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Clinical Correlation > BP, Pulses and Murmurs > Flashcards

BP, Pulses and Murmurs Flashcards

1
Q

briefly go over and explain the pulse scale

A

0 indicating no palpable pulse; 1 + indicating a faint, but detectable pulse; 2 + suggesting a slightly more diminished pulse than normal; 3 + is a normal pulse; and 4 + indicating a bounding pulse.

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2
Q

this is the absence of a palpable pulse despite an audible heartbeat over the precordium. in what medical condition is this commonly found?

A

pulse deficit; aFib

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3
Q

aortic regurgitation is associated with what type of pulse pressure?

A

widened

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4
Q

a wide pulse pressure is typically at least ___mmHg for systolic and a diastolic of what value?

A

60 mmHg; less 70 mmHg

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5
Q

this murmur sounds exactly like mitral stenosis; pathogenesis is not understood, but it results from interaction between regurgitant jet and mitral valve inflow

A

austin-flint murmur

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6
Q

Signs of classical cardiac tamponade include three signs, known as what? What are the signs?

A

Beck’s triad - JVD, muffled heart signs, narrowed pulse pressure

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7
Q

visible pulsation in the nail bed

A

quincke’s pulse

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8
Q

“pistel shot” sound over the femoral artery

A

traube’s sound

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9
Q

bobbing of the uvula

A

müller’s pulse; müller üvular!!

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10
Q

head bobbing in synchrony with the heart beat

A

de Musset’s sign

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11
Q

femoral artery bruit induced by light pressure over the artery

A

Duroziez’s sign

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12
Q

visible carotid pulsations

A

corrigan’s pulse

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13
Q

jerky pulse with full expansion followed by sudden collapse; rapid and sudden systolic expansion; commonly seen in which two conditions related to the heart?

A

water-hammer pulse; aortic regurgitation and PDA - Note: “Watson’s water hammer pulse” and “Corrigan’s pulse” refer to similar observations. However, the former usually refers to measurement of a pulse on a limb, while the latter refers to measurement of the pulse of the carotid artery

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14
Q

pulse that describes a regular rate but with the amplitude varying from beat to beat with weak and strong beats. also name two conditions in which this is commonly seen.

A

Note: this is basically just alternating amplitudes of pulse pressure known as alternating pulse (pulsus alternans); CHF and left ventricular failure

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15
Q

a pulse with two strong systolic peaks separated by midsystolic dip.

A

biferious pulse (pulsus biferiens)

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16
Q

pulse with two beats in rapid succession followed by longer interval;

A

bigeminal pulse (pulsus bigeminus)

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17
Q

pulse that is normal when patient is resting, but increases on standing or sitting.

A

labile pulse

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18
Q

pulse in which the systolic BP changes during respiratory cycle (it increases abnormally);

A

paradoxical pulse; normally systolic BP increases with inspiration, but with this it increases to an abnormally high value.

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19
Q

pulse that refers to unequal pulses between left and right extremities - this also commonly leads to what?

A

pulses differens - impaired circulation

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20
Q

pulse that involves 3 beats followed by a pause - often benign or malignant?

A

trigeminal pulse; benign - can occur after exercise.

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21
Q

small, slow rising delayed pulse with a notch or shoulder on the ascending limb - commonly seen with aortic stenosis

A

pulsus tardus; anacrotic pulse; plateau pulse; pulsus parvus;

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22
Q

an artificially and falsely elevated blood pressure reading obtained through sphygmomanometry due to arteriosclerotic, calcified blood vessels which do not physiologically compress with pressure.

A

osler’s sign of pseudo-hypertension - Because they do not compress with pressure normally, the blood pressure reading is higher than it truly ought to be.

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23
Q

what is your normally palpable radial pulse? femoral? carotid?

A

80, 60, 40 - if only the patient’s carotid pulse is palpable, the systolic blood pressure is 60-70 mm Hg; if carotid and femoral pulses are palpable, the systolic blood pressure is 70-80 mm Hg; and if the radial pulse is also palpable, the systolic blood pressure is more than 80 mm Hg (this is the principle)

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24
Q

what is the site of measurement for taking BP?

A

at the level of the RA with the arm supported

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25
Q

should your BP be higher sitting or standing?

A

lower standing and more accurate sitting

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26
Q

In terms of Korotkoff phases, children’s diastolic is defined as what? adult’s?

A

phase 4; phase 5;

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27
Q

headache that is severe and sudden-onset. It is defined as a severe headache that takes seconds to minutes to reach maximum intensity. It can be indicative of a number of medical problems, most importantly what?

A

subarachnoid hemorrhage

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28
Q

what are the four types of brain bleeds?

A

subarachnoid; subdural; epidural; intracerebral

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29
Q

which brain bleed is venous? arterial? (epidural and subdural are the options)

A

subdural; epidural

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30
Q

which brain bleed is associated with chronicity and typical in elderly people?

A

subdural

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31
Q

if you a female with hypertension, what is one contraindication you should be aware of?

A

receiving estrogen in hormone replacement therapy (and also BCP)

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32
Q

Mastectomy patients often need to have blood drawn or have their blood pressure measured. Performing these procedures on the same side as a mastectomy carries a risk of what?

A

secondary lymphedema in that extremity if the lymph nodes have been removed

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33
Q

a sign of deep vein thrombosis (DVT). A positive sign is present when there is pain in the calf on dorsiflexion of the patient’s foot at the ankle while the knee is fully extended

A

Homan’s sign

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34
Q

an abnormal connection or passageway between an artery and a vein.

A

av fistula

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35
Q

what is the point of origin for most subarachnoid bleeds?

A

circle of willis on the anterior side

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36
Q

what does severe tachycardia do to pulse pressure?

A

decrease

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37
Q

a majority of intracranial aneurysms are of which type?

A

saccular (berry) aneurysms - which are often at the source of a subarachnoid bleed once they rupture.

38
Q

What is the preferred artery for bypass?

A

Mammary artery

39
Q

what is the DOC used to treat HOCM?

A

beta blockers

40
Q

how would you distinguish between MVP and HOCM?

A

mvp has a click (mid-systolic) while HOCM has no click

41
Q

which phase of the valsalva decreases left ventricular volume? and how does it do this?

A

standing/strain phase - decrease left ventricular volume by decreasing venous return (b/c you are standing and straining it is taking the blood longer to return to the heart)

42
Q

which phase of the valsalva decreases vascular tone?

A

standing/strain phase - it also decreases arterial bp

43
Q

which phase of the valsalva increases left ventricular volume from an increase in venous return?

A

squatting phase

44
Q

which phase of the valsalva increases vascular tone and increases arterial BP? (what happens to peripheral vascular resistance?)

A

squatting phase; increases

45
Q

You have 3 systolic murmurs: MVP, HCM, and AS - which is which? intensity of the murmur decreases in the standing phase of valsalva.

A

aortic stenosis

46
Q

You have 3 systolic murmurs: MVP, HCM, and AS - which is which? intensity of the murmur increases in the standing phase of valsalva.

A

MVP and HCM

47
Q

what happens to the click of MVP during standing valsalva?

A

it moves earlier in systole and it also lengthens

48
Q

why is it that the intensity of the murmur increases for HCM during the standing phase of valsalva?

A

b/c during standing phase there is less blood which accentuates the outflow obstruction. (same principle with the click of MVP and why you can hear it more clearly)

49
Q

what does the squatting position of valvsalva do to MVP?

A

delays the click and shortens the murmur - this is what makes it difficult to hear in this position

50
Q

You have 3 systolic murmurs: MVP, HCM, and AS - which is which? intensity of the murmur is increased during squatting phase of valsalva.

A

AS

51
Q

why is it that AS is not very audible on the standing phase of valsalva?

A

because of the decreased blood volume ejected into the aorta! (remember decrease venous return)

52
Q

when an S3 is heard in an adult, what is the pathology that you should be concerned about? (at the very basics) - NOTE: the same worry should go for when you hear an S4

A

change in ventricular compliance

53
Q

events on which side of the heart occur slightly after the other?

A

RIGHT side

54
Q

during inspiration or expiration - when do you hear the splitting of S2 best?

A

inspiration

55
Q

which sound is more pronounced, A2 or P2? why?

A

A2, it’s under higher pressure

56
Q

what is the major difference between chronic MR and acute, severe MR?

A

acute MR is a decrescendo (from high pressure to low pressure - LV to LA) murmur while chronic a plateau murmur

57
Q

post MI there is a risk for both MR (as result of papillary muscle rupture) and ventricular septum rupture - how can you tell the difference? (2)

A

VSR is holosystolic and has a thrill present

58
Q

an uncorrected VSD can lead to what?

A

pulmonary HTN

59
Q

when tricuspid regurgitation increases intensity with inspiration, what is this called?

A

Carvallos’s sign

60
Q

what is the “crescendo” that describes aortic stenosis?

A

crescendo-decrescendo

61
Q

what is it called when you have the transmission of AS to the apex at which point it becomes higher pitched?

A

gallavardin effect

62
Q

when AS presents in the gallavardin effect, how can you differentiate it from MR?

A

MR is constant in intensity while AS would increase with each beat

63
Q

which murmur characteristically is known to paradoxically split S2? (aka, reversed splitting)

A

AS

64
Q

what does inotropic stimulation do for HOCM?

A

increases intensity

65
Q

what are the two key differentiating factors between MVP and HOCM?

A

the presence of the click only in MVP and LVH only in HOCM

66
Q

what is the name of the benign grade 2 vibrating mid systolic murmur heard at lower left sternal border; very common in children and teens?

A

Stills murmur

67
Q

what are the three types of pansystolic/holosystolic murmurs?

A

chronic MR and TR in addition to VSD

68
Q

what is the difference between severe AR and chronic AR?

A

severe is shorter lower pitched

69
Q

what is the heart murmur associated with PR that is decrescendo and begins after P2 of S2? Best heard at 2nd L ITC space and radiates to left sternal border

A

Graham Steell murmur

70
Q

what is the most common cause of PR?

A

increased pulmonary artery pressure

71
Q

what is the main differentiating factor between PR and AR?

A

if there are signs of pulmonary HTN, then it’s PR

72
Q

if you have PR with no signs of pulmonary HTN, what should you think?

A

endocarditis OR some congenital deformed valve

73
Q

what is the most common cause of mitral stenosis?

A

rheumatic fever

74
Q

what is the best position to hear MS?

A

LLD

75
Q

Left or Right sided murmur: heard best at end the expiration?

A

Left

76
Q

Left or Right sided murmur - heard best during inspiration?

A

Right

77
Q

what two murmurs are know are produce paradoxical splitting? (aka reversed splitting)?

A

AS and HOCM

78
Q

what murmur is known to produce fixed splitting? and first, what is fixed splitting?

A

fixed splitting is splitting that does NOT vary with inspiration - it is most common in ASD

79
Q

true or false: all diastolic murmurs are pathologic.

A

true - they indicate valvular heart disease

80
Q

REMEMBER THAT AORTIC REGURGITATION IS AKA AORTIC INSUFFICIENCY!!!

A

AR=AI

81
Q

true or false: all systolic murmurs are pathologic

A

FALSE - some may be some not

82
Q

what is the direction of BF in VSD? r to l or left to right?

A

Right to left

83
Q

what are the four components of tetralogy of fallot?

A

pulmonary stenosis, right ventricular hypertrophy, overriding aorta, vsd

84
Q

what is the murmur in which exercise stress testing is absolutely contraindicated?

A

aortic stenosis

85
Q

a congenital heart defect in which the septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle of the heart.

A

ebstein’s anomaly

86
Q

the strain phase of valsalva is which phase?

A

standing phase

87
Q

signs and symptoms that arise from retrograde (reversed) flow of blood in the vertebral artery or the internal thoracic artery, due to a proximal stenosis (narrowing) and/or occlusion of the subclavian artery.

A

subclavian steal syndrome

88
Q

increased pulse pressure; contour may have rapid rise, brief peak, rapid fall - common in anemia, arthersclerosis, AR, PDA.

A

bounding pulse

89
Q

pulse with a rate less than 60

A

bradycardia

90
Q

pulse with rate over 100 but LESS THAN ____ is considered tachycardia

A

150 (once greater than 150 it’s SVT)

91
Q

what is the order of the heart sounds? (s1 etc.)

A

S4, S1, S2, S3.

Clinical Correlation (10 decks)

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