Cardiac I Flashcards
Diastole
Ventricles fill up, pressure is low
Aortic and pulmonic valves close–> S2. Mitral and tricuspid valves open
Systole
Ejection, squeezing. Mitral and tricuspid valves close–> S1. Aortic and pulmonic valves open.
Pressure in ventricles is high
Normal sinus rhythm
R atrium/ SA node to AV node, to ventricles/Bundle of His, to bundle branches/R and L ventricles
SA node= pacemaker
Emergency heart rates
Extreme tachycardia: 150-250/ min
Extreme bradycardia: less than 30/ min
Escape rhythm
Heart rhythm initiated by lower centers when problem in SA node
Hx questions
Pain (worse w exertion?) Palpitations Syncope, dizziness, lightheaded ness SOB, DOE, PND, Orthopnea, breathlessness Edema
Hepatojugular reflex
Press on liver, see if jugular v bulges (>1cm). Suggest RCHF, constrictive pericarditis, SVC obstruction
(Peripheral edema and ascites also suggest RCHF)
Left lateral decubitus
Position if pt heart difficult to hear (eg obese). Or can lean forward. Or can exhale and hold.
Clicks
Higher pitched than S1, shorter duration. Heard in mitral or tricuspid prolapse from abnormal tension of chordae tendinae
Aortic stenosis murmur
Open. Dilation of aorta (or pulmonary in pulmonary stenosis) artery
Mid systolic, gets louder as flow becomes more obstructed
Regurgitant murmurs
Closed. Retrograde or abnormal blood flow. Mitral or tricuspid.
Tend to be holosystolic–longer duration than ejection murmurs
Diastolic murmurs
Always abnormal. Aortic/pulmonic regurgitation or mitral/tricuspid stenosis.
Neck veins
Inspect for height ~ to R atrial pressure. Jugular v evaluated with pt at 45* (normal <3-4cm)
Increase P= RCHF, constrictive pericarditis, SVC obstruction
Flat veins= vol depletion
Chest inspection and palpation
Deformities, congenital abnormalities; visible precordial impulses, heaves; thrills; apex/PMI
Chest auscultation
Diaphragm: high pitched sounds
Bell: low pitched sounds
Characterize sounds by location, timing, radiation, pitch, quality
Diastolic sounds
S2: lower pitched, due to closure of A and P valves (commonly split)
S3: early diastole, dt non compliant, dilated ventricle (may be normal in children)
S4: late diastole, augmented ventricular filling caused by atrial contraction, more common than S3
OS: opening snap, early diastole, high pitched
Shunt murmurs
Dt abnormal openings bet vessels or heart chambers.
E.g. Patent ductus arteriosis: ventricular or atrial septal defects
Diastolic murmurs
Always abnormal/heart disease. A or P regurgitation; M or T stenosis
Pericardial friction rub
Inflamed visceral and pericardial layers. High pitched squeak.
Best heard w pt leaning forward on hands or knees during expiration.
Abdomen exam
Palpate liver and edge.
Assess for fluid waves, ascites
Splenomegaly
Assess aorta for bruit, aneurysm
Leg exam
Inspect for edema, peripheral vasc dz
Femoral pulse, varicose veins
Stasis dermatitis, ulcers
Chest pain DDX
MI, unstable angina, pulmonary embolism, pericarditis, tumor, pneumothorax, pneumonia, anxiety/emotions, MS, herpes zoster, GI disease
Hx questions w palpitations
Duration, character, triggers, onset/offset
Ask or to tap out beat
Weakness, lightheaded ness, syncope
Other concomitants? Substance use? Caffeine?
Palpitations DDX
Normal with exercise, exertion. W arrhythmia: cardiac dz
Non cardiac: anxiety, anemia, fever, thyrotoxicosis, hypoglycemia, allergy, pheochromocytoma, aortic aneurysm, migraine, drugs, coffee, tobacco, panic disorder
Orthostatic / postural hypotension DDX
Hypovolemia dt dehydration, drug side effects or hemorrhage
Orthostatic/postural hypotension
Fall in BP > 20/10 mmHg when assuming upright position .
Sxs: faintness, lightheadedness, dizziness, autonomic insufficiency (visual impairment, incontinence, constipation, heat intolerance, impotence), CV/neuro/malignant disorders
Orthostatic/postural hypotension PE
Pt supine for 5 min, have pt stand and measure BP at 1 min and 3 mins
If no increased HR…autonomic impairment
> 100 bpm…hypovolemia
Postural tachycardia syndrome
POTS. Big HR increase with posture change wo increase in BP
May be related to increased sympathetic tone
Syncope
LOC dt inadequate cerebral perfusion
Tests: vitals, resting ECG, pulse ox, HCT, electrolytes, cardiac emzymes
Syncope DDX
Circ issues: vasovagal rxns, carotid sinus syncope, vol or electrolyte depletion
Cardiac: arrhythmias, output obstrxn
Neuro: seizures, CV dz
Metabolic: hypoglycemia, hyperventilation, hypoxia
Drugs: antidepressants, antihypertensives
What will plain radiography show?
(CXR). Shadow of heart..fluid? Hypertrophic?
What does ECG assess for?
Arrhythmias, myocardial ischemia, enlarged chambers
Use with orthostatic hypotension, syncope
Why do Echocardiography?
if pt has a murmur!
(Looking at valves, blood flow, size of chambers)
To assess valvular disorders, chamber hypertrophy/dilation, cardiomyopahties, heart failure, pericarditis, K+ levels
Why do EBCT?
(Look at coronary arteries)
Quantification of calcification, assessment of atherosclerosis
Edema DDx
CHF, liver dz, myxedema, trichinosis, protein-losing enteropathy, pericardial dz, nephrotic syndrome, hemiplegia, lymphedema, idiopathic
MRI/MRA tests for?
Mediastinal evaluation, aorta
PET tests for?
Assess for myocardial perfusion, was there a past MI?
Radionuclide imaging
Myocardial perfusion studies, thallium, technetium
When stress vs resting compared can dx CAD
Stress test
ECG when exercising. Used to screen CAD.
Invasive tests
Cardiac catheterization, CABG
