Cardiac Flashcards
claudication
pain in calves with walking
What is the BP goal for pts with DM or CKD?
130/80 mmHg
What can cause bradycardia?
excellent physical conditioning
heart block
Normal range for respiratory rate?
14-20 respirations
infant rate may be as high as 44
How do rectal, tympanic and axillary temps compare to oral temps?
rectal and tympanic temps: 1deg higher than oral
Axillary: 1deg lower than oral
PMI
point of maximal impulse, found at the apex of the heart
What is a murmur?
heart sounds that are produced as a result of turbulent blood flow
What is a thrill?
aka vibration
a palpable murmur usually due to vibrations that accompany loud murmurs
What can cause a thrill?
vigorous blood flow through any narrowed opening, i.e. aortic stenosis, ventricular septal defect, etc.
What is a lift?
aka heave
when the cardiac impulse (apical impulse) feels more vigorous than normal and can be felt through the CW
What can cause a lift/heave?
ventricular hypertrophy or hyper dynamic ventricular activity
What is the precordium? Where do you palpate it?
the front of the chest wall that overlays the heart and epigastrium
palpate at apex, base, and left sternal border
Where is the apical impulse normally found?
at the 5th ICS in MCL
What might you notice on PE for a pt with RVH?
parasternal lift at LSB
What side of the stethoscope is best for high pitch sounds?
Diaphragm
S1/S2
What side of the stethoscope is best for low pitched sounds?
bell
S3/S4 if present
Where do you listen for the aortic heart sounds?
2nd ICS, RSB
Where do you listen for the pulmonic heart sounds?
2nd ICS, LSB
Where do you listen for the 2nd pulmonic heart sounds?
3rd ICS, LSB (Erb’s point)
Where do you listen for the tricuspid heart sounds?
4th and 5th ICS, LSB
Where do you listen for the Mitral (apex) heart sounds?
4th ICS, MCL
Left lateral decubitus (special test)
brings left ventricle close to chest
Place bell lightly on apical impulse
accentuates L sided S3/S4 murmurs and mitral murmurs
What produces the S1 heart sound?
closure of the mitral and tricuspid valves (lub)
occurs during systole
best heard at the apex
carotid upstroke coincides with S1
Systole
contraction of the ventricles, aortic valves forced open & blood is ejected into arteries
What produces the S2 heart sound?
closure of the aortic and pulmonic valves (Dub)
occurs during diastole
carotid upstroke occurs before S2
best heard at base
Diastole
relaxation of heart, ventricles start to refill
best heart at the base
Normal splitting of S2
There can be normal splitting of S2 during inspiration, split into A2 (aortic valve closure) and P2 (pulmonic valve closure)
Why can there be a normal splitting of S2 during inspiration?
because inspiration increased R heart filling> increase R SV > longer R ventricle ejection
Pathologic S2 split?
split heard during expiration
due to delay in closure of pulmonic valve:
- pulmonic stenosis
- right ventricular heart failure
- RBBB
S3 heart sound
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
If present, where is S3 best heard? When would you hear this?
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
S4 heart sound
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
S4 is also called…
where is it best heard?
atrial sounds, atrial gallop
low pitch, best heard with bell at apex
sounds like “ well, fuck you”
When would you hear an S4 heart sound?
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
When does valvular stenosis occur?
when a heart valve is narrowed, prevents the valve from fully opening & therefore obstructs blood flow-causing turbulent flow through the valve
valvular regurgitation
occurs when the leaflets do not close completely, letting blood leak backward across the valve
backward flow= regurgitation flow
Mitral valve prolapse
due to ballooning of the mitral leaflets into the left atrium during systole
Valvular sclerosis
harding/thickening of a valve
Septal defect
a hole in the septum separating the chambers of the heart
Patent ductus arteriosus
occurs when a neonate’s ductus arteriosus fails to close after birth- results in abnormal connection between the aorta and pulmonary artery
coarctation of the aorta
a narrowing of part of the aorta, congenital
hypertrophic cardiomyopathy
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
What are the characteristics of murmurs?
timing location & radiation shape (crescendo-decrescendo) intensity pitch quality response to maneuvers
Gradation of murmurs
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
Systolic murmurs
occur between S1 and S2, associated with ventricular ejection
mid systolic murmurs typically have a crescendo-decrescendo character
Holosystolic
aka pansystolic
murmur has high amplitude throughout systole
can result from mitral or tricuspid regurgitation or from ventricular septal defect
Innocent systolic murmurs
result from turbulent blood flow, but no valvular narrowing or obstruction
may decrease or disappear with sitting
common in children & young adults
Still’s murmur
type of innocent murmur
aka vibratory murmur
common benign pediatric heart murmur
mid systolic, best heard at lower LSB. low pitch, musical quality
Diastolic murmurs
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.
What are diastolic murmurs indicative of?
almost always indicate of valvular disease
Systolic clicks from MVP
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
MRG
murmurs, rubs, gallops
How do you exam axillary lymph nodes?
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
4 sweep technique for palpating axillary lymph nodes
anterior axillary line, midaxillary line, posterior axillary line, medial upper arm
