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Clinical Exams 2013 Fall > Cardiac > Flashcards

Cardiac Flashcards

1
Q

TART findings around T1-T5 on left side result in what potential viscero disorder?

A

cardiac disorder

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2
Q

Why do you perform a left lateral decubitus?

A

To bring out a left-sided S3 and S4 and mitral murmurs, especially MITRAL STENOSIS

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3
Q

Why do you perform a forward leaning?

A

position brings out aortic murmurs. Listening for AORTIC REGURGITATION.

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4
Q

What is the diagnostic meaning of heaves or lifts?

A

enlargement of the cardiac muscle or increased pressure

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5
Q

What is the diagnostic meaning of feeling thrills

A

Signs of turbulence and occur with high-grade heart murmurs (grad IV or higher).

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6
Q

What do jugular veins reflect?

A

right atrial pressure

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7
Q

What are causes for increased jugular venous pressure/distension?

A
  • Right sided congestive heart failure
  • constrictive pericarditis
  • tricuspid stenosis
  • Superior vena cava obstruction
  • 98% specific for increased LV end diastolic pressure and low LV ejection fraction; increased risk of death from heart failure.
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8
Q

If you feel a carotid upstroke when you hear a sound, which sound is this?

A

S1

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9
Q

If you feel a carotid upstroke when you do not hear a sound, which sound is this?

A

S2

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10
Q

A delayed carotid upstroke is indicative of what?

A

aortic stenosis

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11
Q

What does the amplitude of a pulse correlate with?

A

pulse pressure

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12
Q

Describe the normal contour of carotid impulse.

A

Upstroke is brisk, summit is smooth, downstroke is less abrupt. All in midsystolic.

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13
Q

What are some dysfunctions in the contour of the pulse wave?

A
  • Pulsus alternans
  • bigeminal pulse (beat to beat variation = premature contraction).
  • paradoxical pulse (respiratory variation)
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14
Q

When does a normal carotid upstroke occur? Why is this helpful?

A

after S1 and before S2.

Helpful because it helps in correctly identifying S1 and S2

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15
Q

What does a thrill sound like?

A

a purring cat/humming vibrations

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16
Q

What does a bruit sound like?

A

a murmur

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17
Q

Define orthopnea. What is indicative of?

A

dyspnea that occurs when the patient is lying down and improves when the patient sits up

Indicative of: LV heart failure and mitral stenosis

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18
Q

Define paroxysmal Nocturnal Dyspnea. What is indicative of?

A

Sudden dyspnea and orthopnea while sleeping

Indicative of LV heart failure and mitro stenosis

19
Q

What does edema indicative of?

A

Chronic Heart Failures (CHF)

20
Q

What is a functional murmur? How does standing and squatting affect a murmur?

A

A fun murmur is a heart murmur due to physiologic conditions outside the heart. Squatting delays the click and murmur, while standing moves them closer to S1.

21
Q

Is a mitral stenosis murmur systolic or diastolic? What are some characteristics and timing?

A

Diastolic (presystolic);

A crescendo murmor grows louder before S1.

22
Q

Is a mitral regurgitation murmur systolic or diastolic? What are some characteristics and timing?

A

systolic (pansystolic);

A plateau murmur at the same intensity from S1 to S2.

23
Q

Is an aortic stenosis murmur systolic or diastolic? What are some characteristics and timing?

A

systolic (midsystolic)

A crescendo-descrescendo murmur from S1 to S1 (rises and then falls in intensity).

24
Q

Is an aortic regurgitation murmur systolic or diastolic? What are some characteristics and timing?

A

systolic (early diastolic)

Decrescendo murmur from S2 to S1.

25
Q

Is an pulmonary stenosis murmur systolic or diastolic? What are some characteristics and timing?

A

systolic.

Uneven Crescendo and then decrescendo between S1 and A2.

Mild = faster crescendo; slow decrescendo
Severe = slower crescendo, faster decrescendo
26
Q

Is an tricuspid insufficiency murmur systolic or diastolic? What are some characteristics and timing?

A

systolic.

Even intensity between S1 and S2

27
Q

What produces a heart murmur? What is the intensity of each grade (1-6)?

A

turbulent blood flow

Grade-

1: very faint
2: quiet
3: moderate
4: loud (w/ thrill)
5: very loud (w/ thrill)
6: very very loud (heard without stethoscope completely off the chest). (w/ thrill).

28
Q

What is the cause of an S3?

A

rapid deceleration of column of blood against ventricular wall (aka gallop)

29
Q

What is the cause of an S4?

A

atrial contraction (immediately) precedes S1 (systole) and reflects change in ventricular compliance.

30
Q

What is the cause of an OS?

A

opening snap = mitral valve heard with mitral stenosis

31
Q

What is the physiology behind the splitting of a heart sound in inspiration?

A

pulmonic valve close with a slight delay after the closure of the aortic valve due to the fact that the right side of the heart has an increased filling time and right ventricular SV increases during ventricular ejection causes the slight delay.

32
Q

What is the physiology of the speeding of the heart rate?

A

Capillary blood flow is greatest during inspiration helping in VQ matching and aiding in gas exchange.

33
Q

Describe diastole

A

contraction of atria (relaxation of ventricles)

34
Q

Describe systole.

A

contraction of ventricles and relaxation

35
Q

What causes the “Lub” S1 sound?

A

closing of the tricuspid and mitral valve

36
Q

What causes the “Dub” S2 sound?

A

closing of the Aortic and Pulmonic Valves

37
Q

What can cause PMI displacement?

A
  • Left ventricle hypertrophy (LVH) : displacement lateral of L mid-clavicular line and/or enlargement of PMI greater than 2.5cm
  • RVH and/or COPD: Displacement to Xiphoid/Epigastric Area
38
Q

What are the main symptoms of cardiac disease?

A

Chest pain, palpitation, shortness of breath, swelling

39
Q

What is the diagnostic meaning of swelling or edema related to cardiac disease?

A

congestive heart failure

40
Q

What is the diagnostic meaning of dyspnea as related to cardiac disease?

A

pulmonary embolus, spontaneous pneumothorax, anxiety

41
Q

What is the diagnostic meaning of orthopnea as related to cardiac disease?

A

LV heart failure, mitral stenosis, obstructive lung disease

42
Q

What is the diagnostic meaning of paroxysmal nocturnal dyspnea as related to cardiac disease?

A

LV heart failure, mitral stenosis

43
Q

What is the diagnostic meaning of chest pain?

A

agnia pectoris in 50% of MI patients

Anterior Chest pain: acute aortic dissection

44
Q

What is the diagnostic meaning of palpitation?

A

Doesn’t mean there is a heart disease

Clinical Exams 2013 Fall (6 decks)

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