BP, Pulses and Murmurs Flashcards
briefly go over and explain the pulse scale
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.
this is the absence of a palpable pulse despite an audible heartbeat over the precordium. in what medical condition is this commonly found?
pulse deficit; aFib
aortic regurgitation is associated with what type of pulse pressure?
widened
a wide pulse pressure is typically at least ___mmHg for systolic and a diastolic of what value?
60 mmHg; less 70 mmHg
this murmur sounds exactly like mitral stenosis; pathogenesis is not understood, but it results from interaction between regurgitant jet and mitral valve inflow
austin-flint murmur
Signs of classical cardiac tamponade include three signs, known as what? What are the signs?
Beck’s triad - JVD, muffled heart signs, narrowed pulse pressure
visible pulsation in the nail bed
quincke’s pulse
“pistel shot” sound over the femoral artery
traube’s sound
bobbing of the uvula
müller’s pulse; müller üvular!!
head bobbing in synchrony with the heart beat
de Musset’s sign
femoral artery bruit induced by light pressure over the artery
Duroziez’s sign
visible carotid pulsations
corrigan’s pulse
jerky pulse with full expansion followed by sudden collapse; rapid and sudden systolic expansion; commonly seen in which two conditions related to the heart?
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
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.
Note: this is basically just alternating amplitudes of pulse pressure known as alternating pulse (pulsus alternans); CHF and left ventricular failure
a pulse with two strong systolic peaks separated by midsystolic dip.
biferious pulse (pulsus biferiens)
pulse with two beats in rapid succession followed by longer interval;
bigeminal pulse (pulsus bigeminus)
pulse that is normal when patient is resting, but increases on standing or sitting.
labile pulse
pulse in which the systolic BP changes during respiratory cycle (it increases abnormally);
paradoxical pulse; normally systolic BP increases with inspiration, but with this it increases to an abnormally high value.
pulse that refers to unequal pulses between left and right extremities - this also commonly leads to what?
pulses differens - impaired circulation
pulse that involves 3 beats followed by a pause - often benign or malignant?
trigeminal pulse; benign - can occur after exercise.
small, slow rising delayed pulse with a notch or shoulder on the ascending limb - commonly seen with aortic stenosis
pulsus tardus; anacrotic pulse; plateau pulse; pulsus parvus;
an artificially and falsely elevated blood pressure reading obtained through sphygmomanometry due to arteriosclerotic, calcified blood vessels which do not physiologically compress with pressure.
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.
what is your normally palpable radial pulse? femoral? carotid?
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)
what is the site of measurement for taking BP?
at the level of the RA with the arm supported
should your BP be higher sitting or standing?
lower standing and more accurate sitting
In terms of Korotkoff phases, children’s diastolic is defined as what? adult’s?
phase 4; phase 5;
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?
subarachnoid hemorrhage
what are the four types of brain bleeds?
subarachnoid; subdural; epidural; intracerebral
which brain bleed is venous? arterial? (epidural and subdural are the options)
subdural; epidural
which brain bleed is associated with chronicity and typical in elderly people?
subdural
if you a female with hypertension, what is one contraindication you should be aware of?
receiving estrogen in hormone replacement therapy (and also BCP)
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?
secondary lymphedema in that extremity if the lymph nodes have been removed
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
Homan’s sign
an abnormal connection or passageway between an artery and a vein.
av fistula
what is the point of origin for most subarachnoid bleeds?
circle of willis on the anterior side
what does severe tachycardia do to pulse pressure?
decrease
a majority of intracranial aneurysms are of which type?
saccular (berry) aneurysms - which are often at the source of a subarachnoid bleed once they rupture.
What is the preferred artery for bypass?
Mammary artery
what is the DOC used to treat HOCM?
beta blockers
how would you distinguish between MVP and HOCM?
mvp has a click (mid-systolic) while HOCM has no click
which phase of the valsalva decreases left ventricular volume? and how does it do this?
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)
which phase of the valsalva decreases vascular tone?
standing/strain phase - it also decreases arterial bp
which phase of the valsalva increases left ventricular volume from an increase in venous return?
squatting phase
which phase of the valsalva increases vascular tone and increases arterial BP? (what happens to peripheral vascular resistance?)
squatting phase; increases
You have 3 systolic murmurs: MVP, HCM, and AS - which is which? intensity of the murmur decreases in the standing phase of valsalva.
aortic stenosis
You have 3 systolic murmurs: MVP, HCM, and AS - which is which? intensity of the murmur increases in the standing phase of valsalva.
MVP and HCM
what happens to the click of MVP during standing valsalva?
it moves earlier in systole and it also lengthens
why is it that the intensity of the murmur increases for HCM during the standing phase of valsalva?
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)
what does the squatting position of valvsalva do to MVP?
delays the click and shortens the murmur - this is what makes it difficult to hear in this position
You have 3 systolic murmurs: MVP, HCM, and AS - which is which? intensity of the murmur is increased during squatting phase of valsalva.
AS
why is it that AS is not very audible on the standing phase of valsalva?
because of the decreased blood volume ejected into the aorta! (remember decrease venous return)
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
change in ventricular compliance
events on which side of the heart occur slightly after the other?
RIGHT side
during inspiration or expiration - when do you hear the splitting of S2 best?
inspiration
which sound is more pronounced, A2 or P2? why?
A2, it’s under higher pressure
what is the major difference between chronic MR and acute, severe MR?
acute MR is a decrescendo (from high pressure to low pressure - LV to LA) murmur while chronic a plateau murmur
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)
VSR is holosystolic and has a thrill present
an uncorrected VSD can lead to what?
pulmonary HTN
when tricuspid regurgitation increases intensity with inspiration, what is this called?
Carvallos’s sign
what is the “crescendo” that describes aortic stenosis?
crescendo-decrescendo
what is it called when you have the transmission of AS to the apex at which point it becomes higher pitched?
gallavardin effect
when AS presents in the gallavardin effect, how can you differentiate it from MR?
MR is constant in intensity while AS would increase with each beat
which murmur characteristically is known to paradoxically split S2? (aka, reversed splitting)
AS
what does inotropic stimulation do for HOCM?
increases intensity
what are the two key differentiating factors between MVP and HOCM?
the presence of the click only in MVP and LVH only in HOCM
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?
Stills murmur
what are the three types of pansystolic/holosystolic murmurs?
chronic MR and TR in addition to VSD
what is the difference between severe AR and chronic AR?
severe is shorter lower pitched
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
Graham Steell murmur
what is the most common cause of PR?
increased pulmonary artery pressure
what is the main differentiating factor between PR and AR?
if there are signs of pulmonary HTN, then it’s PR
if you have PR with no signs of pulmonary HTN, what should you think?
endocarditis OR some congenital deformed valve
what is the most common cause of mitral stenosis?
rheumatic fever
what is the best position to hear MS?
LLD
Left or Right sided murmur: heard best at end the expiration?
Left
Left or Right sided murmur - heard best during inspiration?
Right
what two murmurs are know are produce paradoxical splitting? (aka reversed splitting)?
AS and HOCM
what murmur is known to produce fixed splitting? and first, what is fixed splitting?
fixed splitting is splitting that does NOT vary with inspiration - it is most common in ASD
true or false: all diastolic murmurs are pathologic.
true - they indicate valvular heart disease
REMEMBER THAT AORTIC REGURGITATION IS AKA AORTIC INSUFFICIENCY!!!
AR=AI
true or false: all systolic murmurs are pathologic
FALSE - some may be some not
what is the direction of BF in VSD? r to l or left to right?
Right to left
what are the four components of tetralogy of fallot?
pulmonary stenosis, right ventricular hypertrophy, overriding aorta, vsd
what is the murmur in which exercise stress testing is absolutely contraindicated?
aortic stenosis
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.
ebstein’s anomaly
the strain phase of valsalva is which phase?
standing phase
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.
subclavian steal syndrome
increased pulse pressure; contour may have rapid rise, brief peak, rapid fall - common in anemia, arthersclerosis, AR, PDA.
bounding pulse
pulse with a rate less than 60
bradycardia
pulse with rate over 100 but LESS THAN ____ is considered tachycardia
150 (once greater than 150 it’s SVT)
what is the order of the heart sounds? (s1 etc.)
S4, S1, S2, S3.
