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Advanced Clinical Assessment Across Lifespan > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Stable Angina

A
  • Most common symptom: chest pain the occurs behind the breastbone or slightly to the left
  • begins slowly and gets worse over a few minutes before going away
  • usually occurs with exercise, walking up stairs
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2
Q

Unstable Angina

A
  • sudden chest pain that gets worse over time, lasts longer than 15-20 minutes
  • associated with SOB drop in BP
  • occurs without cause
  • doesn’t respond well to nitroglycerine
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3
Q

Variant (Prinzmetal’s angina)

A
  • coronary artery spasm
  • sudden narrowing of one of the coronary arteries.
  • chest pain may occur at same time every day, usually between midnight and 8AM
  • not usually with exercise
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4
Q

Acute mitral valve prolapse (regurgitation)

A
  • one or both mitral valve leaflets ruptures suddenly, blood rushes to the left ventricle
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5
Q

Pericarditis

A
  • inflammation of the pericardium caused by a virus, bacteria, uremia, lupus or neoplasm, which causes chest pain
  • chest pain is pleuritic or crushing in the retrosternal area
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6
Q

Dissecting aneurysm

A
  • chest pain from tearing of arterial intima

- begins suddenly, tearing quality, sharp pain radiating into back or neck

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7
Q

Pulmonary embolism

A
  • dyspnea more common

- may be asymptomatic

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8
Q

Pleuisy

A
  • chest pain is worse with breathing, disappears when hold breath
  • preceded by viral infection
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9
Q

Pulmonary hypertension

A
  • dyspnea is common

- chest pain is described as discomfort, non-raditating tight constricting band across the chest

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10
Q

Pneumothorax

A

Air in pleural cavity collapses the lung

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11
Q

Mediastinal emphysema

A
  • free air in the mediastinum which makes chest tightness and dyspnea
  • Hamman’s sign- crunchy sound because heart is beating against air filled cavity
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12
Q

Costochonditis

A
  • reproducible chest pain
  • tenderness over the costochondral rib joint
  • point pressure reproduces pain
  • usually 3rd rib joint down and can be multi. rib joints
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13
Q

Herpes Zoster

A
  • chest pain precedes rash

- follows a dermatome distribution

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14
Q

Fibromyalgia

A
  • second costochondral joint tenderness, seen in 85% of people with fibromyalgia
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15
Q

Esophageal spasm

A
  • sub-sternal pain and dyspnea

- may mimic angina

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16
Q

Esophageal reflux

A
  • sub-sternal burning or cramping radiates to arms, neck, and jaw
  • relieved with antacids
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17
Q

Gallstone Colic

A

RUQ pain radiating to back to right shoulder

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18
Q

Dyspnea

A

SOB, uncomfortable awareness of breathing

- feels smothering, causing urgent need to take another breath

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19
Q

Orthopnea

A
  • Dyspnea occurs soon after lying down and relieved by sitting up or standing
  • 2-3 pillows at night
  • shift of blood from periphery to pulmonary
  • From: COPD, CHF, Mitral Stenosis/Regurg
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20
Q

Paroxysmal Nocturnal Dyspnea

A
  • Dyspnea after lying down for 1-2 hours
  • Usually wakes up at night dyspneic
  • Not relieved easily after sitting or standing
  • Early signs of CHF or pulmonary edema
  • Occurs b/c redistribution of fluid with prolonged supine position
  • Differential Dx: nocturnal asthma attack
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21
Q

What are two main causes of dyspnea

A
  • Pulmonary edema

- Valvular Heart Disease

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22
Q

Causes of Pulmonary edema

A
  • pulmonary congestion (L- sided HF)
  • reduced myocardium contractility
  • patient is anxious dyspneic
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23
Q

Valvular heart disease

A

Dyspnea is principle symptom of:

  • mitral stenosis
  • late mitral regurgitation
  • late aortic stenosis/regurg
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24
Q

How to differentiate pulmonary v. cardiac dyspnea?

A

Pulmonary:

  • dyspnea asso. with cough, sputum, COPD
  • expectoration relieves dyspnea
  • gradual onset: COPD
  • abrupt onset: pulmonary emboli, pneumothorax

Cardiac:

  • relief with sitting up
  • develops over hours or days
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25
Q

Paroxysmal supraventricular tachycardia

A

Palpitations with an abrupt onset, atria rate is higher than the ventricles
- tx: ablation of cells with increased rate

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26
Q

Neurally mediated syncope (vasovagal)

A
  • mediated by emotional stress, orthostatic stress
  • situation due to coughing, sneeze, defecation, visceral pain, micturition (urination), post micturition, post exercise, post-parandial
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27
Q

Cardiovascular causes of syncope

A
  • Arrhythmias, bradycardia, tachycardia
  • cardiac outflow obstruction
  • aortic stenosis
  • mitral valve prolapse
  • carotid sinus syncope: hypersensitivity from shaving or tight collar
  • hypovolemia
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28
Q

Edema

A
  • excess accumulation of fluid in connective tissue’s interstitial space
  • usually gradual, develops in legs/ankles, worse in evening
  • can be pitting (1+, 2+, 3+)
  • Most common cause: CHF
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29
Q

Hemoptysis

A
  • coughing up blood
  • often a sign of pulmonary disease
  • if cause is mitral valve stenosis: increased venous congestion will cause ruptured blood vessels or pulmonary infarct
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30
Q

Central cyanosis

A

a drop in the pulmonary venous saturation, due to arterial unsaturation, the aortic blood carries reduced hemoglobin

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31
Q

Peripheral cyanosis

A

normal systemic arterial saturation, but decrease flow through capillaries from decreased cardiac output

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32
Q

What are cardiac disease risk factors?

A
  • high blood pressure
  • high cholesterol, esp. LDL
  • diabetes
  • obesity
  • smoking
  • poor diet
  • sedentary lifestyle
  • alcohol consumption
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33
Q

What does the Framingham Risk Score?

A 
Identified 10 year risk for heart attack or stroke
Looks at:
- age
- gender
- smoking
- systolic BP
- total cholesterol
- HDL cholesterol
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34
Q

what needs to be assessed in patients taking a hypertensive medication?

A

Orthostatic BP

- should NOT drop more than 5-10 mmHg with position change

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35
Q

Normal BP

A

less than 120/80 mmHg

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36
Q

Pre-hypertension

A

120-139/80-89 mmHg

- warrants lifestyle changes

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37
Q

Stage 1 HTN

A

140-159/90-99 mmHg

- warrants initiation of antihypertensive drugs

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38
Q

Stage 2 HTN

A

160+/100+

- Need LIFESTYLE changes

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39
Q

What is the target BP for diabetics and chronic kidney disease?

A

less than 130/80

40
Q

What is the target BP for patient over 60 with no DM or CKD?

A

less than 150/90

41
Q

What are lifestyle modifications to lower blood pressure?

A
  • BMI between 18.5-24.9
  • No more than 2.4g sodium per day (about 1 tsp)
  • Aerobic exercise 30 min/day, most days of the week
  • Moderate alcohol consumption (less than 2 for males and 1 for females per day)
  • Vit D. supplement for ppl with low Vit. D
  • DASH diet: lots of fruits and veggies, low fat dairy products
42
Q

What can a delayed upstroke be in a carotid pulse be?

A

aortic stenosis

43
Q

What can a bounding upstroke be in a carotid pulse be?

A

aortic insufficiency

44
Q

What can a weak amplitude in a carotid pulse be?

A

cardiogenic shock

45
Q

What can a bounding amplitude in a carotid pulse be?

A

aortic insufficiency

46
Q

What does it mean if your heart rhythm is regular and your amplitude is alternating?

A

left ventricular failure

47
Q

What is a paradoxical pulse?

A

a decrease in amplitude on quiet inspiration

- found in pericardial tamponade, constrictive pericarditis and obstructive lung disease

48
Q

What is the difference between an internal jugular vein and a carotid artery?

A

IJV

  • rarely palpable
  • soft biphasic quality
  • eliminate the pulse by pushing on it
  • height of pulsation changes with position and inspiration
  • height falls with inspiration

Carotid Artery

  • palpable
  • single thrust
  • can’t eliminate pulse with pressure
  • height does not change, not even with inspiration
49
Q

What is the normal JVP above the sternal angle?

A

3-4 cm

50
Q

What is the normal JVP above the right atrium?

A

8-9 cm

51
Q

What is hepatic jugular reflex?

A
  • look at JVP pulsations during quiet inspiration, then press on RUQ or middle abdomen for 10 seconds
  • Normal: slight rise then drop in pressure
    Positive HJR: increase of JVP of 3cm, indicates fluid overload, usually from right sided heart failure
52
Q

Where is the apical pulse?

A

5th intercostal space, at the midclavicular line

53
Q

PMI findings?

A

Normal: tapping
Sustained: suggest LV hypertrophy from HTN or aortic stenosis
Diffuse: dilated ventricle from CHF or cardiomyopathy

54
Q

What does a murmur feel like in the precordium?

A
  • palpable vibration, like purring cat
55
Q

What is the S1 heart sound made by?

A

Closure of the mitral and tricuspid valves

- marks the beginning of systole

56
Q

What is the S2 heart sound made by?

A

Closure of the aortic and pulmonic valves

- marks end of systole

57
Q

What is a split S2?

A

hear the pulmonic close before the aortic valve

58
Q

S3- Ventricular Gallop

A
  • due to rapid ventricles filling makes a noise
  • just after S2
  • dull soft, low pitch sound
  • can be normal or abnormal
59
Q

S4- Atrial Gallop

A
  • Ventricles are noncompliant/stiff
  • Immediately before S1
  • soft low pitch
  • heard best with the bell at the apex with patient in left lateral position
  • always abnormal
60
Q

Mid-systolic click

A
  • mitral valve prolapse: mitral valve closes and then balloons backwards towards the atria
  • sharp, high pitched sound
  • heard of apex, usually followed by a murmur
61
Q

How should murmurs be characterized?

A
  • Timing: systolic or diastolic
  • Location: apex, LSB, base
  • Shape: crescendo-descendo
  • Pitch: high, medium, low
  • Quality: musical, blowing, harsh
  • Intensity: graded I-VI
  • Radiation: axillae, neck
62
Q

Shape of murmurs

A
  • determined by its intensity over time

- crescendo, descendo, or both, plateau

63
Q

Quality of murmurs

A

harsh, musical, soft, blowing, rumbling

64
Q

Radiation of murmurs

A

heard in another place

like the neck, back or axilla

65
Q

What is Grade I murmur?

A

faintest murmur that can be heard with difficulty

66
Q

What is a Grade II murmur?

A

murmus is faint, but can be identified immediately

67
Q

What is a Grade III murmur?

A

murmur is moderately loud

68
Q

What is Grade IV murmur?

A

murmur is loud and associated with a palpable thrill

69
Q

What is a Grade V murmur?

A

murmur is very loud but only heard with a stethoscope

70
Q

What is a Grade VI murmur?

A

murmur is very loud and can be heard without a stethoscope

71
Q

Mid Systolic murmur

A
  • most common murmur
  • heard after S1 and peaks near mid systole and stops before S2
  • asso. with blood flow across semilunar valves
  • can be innocent, physiologic or pathologic
72
Q

Innocent/Physiologic Murmur

A
  • Location: 2nd to 4th rib
  • Radiation: little to none
  • Intensity: low I-II/ VI
  • Quality: variable, vibratory, musical
  • decreases or disappears when sitting
  • heard best when lying down
  • no underlying CVD
73
Q

Aortic Stenosis

A
  • loud harsh, midsystolic, crescendo or decrescendo
  • loudest at 2nd right ICS
  • intensity: soft to loud
  • harsh sound, maybe musical at apex
  • calcification of cusps, LVH develops
  • fatigue, palpations, dizziness, fainting
  • heard best when sitting
  • intensity increases with squatting
  • often found in older adults
74
Q

Pulmonic Stenosis

A
  • heard midsystolic
  • best heard at 2nd ICS
  • radiates to neck
  • thrill, ejection click, wide split S2, right ventricular after load
  • intensity: soft to loud
  • Pitch: medium to high
  • Quality: harsh, corse
75
Q

Hypertrophic Cardiomyopathy

A
  • genetic disorder (autosomal dominant)
  • left ventricular outflow obstruction
  • increases R. for life threatening arrhythmia and sudden death
  • decreases with squatting
  • increases with valsalva
  • asso. with S4
76
Q

Pansystolic or Holosystolic murmur

A
  • Pathologic murmur
  • comes from blood going from chamber of high pressure to low pressure through a valve
  • Begins immediately with S1 and continues to S2
  • not louder with inspiration
77
Q

Mitral Regurgitation

A
  • pansystolic
  • often loud, blowing, best heard over apex
  • radiates to axilla
  • S/S: fatigue, palpitation, orthopnea, PND
  • blood regurgitation from left ventricle to left atrium when mitral valve fails to fully close and then back into a ventricle during diastole
  • results in fluid volume overload on left ventricle with subsequent dilation and hypertrophy
  • S3 can be heard
78
Q

Tricuspid Regurgitation

A
  • pansystolic
  • soft, blowing, best heard over LL sternal boarder
  • gets louder with inspiration
  • engorged pulsating neck veins, hepatomegaly
  • blood regurgitates from right ventricle to right atrium when valve doesn’t fully close
  • right ventricular hypertrophy
79
Q

Aortic regurgitation

A
  • murmur starts with S2
  • soft, high pitched, blowing diastolic, decrescendo
  • best heard at L 3rd ICS at base
  • Radiates: down
  • Minor symptoms for many years, then rapid deterioration
  • Bounding water-hammer pulse in carotids, brachial and femoral arteries, wide pulse pressure
  • LVH and dilatation ensue
  • blood regurgitates back into left ventricles
  • best heard when pt. leaning forward
80
Q

Mitral Stenosis

A
  • low pitch rumble
  • doesn’t radiate
  • S/S: fatigue, palpitation, DOE, orthopnea, occasional PND or pulmonary edema
  • diminished, irregular arterial pulse
    Results in LA enlargement and LA increased pulse pressure
  • heard best at apex in left lateral position
81
Q

Pericardial Friction Rub

A
  • inflammation of pericardium
  • high-pitched, scratchy, scraping sound
  • heard best: leaning forward at LSB with diaphragm
  • 3 components:
    1- atrial kick
    2- ventricular systole
    3- ventricular diastole
82
Q

Peripheral Vascular Disease Risk Factors

A
  • less than 50 years if hx: diabetic, smoker, dyslipidemia, HTN, hyperhomocysteninemia
  • 50-69 if hx: smoking or diabetes
  • Over 70: all
  • leg symptoms with exertion or ischemia pain at rest
  • abnormal lower extremity pulses
  • known atherosclerotic coronary, carotid or renal artery disease
83
Q

What are PVD warning signs?

A
  1. fatigue, aching, numbness, pain when walking (erectile dysfunction)
  2. Poorly healing or non-healing wound on legs/feet
  3. Abdominal pain after meals asso. with food fear and weight loss
  4. Any first degree relative with any AAA
84
Q

Raynaud’s Phenomena

A
  • turning white and/or blue when cold
  • painful when they warm up again (re-vascular)
  • occurs from cold temp or stress
  • symmetrical episodic attack
85
Q

Intermittent Claudication

A
  • arterial disorder
  • episodic muscular ischemic induced by exertion
  • due to arteriosclerosis of large or medium arteries
  • location depends on level of obstruction. common: calfs, butt, thighs, hips
  • resolves with rest in 10 minutes
86
Q

Rest Pain

A
  • arterial disorder
  • episodic muscular ischemic pain, even at rest
  • distal pain
  • persistent, worse at night
  • aggravated with elevated feet
  • better sitting legs dependent
87
Q

What are the 5 P’s of acute arterial occlusion?

A 
Pain 
Pulseless 
Pallor 
Parasthesia 
Paralysis
88
Q

Acute arterial occlusion

A
  • arterial disorder
  • embolism or thrombosis
  • distal pain, usually foot and leg
  • sudden onset
  • coldness, numbness, weakness, absent distal pulses
89
Q

Chronic renal insufficiency

A
  • intermittent claudication, progressing to pain at rest
  • Decreased or absent pulses
  • pale when elevation, red on dependent
  • cool temperature
  • mild edema
  • trophic skin changes: shiny, thin, loss of hair, thickened toe nails
  • Ulcers on toes or feet
  • gangrene may develop
90
Q

Superficial thrombophlebitis

A
  • venous disorder
  • pain, tenderness, induration and erythema along the superficial vein
  • from inflammation and/or thrombosis of superficial vein
  • benign and self-limiting
  • increased risk for DVT or PE
91
Q

DVT Risk factors

A
  • hx: immobilization or prolonged hospitalization/bed rest or flying
  • recent surgery
  • obesity
  • prior DVT
  • lower extremity trauma
  • malignancy
  • Use of oral contraception or hormone replacement therapy, especially with smoking
  • pregnancy or post partum status
  • stroke
92
Q

DVT physical findings

A
  • swelling pain and edema of lower extremity
  • difference in calf diameter
  • order an ultrasound
93
Q

Chronic Venous Insufficiency

A
  • Pain: none to aching on dependency
  • Pulses: normal. but may be hard to find
  • Color: normal or cyanotic on dependency. With chronic CVI: petechiae, then brown
  • leg may narrow as scarring develops
  • edema present
  • no gangrene
94
Q

Thromboangitis Obliterans/ Buergers Disease

A
  • inflammation and thrombotic occlusion of small arteries and veins
  • occurs in smokers
  • intermittent claudication in arch of the foot
  • Pain at rest in fingers and toes, brief and recurrent
  • aggravated by exercise and relived with rest
  • distal coldness, sweating, numbness and cyanosis
  • maybe gangrene or ulceration in toes
95
Q

What is the normal Ankle Brachial Index?
Mild PAD?
Moderate PAD?
Severe PAD?

A

Normal PAD = 0.9 +
Mild PAD = 0.6 - 0.9
Moderate PAD = 0.4 - 0.6
Severe PAD = less than 0.4

96
Q

What is ABI?

A

BP leg / BP arm

97
Q

Who should have ABI testing/

A
  • Ppl. over 70 years
  • abnormal/absent pulses
  • 50-69 years with smoking hx or diabetes

Advanced Clinical Assessment Across Lifespan (12 decks)

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