Cardiac history and PE

Question 1

Stable angina definition

Answer 1

recurrent chest pain of at least two months in duration, related in a predictable fashion to a given level of exercise or emotional stress, and fairly constant in its degree of intensity, duration, location and quality

Question 2

Atypical angina definition

Answer 2

may be unrelated to exertion or have unusual quality or location. Implies a high risk of impending acute coronary syndrome requiring aggressive action including possible cardiac catheterization.

Question 3

Acute coronary syndrome definition

Answer 3

comprises a spectrum of recent onset presentations ranging from “unstable angina” with ischemia without irreversible damage to “myocardial infarction” involving myocardial necrosis. May begin at rest or with physical activity/ emotional stress

Question 4

Symptoms of acute coronary syndrome

Answer 4

Dyspnea, diaphoresis, nausea, vomiting, profound weakness, or gaseous distention. Palpitations, lightheadedness, dizziness or syncope due to arrhythmias. Inferior infarcts may also cause hiccups due to diaphragm irritation

Question 5

Common causes of chest pain (other than acute coronary syndrome)

Answer 5

musculoskeletal pain (precipitated by palpation), pericarditis (exacerbated by cough/deep breath and positional change), pneumonia (with rales, cough and fever), GERD (worse at night)

Question 6

Symptoms to look for in patient with any form of cardiac disease

Answer 6

discomfort/pain in chest Faintness or dizziness (from low CO, overtreatment with diuretics, arrhythmias)
Stroke
Irregularity of your heart beat
Shortness of breath during physical activity (dyspnea)
Swelling of your feet (edema)
Awakening from sleep short of breath
Trouble sleeping while lying flat
Pain in your legs during physical activity
discomfort/pain in chest Faintness or dizziness (from low CO, overtreatment with diuretics, arrhythmias)
Stroke
Irregularity of your heart beat
Shortness of breath during physical activity (dyspnea)
Swelling of your feet (edema)
Awakening from sleep short of breath
Trouble sleeping while lying flat
Pain in your legs during physical activity

Question 7

Common distribution of pain with MI

Answer 7

from sterum, through left chest and into left arm (more ulnar side)

Question 8

Less common distributions of pain with MI

Answer 8

Right chest/arm, left jaw, epigastrium, back

Question 9

important questions to ask during cardiac exam (ROS)

Answer 9

Have you ever had or been told of:                         A "heart attack“ or a “heart murmur”
  An abnormal electrocardiogram
  High blood pressure 
  High cholesterol or blood lipids      
  Diabetes or high blood sugar        
  A problem with your thyroid gland     
  Rheumatic fever     Have you ever had or been told of:                         A "heart attack“ or a “heart murmur”
  An abnormal electrocardiogram
  High blood pressure 
  High cholesterol or blood lipids      
  Diabetes or high blood sugar        
  A problem with your thyroid gland     
  Rheumatic fever

Question 10

Social history questions to ask

Answer 10

smoking, alcohol, coffee (> 3 cups of coffee or tea per day), Has your weight changed in past year?

Question 11

Family history questions to ask

Answer 11

Have any parent, siblings or other relatives had: heart disease, HTN, diabetes, death of unknown cause

Question 12

How to find jugular venous pressure

Answer 12

Find internal jugular vein on the right side with the head turned slightly to the left

Question 13

Steps in examining carotid arteries

Answer 13

1-2 fingers btw larynx and anterior border of sternocleidomastoid at level of cricoid cartilage- fell for amplitude, upstroke and character. Also ausculatate both carotids for bruits.

Question 14

How to find the apex in cardio exam

Answer 14

Apex beat is located in the 5th intercostal space in the mid-clavicular lilne. Start by using entire hand then become more specific. Feel for amplitude, character, displacement

Question 15

Where do you palpate the right ventricle?

Answer 15

In the epigastriumor lower left sternal border. Feel for lifts

Question 16

Where do you palpate for pulmonic and aortic lifts?

Answer 16

pulmonic: left 2nd and 3rd intercostal space around the mid-clavicular line (slightly more medial). Aortic: right 2nd intercostal space around mid-clavicular line

Question 17

Where should you listen for S2 heart sounds?

Answer 17

pulmonic area (listen for split and amplitude)

Question 18

Where should you listen for S1 and S4?

Answer 18

tricuspid area

Question 19

Where should you listen for S3?

Answer 19

apex (mitral area)

Question 20

What kinds of murmurs should you listen for and where do you listen?

Answer 20

systolic murmurs: listen at aortic, pulmonic, tricuspid and mitral areas. Diastolic regurgitant murmurs: Listen at left sternal border for pulmonic and aortic (may be best when sitting up), and at the tricuspid and mitral areas. Also listen for tricuspid and mitral stenosis (low pitchd murmurs) or rapid early filling after regurgitant murmurs.

Question 21

How to identify pericarditis?

Answer 21

listen for a rub in several precordial sites

Question 22

In cardio exam, you should examine abdomen for ______________, and the legs/feet for _____________

Answer 22

hepatomegaly/ascites, and edema

Question 23

systolic ejection murmurs- examples and location

Answer 23

Aortic stenosis (2nd right intercostal space, radiates to neck) and pulmonary stenosis (2-3 left intercostal space)

Question 24

Pansystolic (holosystolic) murmurs- example and locations

Answer 24

mitral regurgitation (apex radiates to axilla), and tricuspid regurgitation (left lower sternal border radiates to right lower sternal border)

Question 25

Late systolic murmur- example and location

Answer 25

mitral valve prolapse (apex radiates to axilla)

Question 26

Early diastolic murmur- ex. And location

Answer 26

aortic regurgitation (along left side of sternum) and pulmonic regurgitation (upper left side of sternum)

Question 27

Mid-to -late diastolic murmur- ex and location

Answer 27

mitral stenosis (apex)