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Test 2 > Cardiac > Flashcards

Cardiac Flashcards

1
Q

Conduction System of the heart

A 
SA node
AV node
Bundle of His
Right and Left bundle branches
Purkinje fibers
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2
Q

Aortic Heart sound

A

2cd intercostal space, RSB

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3
Q

Pulmonic

A

2cd ISC, LSB

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4
Q

Tricuspid

A

LLSB

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5
Q

Mitral

A

Cardiac apex (5th ICS-LMCL)

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6
Q

Erb’s Point

A

Area at which pulmonic and aortic sounds are best heard

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7
Q

Cardiac Cycle

A

Normally, only the closing of the valves is auscultated
S1 = closure of the AV valves (mitral and tricuspid)
S2= closure of the semilunar valves (aortic and pulmonic valve)
Period between S1 and S2 = systole
period between S2 to the next S1 = diastole

the opening of the valves are only heard if the valves are damaged

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8
Q

S3 heart sound

A

S3 may occur 120-170 msec after S2 (normally in children and young adults, otherwise can signal volume overload)

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9
Q

S4 heart sound

A

S4 = extra heart sound before S1 (normal in children and young adults; otherwise indicative of a stiff ventricle)

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10
Q

Blood Pressure

A

systolic blood pressure is the peak pressure in the arteries, regulated by stroke volume and compliance of blood vessels
Diastolic blood pressure is the lowest pressure in the arteries and depends on peripheral resistance
Pulse pressure = difference between the systolic and diastolic pressures
systolic blood pressure increases as distance from the heart increases

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11
Q

physical exam components

A 
inspection of the patient
assessment of blood pressure
Assesment of pulses
assessment of jugular venous pulse
percussion of the heart
palpation of the heart
auscultation of the heart
assessment for dependent edema
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12
Q

Inspection

A

evaluate general appearance (any distress? how is their breathing)
inspect the skin (temperature, xanthomas, rash or asters nodes)
inspect the nails for - splinter hemorrhages and capillary refill

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13
Q

inspection

A

inspect the facies (earlobe crease which is Lichstein’s sign)
inspect the eyes (xanthelasma or Marcus seniles)
Inspect the mouth (inspect the palate)

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14
Q

Inspection

A

inspect the neck ( Turner’s syndrome - neck webbing and coarctation of the aorta) (Noonan’s syndrome - pulmonic stenosis)
Inspect the chest configuration (pacts excavated and precuts carinatum)
inspect the extremities (extra digits? atrial septa defects) (long slender fingers? = Marfan’s syndrome)

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15
Q

Rule out orthostatic hypotension

A

make sure pt is recumbent for at least 5 minutes

Significant if greater than 20 mmHG drop plus symptomatic

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16
Q

Rule out supravalular aortic stenosis

A

difference in blood pressure between both arms

17
Q

rule out coarctation of the aorta

A

compare BP in arms to BP in thighs

be suspicious if BP in arms I is higher than legs

18
Q

Rule out Cardiac Tamponade

A

Becks’s Triad = low BP, distended neck veins, muffled heart sounds

Pulsus paradoxus _exaggeration of the normal inspiratory fall in systolic pressure
normal fall is 5 mmhg with inspiration
greater than 10 mg; think cardiac tamponade

19
Q

Palpation and pulses

A

Arterial pulse is produced by the ejection of the blood into the aorta.
(assess radial pulse and carotid pulse, evaluate the characteristics of the pulse) (normal, diminished or bounding)

20
Q

Palpation and pulses

A

Jugular venous pulse provides direct information about the pressures in the right side of the heart

21
Q

evaluate the hepatojugular reflux

A

apply pressure of the liver (RUQ) are you able to grossly assess right ventricular function?
its with R ventricular failure have dilated sinusoids in the liver, that will become drained with compression
Maintain RUQ pressure for 10 seconds.
Normal response: increase in neck vein distention that resolves after a few seconds
Abnormal response: neck veins remain distended through entire compression

22
Q

evaluate the apical impulse (point of maximum implies PMI)

A

easiest if pt is sitting in position
5th ICS, Left MCL
a PMI that is laterally displaced or felt in two intercostal spaces is suggestive of cardiomegaly
In chronic lung disease, the PMI may be felt in the epigastric area

23
Q

Determine the presence of thrills

A

superficial vibratory sensations felt on the skin overlying an area of turbulence
Presence of thrill = loud murmur
Adds little to the diagnosis since the murmur will be able lot be auscultated

24
Q

Percussion

A

Performed at the 3rd, 4th and 5th ICS from the left anterior axillary line to the right anterior axillae line
percussion note is dull over the area of the heart
can be used to help determine cardiomegaly (greater than 10.c cm in the left 5th intercostal space)

25
Q

Auscultation

A

Bell of the stethoscope should be applied lightly to the skin. Best to hear low pitched sounds and AV stenosis murmurs
The diaphragm of the stethoscope requires firm pressure (best for high pitched sounds, systolic events and regurgitant murmurs)
Move through the points of auscultation with diaphragm first, then repeat with bell
Four standard position for auscultation : supine, left lateral side, upright, upright and leaning forward.
pay attention to the influence of breathing on heart sounds

26
Q

Pericardial Rub

A

Extra cardiac sounds of short duration
Usually heard as one systolic and two diastolic (systolic component occurs during ejection and diastolic components occur during rapid filling and atrial contraction)
Sounds like scratching on sandpaper
Best heard in supine position with patient holding their breath in expiration

27
Q

Murmurs

A

Occurs when turbulent blood flow is present
systolic murmurs occur with or after s1 and end before or with s2
Diastolic murmurs occur with or after s2 and end before or with s1
more significantly in pathology than systolic murmurs

28
Q

MR ASS

A 
M – mitral
R. – regurgitation
A – aortic 
S - stenosis
S - systolic
29
Q

MS ARD

A 
M- mitral
S- stenosis
A- Aortic
R- regurgitation
D- diastolic
30
Q

describe any murmurs present

A

Timing, location, radiation, duration, intensity, pitch, quality, relationship to respiration, and relationship to body position

31
Q

Grading of murmurs

A

I : low intensity, difficult to hear
II : low intensity, usually easily heard
III : medium intensity, without a thrill
IV : medium intensity, with a thrill
V : loudest murmur that is heard with a stethoscope (and + thrill)
VI : audible when stethoscope is removed from chest (and + thrill)

32
Q

Checking Edema

A

When peripheral venous pressure is high, pressure in the veins is distributed in a retrograde manner to the smaller vessels
Edema of dependent areas occur and cause “pitting” edema

\+1 = 2 mm depth and disappears rapidly
\+2 = 4 mm depth and disappears in 10-15 seconds
\+3 = 6 mm depth and may take more than 1 min to resolve
\+4 = 8 mm depth or more and may last 2-5 mins
33
Q

Chest pain

A

Probably the most important symptom of cardiac disease
however can have many non cardiac origins
“Angina Pectoris” is the true symptom of CHD
- consequence of hypoxia to the myocardium which results in an imbalance of coronary supply and myocardial demand
Levine’s sign - clenching of the fist and placing it over the sternum

34
Q

Palpitations

A

Associated with a wide range of arrhythmias
may be described as “fluttering” “skipped beats” “pounding” “jumping” “stopping” or “irregularity
quite common and do not necessarily mean serious heart problems
seek to rule out
thryotoxicosis
hypoglycemia
fever
anemia
pheochromocytoma
anxiety
caffeine, tobacco and drugs

35
Q

Dyspnea

A

Shortness of breath “I can’t get enough air”
related to cardiac or pulmonary causes
Paroxysmal nocturnal dyspnea (PND)
- awakened from sound sleep and is markedly dyspneic and coughing
-relatively specific for CHF

Dyspnea on exertion

  • usually caused by CHF or pulmonary dx
  • attempt to quantify the dyspnea, especially over time
36
Q

syncope

A

fainting or the transient loss of consciousness due to inadequate cerebral perfusion
can have cardiac and non cardiac causes
determine the activity breeding the syncope
determine position of the patient before fainting
40% of syncope episodes are vasovagal in nature

37
Q

Fatigue

A

Common symptom of decreased cardiac output
patients with CHF and mitral valvular dx commonly complain of fatigue
multiple possibilities for causation
-anxiety and depression (most common)
-anemia
-chronic disease status

38
Q

Dependent edema

A

swelling of the legs
its with CHF have symmetrical edema
-less in the morning and with feet elevated
-if accompanied by dyspnea, think CHF
-Typically, the dyspnea will precede the swelling
If edema is only one sided, think possible DVT
-will also have accompanying tenderness, redness, and warmth

39
Q

cyanosis of the the lower extremities

A

termed “differential cyanosis”
related to a right to left shunt from paint ductus arterioles (PDA)
deoxygenated blood is pumped only to the lower extremities

Test 2 (3 decks)

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