Cardiac (lecture and objects- doesn't include tables) Flashcards
What is the ROS for cardiovascular system?
Chest pain DOE orthopnea PND (paroxysmal nocturnal dyspnoea) palpitations edema
What population do you really want to screen for major risk factors of CVD?
African Americans
Females
When should you begin screening for diabetes?
45 years old and every 3 years after
What are risk factors for DM?
BMI >25
CVD, insulin resistance, HTN, sedentary, ethnicity, hx GDM, dyslipidemia, PCOS (polycystic ovary syndrome), elevated fasting glucose or Hgb A1c, 1st degree relatives
According to ATP III LDL guidelines, for a high risk individual what should their LDL be?
<100
According to ATP III LDL guidelines, for a moderate high risk or moderate individual what should their LDL be?
<130
According to ATP III LDL guidelines, for a low risk individual what should their LDL be?
<160
What are the 5 guidelines for metabolic syndrome?
WC: males > 102 cm; females > 88 cm fasting Glucose: > 100mg/dl or on Rx HDL: males < 40 mg/dl; females < 50 mg/dl; on Rx TG: > 150 mg/dl or on Rx BP: > 130/> 85 or on Rx
What artery is to the left of the sternum?
Pulmonary artery
Where does the R ventricle sit?
Inferior border of R ventricle is below the junction of the sternum and the xiphoid process
Where is the PMI normally found
the 5th intercosatal space 7 cm to 9 cm lateral to the midsternal line (not always palpable)
What does a PMI greater than 2.5 cm indicate?
Left ventricular hypertrophy (seen in hypertension and aortic stensosis)
What does displacement of the PMI lateral to midclavicular line or greater than 10 cm lateral to midsternal line suggest?
LVH (left ventricular hypertrophy)
Where does the aorta arch back to the left then downward?
Sternal angle
What does S1 indicate?
Beginning of systole
Closure of mitral valves, ejection of blood from LV
What does S2 indiciate
Beginning of diastole
It may split with respiration
What type wave deflection are the Q and S waves?
Negative
What type reflection is the R wave?
Positive
In normal physiologic splitting, what accentuates the split? When does it disappear?
Accentuated on inspiration
Disappears on expiration
What does pathological splitting involve?
Splitting during expiration and suggests heart disease
What type splitting could mean these things “delayed closure of pulmonic valve (pulmonic stenosis or R bundle branch block) Can also be caused by early closure of the aortic valve, as in mitral regurg “
Wide splitting
What type splitting doesn’t vary with respiration and occurs in ASD and R ventricular failure?
Fixed splitting
What is the name of the type of pathologic splitting that appears on expiration and disappears on inspiration. The closure of the aortic valve is abnormally delayed so A2 follows P2 in expiration. Common cause is L bundle branch block.
paradoxical or reversed splitting
What will a thrill feel like?
Buzzing or vibratory sensation when you press the ball of your hand to the chest
What sound should the PMI correspond with?
Early systole (S1)
Where is the PMI located?
4th-5th LICS MCL
What is the amplitude of the PMI?
Gentle, brisk tap
What type sounds can the Bell hear?
Low pitched
S3 and S4
Stenosis murmur
What type sounds can the diaphragm hear?
High pitched sounds S1 and S2 aortic and mitral regurg murmurs rubs
These sounds are accentuated in what position : S3, S4, mitral valve murmurs?
Left lateral decubitus (LLD)
What position accentuates aortic valve murmurs?
Sit and lean forward
What can you hear upon stand and strain phase of valsalva?
decreased venous return, decreased arterial BP
What can you hear on the release phase of Valsalva?
increase LV volume
increased arterial Bp
What grade must a thrill have?
4-6
What murmurs radiate downward (think MRTAPS)
Mitral and tricuspid regurg
What murmurs radiate up (think MRTAPS)
Pulmonic (L side of neck)
Aortic (Carotids)
