Cardiac Flashcards
1
Q
Cardiac CP
A
Substernal
Provoked by effort, emotion, eating
Relieved by rest, nitro
Accompanied by diaphoresis, occasionally N
2
Q
Pleural CP
A
Precipitated by breathing or coughing
Usually sharp
Present with respiration
Absent with breath held
3
Q
Esophageal CP
A
Burning, substernal
Occasional radiation to the shoulder
Nocturnal occurrence, usually lying flat
Relief with food, antacid, sometimes nitro
4
Q
CP from peptic ulcer
A
Almost always infradiaphragmatic, and epigastric
Nocturnal occurrence and daytime attacks relieved by food
Unrelated to activity
5
Q
Biliary CP
A
Usually under right scapula, prolonged duration
Often after eating
Triggers angina more than mimic it
6
Q
Arthritis/bursitis CP
A
Usually lasts for hours
Local tenderness and/or pain with movement
7
Q
Cervical CP
A
Associated with injury
Provoked by activity, persists after activity
Painful on palpation and or movement
8
Q
Musculoskeletal CP
A
Intensified or provoked by movement (twist, costochondral bending)
Longlasting
Associated with focal tenderness
9
Q
Psychoneurotic
A
Anxiety
Poorly described
Intramammary region
10
Q
Order for palpation
A
To palpate the precordium,
Apex -> inferior left sternal border -> up the sternum to the base and down the right sternal border
11
Q
Apical pulse more vigorous
A
Heave or lift
More forceful, wide, fill systole, displace laterally and down = increased CO of LV hypertrophy
Lift in left sternal border = RV hypertrophy
12
Q
Displacement of apical pulse
A
Without loss/gain in thrust = dextrocardia, diaphragmatic hernia, distended stomach, pulmonary abnormality
13
Q
Thrill
A
Fine, palpable rushing vibration
Often over the base of the heart = pulmonic stenosis or aortic stenosis
14
Q
Carotid pulse is synchronous with
A
S1
15
Q
Split S2 heard best in
A
pulmonic auscultory region
16
Q
S1 coincides with closing of
A
AV valves
mitral and tricuspid
17
Q
Left lateral recumbent is best to hear
A
Low-pitched filling sounds in diastole with the bell
18
Q
Split S1
A
Occurs when mitral and tricuspid values do not close simultaneously
Rare
Sometimes in the tricuspid area
Esp. with inspiration
19
Q
Split S2
A
Occurs when the aortic and pulmonic valves do not close simultaneously
Closure of the AV tends to mask the PV
Splitting more distinct in the young
20
Q
S3
A
Quiet, low-pitched
Ken-TUCK-y
21
Q
Increase venous return
A
Make S3 and S4 easier to hear
Raise leg or inhale
22
Q
Raise arterial pressure
A
Make S3 and S4 easier to hear
Grip your hand repeatedly
23
Q
When S3 becomes intense
A
Result sounds like a gallop in the early diastolic gallop rhythm
24
Q
S4
A
Commonly in older patients
Increased resistance to filling because the ventricular walls have lost compliance eg. HTN, CAD, or with increased stroke volume of high output states (anemia, pregnancy, thyrotoxicosis)
TEN-nes-see
ALWAYS PATHOLOGICAL
25
Opening snap
Valvular stenosis of MV
26
Ejection click
Valvular stenosis of SL
27
Mid to late non ejection systolic click
Mitral prolapse
28
Pericardial rub
Friction rub from inflammation of the pericardial sac causing roughening of the parietal and visceral surfaces producing a rubbing sound
May obscure hear sounds
Heard throughout cycle
29
Causes of murmur other than stenosis of regurgitation
High output (pregnancy, fever)
Structural defect (atrial or ventricular septal defects)
Diminished myocardial contraction
Ruptured chord tendineae of the MV
Vigorous LV ejection (normal in children)
Persistant fetal circulation (eg. patent ductus arteriosus)
30
When auscultating with the bell, hold it
Lightly
31
In infants the murmur should dissapear
Within two or three days when the ductus areteriosus closes
32
Still murmur
Named after discovering physician
| Occurs in active, healthy child 3-7 years old
33
Pregnant women
Split S1, S2, even S3 can be normal >20 weeks
| Systolic ejection murmur over the pulmonic area can be normal
34
Bacterial endocarditis
Congenital or acquired valve defects; history endocarditis; IV drug users susceptible
Fever, fatigue, Suden onset CHF (SOB, edema)
Murmur, neuro dysfunction, Osler nodes (appear on fingers, toes = septic emboli)
35
Left-sided HF
Heart fails to propel blood forward = congestion in PULMONARY circulation
Patho: LV hypertrophy; cardiomyopathy; damaged aortic, mitral valves; ischemic cardiomyopathy (from CAD); nonischemic cardiomyopathy; toxins (ETOH, cocaine); viruses (coxsackie B); characterized as systolic or diastolic
Sx: dyspnea, orthopnea, tachycardia, S3, crackles, fatigue
36
Diastolic CHF
Result of advanced glycation cross-linking collagen and creating a stiff ventricle unable to dilate effectively
Older adults with DM who tissue is exposed to glucose for a long time
Wide Pulse Pressure
37
Systolic CHF
Narrow Pulse Pressure
38
Right-sided HF
Heart fails to propel blood forward = congestion in SYSTEMIC circulation
Patho: Decreased CO causes decreased blood flow to tissues
Sx: pitting, peripheral edema (end of day esp.), weight gain, JVD
39
Pericarditis
Inflammation of pericardium
Patho: result of viral infection (echovirus, coxsackie virus); CA; HIV; hypothyroid; kidney failure; rheumatic fever; TB; Kawasaki
Other causes: heart attack; heart surgery; trauma; medications (procainamide, hydrazine, phenytoin, INH); radiation to the chest
May cause pericardial fusion -> cardiac tamponade
Sx: sharp, stabbing CP worse with cough, swallow, flat; relieved by sitting up; dry cough; anxiety
Hear a friction rub esp TV MV area
40
Cardiac Tamponade
Excess accumulation of effused fluids or blood between the pericardium and the heart
Constrains cardiac relaxation
Patho: pericarditis, malignancy, aortic dissection, trauma
Sx: Anxiety, CP, SOB, discomfort (sometimes relieved by sitting upright), syncope, pale, palpitations, tachypnea, swelling of ABD, arms, neck veins
BECK Triad: JVD, hypotension, muffled heart sounds
41
Cor Pulmonale
Enlargement of the RV secondary to lung disease
Patho: usually chronic (sometimes acute); Acute cause: massive PE or ARDs; chronic from COPD have gradual hypertrophy of the RV
Sx: fatigue, tachypnea, DOE, cough, hemoptysis, light-headed, syncope; wheezes/crackles on auscultation; increase in chest diameter; evidence of right-sided HF/hypertophy; cyanosis; loud S2
42
Myocardial Infarction
Ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium
Patho: commonly affects the LV; results from atherosclerosis of the coronary blood vessels; atherosclerotic plaques rupture, thrombosis forms causing sudden obstruction of blood flow
Sx: deep substernal or visceral pain often radiates to the jaw, neck, left arm; N/V; fatigue; SOB; dysrhythmias; S4; soft, systolic apical murmur; thready pulse
43
Myocarditis
Focal or diffuse inflammation of the myocardium from direct cytotoxic effect of secondary immune response
Sx: fatigue, dyspnea, fever, palpitations, hx of recent flu-like symptoms; cardiac enlargement; murmurs; gallop; tachycardia; dysrhythmias; pulses alternans
44
Tetralogy of Fallot
Congenital heart defect composed of four cardiac defects: ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, RV hypertrophy
Increased RV outflow tract obstruction leads to increased right to left shunting of blood through the underdeveloped interventricular septum
Sx: cyanosis during crying/agitation; dyspnea with feeding; poor growth; exercise intolerance; paroxysmal dyspnea with loss of consciousness and central cyanosis (tet spell); parasternal heave and precordial prominence; systolic ejection murmur over third intercostal sometimes radiating to the left side of neck; clubbing
Heart failure without surgery
45
Ventricular Septal Defect
Opening between left and right ventricles
May spontaneously close in first 2 years of life
Sx: recurrent respiratory infections; poor growth; CHF
arterial pulse small, jugular venous pulse unaffected; left peristernal lift; small defect makes larger murmur, more easily felt
46
Patent Ductus Arteriosus
Failure of the ductus arteriosus to close after birth
Blood flows through ductus during systole and diastole; increases pressure in the pulmonary circulation and workload of RV
Large shunt causes DOE; dilated/pulsing neck vessels; wide pulse pressure; harsh loud murmur
47
Atrial Septal Defect
Congenital defect in the septum dividing the left and right atria
Large >9mm allows left to right shunting of blood; may cause volume overload of RA and RV; right hypertrophy
Sx: often asymptomatic; more commonly children; crescendo-decrescendo systolic ejection murmur; brief rumbling early diastolic murmur; systolic thrill over area of murmur; S2 split
48
Acute rheumatic fever
Systemic connective tissue disease occurring after strep pharyngitis or skin infection
Affected valve becomes stenotic
Commonly children 5-15 years
Sx: fever, inflamed, swollen joint; flat/raised painless rash (erythema marginatum), aimless jerky movement; small painless nodules; CP; palpitations; fatigue; SOB; murmurs of mitral regurgitation and aortic insufficiency; cardiomegaly; signs of CHF
49
Jones Crieria for Diagnosis of Rheumatic Fever
Major: Carditis; Polyarthritis; Chorea; Erythema marginatum; SubQ nodules
Minor: previous rheumatic fever; Arthralgia; Fever; Lab; ESR, C-reactive protein; leukocytosis; Prolonged PR
50
Senile Cardiac Amyloidosis
Amyloid, fibrillary protein by chronic inflammation of neoplastic disease, deposition in heart
Heart contractility reduced; causes HF
Sx: palpitations, BLE edema; activity intolerance; pleural effusion; arrhythmia; dilated neck veins; hepatomegaly or ascites; ECG; Echo (small, thick LV)
51
Risk factors for preeclampsia
```
Older than 40
First pregnancy
Preexisting chronic HTN
Multifetal gestation
Renal disease
DM
Family history
Previous preeclampsia, gestational DM
Obesity
```
52
Risk factors for varicose veins
Gender - women 4x more likely, esp. during pregnancy (hormones)
Genetics
Tobacco
Sedentary lifestyle (allows pooling of blood)
Age (less elastic)
History of extremity trauma or DVT
53
Allen test
Assesses the potency of the ulnar artery (prior to artery puncture for ABG or A-line)
Do not puncture radial if ulnar artery insufficiency is suspected
54
Claudication
First symptom of pain that results from muscle ischemia
| Dull ache, muscle fatigue, cramps
55
To judge the degree of narrowing/arterial insufficiency
```
Have patient lie supine and elevate extremity, note blanching
Lower extremity (sitting)
Note the time for maximal return of color
```
56
Pulsus aternans
LV failure
Alternating pulse
Characterized by alternation of pulsation
More significant if pulse is slow
57
Pulsus bisferiens
Aortic stenosis, aortic insufficiency
Detected by palpation of the carotid
Two main peaks (percussion wave and tidal wave) = reverberation
58
Jugular has _____ positive wave(s) in NSR
Three
| Undulating waves
59
Carotid has _____ wave(s)
One
| Brisk wave
60
Hepatojugular reflex
Exaggerated with right-sided HF
Apply firm pressure to mid-epigastric region
Breathe normal
Observe for elevation of JVP followed by abrupt fall in JVP as the pressure is released
61
Normal JVP
<9 cm
Should be visible when patient seated unless patient has right-sided HF, TV insufficiency, constructive pericarditis, cardiac tamponade
62
Evaluation of hand veins
Should precisely mirror measurement of JVP
Not possible if patient has AV fistula or thrombosis
Slowly raise hand until the hand vein claps and measure from the midaxillary line at the nipple
63
Venous hum
Normal in children
Indicates turbulent blood flow in the IJ veins
Auscultate over the supraclavicular space at the medial end of the clavicle
Diminished with valsalva
Continuous low sound louder during diastole
Can be confused with patent ductus arteriosus, aortic regurgitation, murmur
64
Temporal arteritis
Giant cell arteritis
An inflammatory disease of the branches of the aortic arch, including temporal arteries
Inflammatory infiltrates develop in the thoracic aorta
Arterial wall thickens, thrombosis leads to reduced blood supply and ischemia of structures (master muscle, tongue, optic nerve)
Older than 50 y/o, flu-like symptoms, HA in the temporal region, polymyalgia, tongue pain
**Loss of vision**Loss of hearing**
Temporal pulse may be strong, weak or absent
Area over temporal artery may be red, swollen, tender, nodular
65
Aterial aneurysm
Localized dilation (1.5x) of the normal artery caused by weakness in the arterial wall
D/t tobacco, family hx, HTN
4x more likely in men than women
Commonly in renal, femoral, popliteal arteries
Generally asymptomatic until dissect of compress adjacent structure
Dissection: severe ripping pain
Pulsatile swelling
Thrill or bruit
66
AV fistula
Pathologic condition between artery and vein
Congenital or acquired
Damage to vessels by catheterization is common etiology
May have LE edema, varicose veins, claudication due to ischemia
67
Peripheral artery disease
Stenosis of blood supply to the extremities by atherosclerotic plaques
Peripheral atherosclerosis, DM, HTN, DLD, tobacco, vascular trauma, radiation, vasculitis
Pain in muscle with exercise, weak pulses, progressive stenosis results in severe ischemia (cold, numb, dry, scaling)
Ulceration is common (rarely edema)
68
Raynaud phenomenon
Exaggerated spasm of the digital arterioles (occasionally nose, ears) usually in response to cold exposure
Primary Raynaud occurs in young, otherwise healthy esp. women
Secondary Raynaud is associated with connective tissue disease (esp. scleroderma, SLE)
Primary skin has triphasic demarcated skin pallor (white), cyanosis (blue), reperfusion (red)
Areas feel cold, achy, improve on rewarming
In secondary have intense pain from digital ischemia
Secondary ulcers appear of tips of digits
69
Aterial embolic diseases
A-fib can lead to clots in the atrium then dispersed to body, or atherosclerotic plaques, infectious (fungi, bacterial endocarditis), atrial myxomas
Commonly pain, parathesias
Occlusion -> necrosis "blue toe syndrome"
Slinter hemorrhages seen in nail bed with endocarditis
70
Venous thrombosis
Sudden or gradual with varying severity d/t trauma or immobilization
Tenderness in area of thrombus esp. iliac vessels or femoral canal, popliteal space, over deep calf veins
DVT in femoral and pelvic circulations may be asymptomatic
Minimal ankle edema, low-grade temp, tachycardia
71
Tricuspid regurgitation
Backflow of blood into the RA during systole
Mild degree in up to 75% of adult population
Commonly d/t conditions -> dilation of RV (HTN, pulmonary thrombosis) occasionally PVD
Severe disease see sx of right-sided HF (ascites, peripheral edema)
See prominent v-wave in venous pulsation
Hear a holosystolic murmur in the TV
72
Coartation of the aorta
Stenosis seen most commonly in the descending aortic arch near origin of the left SC artery and ligamentum arteriosum
Freq. d/t congenital defect of underlying vascular wall
Acquired d/t inflammatory aortic disease or severe atherosclerosis
Asymptomatic unless severe HTN or vascular insufficiency develops
Sx of HF, vascular insufficiency of involve UE
See difference in BP b/w upper and lower extremities
Femoral pulses are weaker (or absent) than radial pulses
73
Kawasaki disease
Acute, small vessel vasculitic illness of uncertain cause affecting young males more
May cause coronary artery aneurysms
Immune mediated blood vessel damage results in both vascular stenosis and aneurysm formation
Diffuse, typified by fever > 5 days
Systematic vasculitis: weight loss, fatigue, myalgia, arthritis
Fever, conjunctival infection, STRAWBERRY TONGUE, edema of hands and feet
Lymphadenopathy and polymorphous nonvascular rashes
74
Preeclampsia-eclampsia
Syndrome in pregnancy, HTN (SBP > 160,DBP > 110) that occurs after 20th week
Proteinuria
Eclampsia is preeclampsia with seizures
Vascular and immunologic abnormalities within the uteroplacental circulation
Sx: visual changes, HA, abd pain, pulmonary edema
75
Venous ulcers
D/t chronic venous insufficiency
Obstruction of venous flow may result in incompetent valves
May describe leg heaviness
Ulcers on medial or lateral aspects of LE
Induration edema and hyperpigmentation
