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History & Physical > Cardiac > Flashcards

Cardiac Flashcards

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1
Q

claudication

A

pain in calves with walking

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2
Q

What is the BP goal for pts with DM or CKD?

A

130/80 mmHg

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3
Q

What can cause bradycardia?

A

excellent physical conditioning

heart block

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4
Q

Normal range for respiratory rate?

A

14-20 respirations

infant rate may be as high as 44

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5
Q

How do rectal, tympanic and axillary temps compare to oral temps?

A

rectal and tympanic temps: 1deg higher than oral

Axillary: 1deg lower than oral

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6
Q

PMI

A

point of maximal impulse, found at the apex of the heart

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7
Q

What is a murmur?

A

heart sounds that are produced as a result of turbulent blood flow

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8
Q

What is a thrill?

A

aka vibration

a palpable murmur usually due to vibrations that accompany loud murmurs

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9
Q

What can cause a thrill?

A

vigorous blood flow through any narrowed opening, i.e. aortic stenosis, ventricular septal defect, etc.

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10
Q

What is a lift?

A

aka heave

when the cardiac impulse (apical impulse) feels more vigorous than normal and can be felt through the CW

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11
Q

What can cause a lift/heave?

A

ventricular hypertrophy or hyper dynamic ventricular activity

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12
Q

What is the precordium? Where do you palpate it?

A

the front of the chest wall that overlays the heart and epigastrium

palpate at apex, base, and left sternal border

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13
Q

Where is the apical impulse normally found?

A

at the 5th ICS in MCL

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14
Q

What might you notice on PE for a pt with RVH?

A

parasternal lift at LSB

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15
Q

What side of the stethoscope is best for high pitch sounds?

A

Diaphragm

S1/S2

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16
Q

What side of the stethoscope is best for low pitched sounds?

A

bell

S3/S4 if present

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17
Q

Where do you listen for the aortic heart sounds?

A

2nd ICS, RSB

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18
Q

Where do you listen for the pulmonic heart sounds?

A

2nd ICS, LSB

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19
Q

Where do you listen for the 2nd pulmonic heart sounds?

A

3rd ICS, LSB (Erb’s point)

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20
Q

Where do you listen for the tricuspid heart sounds?

A

4th and 5th ICS, LSB

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21
Q

Where do you listen for the Mitral (apex) heart sounds?

A

4th ICS, MCL

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22
Q

Left lateral decubitus (special test)

A

brings left ventricle close to chest

Place bell lightly on apical impulse

accentuates L sided S3/S4 murmurs and mitral murmurs

23
Q

What produces the S1 heart sound?

A

closure of the mitral and tricuspid valves (lub)

occurs during systole

best heard at the apex

carotid upstroke coincides with S1

24
Q

Systole

A

contraction of the ventricles, aortic valves forced open & blood is ejected into arteries

25
Q

What produces the S2 heart sound?

A

closure of the aortic and pulmonic valves (Dub)

occurs during diastole

carotid upstroke occurs before S2

best heard at base

26
Q

Diastole

A

relaxation of heart, ventricles start to refill

best heart at the base

27
Q

Normal splitting of S2

A

There can be normal splitting of S2 during inspiration, split into A2 (aortic valve closure) and P2 (pulmonic valve closure)

28
Q

Why can there be a normal splitting of S2 during inspiration?

A

because inspiration increased R heart filling> increase R SV > longer R ventricle ejection

29
Q

Pathologic S2 split?

A

split heard during expiration

due to delay in closure of pulmonic valve:

  • pulmonic stenosis
  • right ventricular heart failure
  • RBBB
30
Q

S3 heart sound

A

referred to as an S3 gallop

low pitch sound created in early diastole by early passive rapid filling of the ventricles with blood from the atria

31
Q

If present, where is S3 best heard? When would you hear this?

A

with bell at apex

sounds like “fuck…you’re screwed”

may be normal in kids/young adults. In adults >40, usually indicates pathologic change of ventricular compliance

32
Q

S4 heart sound

A

created by 2nd phase of V filling as the atria contract, may be produced as the rush of blood causes vibration of valves, papillary muscles and V walls

33
Q

S4 is also called…

where is it best heard?

A

atrial sounds, atrial gallop

low pitch, best heard with bell at apex

sounds like “ well, fuck you”

34
Q

When would you hear an S4 heart sound?

A

uncommon in health adults , but may be normal for some older individuals (if no other CV disease)

can be pathologic due to resistance to ventricular filling

35
Q

When does valvular stenosis occur?

A

when a heart valve is narrowed, prevents the valve from fully opening & therefore obstructs blood flow-causing turbulent flow through the valve

36
Q

valvular regurgitation

A

occurs when the leaflets do not close completely, letting blood leak backward across the valve

backward flow= regurgitation flow

37
Q

Mitral valve prolapse

A

due to ballooning of the mitral leaflets into the left atrium during systole

38
Q

Valvular sclerosis

A

harding/thickening of a valve

39
Q

Septal defect

A

a hole in the septum separating the chambers of the heart

40
Q

Patent ductus arteriosus

A

occurs when a neonate’s ductus arteriosus fails to close after birth- results in abnormal connection between the aorta and pulmonary artery

41
Q

coarctation of the aorta

A

a narrowing of part of the aorta, congenital

42
Q

hypertrophic cardiomyopathy

A

HCM

a portion of the heart muscle becomes hypertrophied (thickened) without any obvious cause

autosomal dominant inheritance. Well known as the leading cause of sudden cardiac death in young athletes. Many with HCM live normal healthy lives

43
Q

What are the characteristics of murmurs?

A 
timing 
location & radiation 
shape (crescendo-decrescendo) 
intensity 
pitch 
quality 
response to maneuvers
44
Q

Gradation of murmurs

A

Grade 1/6: Barely audible in quiet room
Grade 2/6: Quiet but clearly audible
Grade 3/6: Moderately loud
Grade 4/6: Loud, associated with thrill
Grade 5/6: Very loud, heard with stethoscope partially off chest; obvious thrill
Grade 6/6: Very loud, heard with stethoscope entirely off the chest, obvious thrill

45
Q

Systolic murmurs

A

occur between S1 and S2, associated with ventricular ejection

mid systolic murmurs typically have a crescendo-decrescendo character

46
Q

Holosystolic

A

aka pansystolic

murmur has high amplitude throughout systole

can result from mitral or tricuspid regurgitation or from ventricular septal defect

47
Q

Innocent systolic murmurs

A

result from turbulent blood flow, but no valvular narrowing or obstruction

may decrease or disappear with sitting

common in children & young adults

48
Q

Still’s murmur

A

type of innocent murmur

aka vibratory murmur

common benign pediatric heart murmur

mid systolic, best heard at lower LSB. low pitch, musical quality

49
Q

Diastolic murmurs

A

occur after S2 and are associated with ventricular relaxation/filling

a majority of diastolic murmurs are due to aortic regurgitation. May also be due to pulmonic regurgitation, mitral and tricuspid stenosis.

50
Q

What are diastolic murmurs indicative of?

A

almost always indicate of valvular disease

51
Q

Systolic clicks from MVP

A

mitral valve prolapse is due to ballooning of mitral leaflets into the left atrium during systole

Mid-late systolic “clicks” are often present

common, usually benign

52
Q

MRG

A

murmurs, rubs, gallops

53
Q

How do you exam axillary lymph nodes?

A

use 4 sweep technique.

Palpate for size, consistency, mobility and tenderness of nodes, normally will not be palpable, palpable nodes raise suspicion for Breast cancer

54
Q

4 sweep technique for palpating axillary lymph nodes

A

anterior axillary line, midaxillary line, posterior axillary line, medial upper arm

History & Physical (8 decks)

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