sxs of arrhythmia?
1) palpitation 2) SOB, dizziness, lightheadedness, fainting 3) nervousness, anxiety
87
What are sxs of CHF?
1) SOB, DOE 2) orthopnea, PND 3) peripheral edema 4) cough 5) weakness, fatigue
88
What are sxs of MI?
1) moderate-severe angina not relieved by rest or NTG 2) pain radiation to neck/jaw/shoulder/back 3) SOB, DOE 4) n/v 5) sweating 6) lightheadedness, dizziness, syncope
89
When is carotid impulse auscultation done?
reserved for - - elderly - - h/o syncope - - CVD sxs
90
How is the carotid impulse evaluated?
1) auscultate right then left with diaphragm and bell -- might be best if patient holds breath 2) palpate right then left
91
What does lateral /downward PMI displacement suggest?
CHF or myopathy
92
What factors increase PMI amplitude and duration?
1) LVH 2) anxiety 3) fever 4) hyperthyroidism 5) anemia
93
What things are noted upon evaluating PMI?
size, location, duration, amplitude | LADS
94
What does JVP reflect?
Right atrial pressure / central venous pressure | -- and anything impairing right heart filling (CHF)
95
What is normal JVP?
less than or equal to 3 cm above sternal angle
96
How is JVP best assessed?
pulsation in right internal jugular
97
What is a positive JVD finding?
JVP ≥ 3 cm
98
When is HJR evaluated?
-- JVD present or signs/sxs of CHF, liver failure, or cirrhosis
99
When is a positive HJR finding?
when JVP stays elevated after compressing right lower abdomen ( indicates hepatic venous congestion / right-side CHF)

PPS 939 (4 decks)

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