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Physical Diagnosis & Assessment > Cardiac Pathology > Flashcards

Cardiac Pathology Flashcards

1
Q

what does the presentation of equivocal pain characterized as if a pt denies any true chest pain?

A

not pain in the chest -> can be localized to shoulder or jaw
-not relieved w/ rest & is persistent

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2
Q

why does radiation of chest pain occur and where in the body does it typically radiate?

A

They have the same dermatomes of the spinal cord that innervate the heart

  • arm
  • lower jaw/neck
  • chest
  • upper abdominal area
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3
Q

____ is used to distinguish STEMI from NSTEMI when troponin is elevated in a pt

A

EKG

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4
Q

___ to the heart that results in irreversible muscle damage

A

prolonged ischemia

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5
Q

what differential diagnoses should be considered for patients w/ chest pain that are not cardiac related?

A 
• Pulmonary conditions
 > PTX
 > PE
• MSK condition 
 > rib fx
 > pleurisy
• GERD 
• Cholecystitis
 > ask pt if pain is worse w/ fatty foods  
• Anxiety
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6
Q

what is a possible finding in pulmonary exam for a pt that you suspect MI?

A

rales

- left side of heart has an issue because blood flow backs up from lungs

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7
Q

what is a possible finding on cardiac exam for a pt that you suspect MI?

A

New/worsening murmurs

S3

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8
Q

for a pt that presents to the ED and you suspect an MI, what might their vitals be?

A

hypotension

tachycardia

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9
Q

what is the hallmark diagnostic used to determine if a patent is having a MI?

A

EKG

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10
Q

_____ is a chest discomfort that occurs when myocardial oxygen demand exceeds oxygen supply. this is a ____ myocardial ischemia

A

angina pectoris

-temporary

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11
Q

what are risk factors assoc. w/ incidence of MI?

A
  • Smoking
  • Age > 65
  • DM & age > 50
  • Cholesterol
  • HTN
  • Family History
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12
Q

angina pectoris (is/is not) considered one of the acute coronary syndromes

A

is

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13
Q

True or false: angina pectoris presents with the same symptoms, risk factors, exam findings as a MI.

A

True

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14
Q

what should be ordered to r/o ischemia/infarct in a pt w/ angina pectoris when the EKG and trop are both negative?

A

stress imaging

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15
Q

what makes angina pectoris atypical from a pt that has chest pain and MI is evident on EKG?

A

angina pectoris is more gradual

*** significant exertional component

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16
Q

in systolic heart failure, there is (decreased/increased) myocardial contractility

A

decreased

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17
Q

if there is an increase in pre-load, a pt w/ systolic failure most likely has valvular ______

A

regurgitation

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18
Q

common conditions that a pt w/ systolic heart failure which causes increased afterload include:

A

chronic HTN

aortic stenosis

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19
Q

in diastolic heart failure, there is abnormal _____ of the Left Ventricle or Right Ventricle

A

filling

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20
Q

in diastolic heart failure, there is ____ myocardial relaxation of the heart & the chamber becomes _______

A

impaired

non-compliant

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21
Q

what risk factors are associated with CHF?

A
  • Age: >65 year old
  • History of HTN
  • coronary artery disease
  • myocardial infarction
  • Smoking
  • Diabetes
  • Obesity
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22
Q

symptoms such as edema, pain from hepatic congestion, & abdominal discomfort due to distension from ascites are related to _____ heart failure

A

right sided

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23
Q

symptoms such as dyspnea & orthopnea are seen in _____ heart failure due to _______

A

left sided

-excessive fluid accumulation

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24
Q

the most common symptoms that a pt w/ acute right sided heart failure has are:

A

leg swelling/edema

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25
Q

the most common symptoms that a pt w/ acute left sided heart failure will have are:

A

dyspnea
cough
wheezing

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26
Q

what are non-systemic differential diagnoses that should be considered when working up a pt for CHF?

A 
deconditioning- prolonged bed rest
sleep apnea
depression
drug side effects
cirrhosis
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27
Q

what non cardiac differential diagnoses should be considered when working up a pt for CHF?

A 
>> pulmonic disorders
-COPD
-asthma
>> venous thrombosis
-swelling will be acute 
>> venous insufficiency
-look for chronic discoloration 
>> renal disease 
-can affect sodium retention
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28
Q

what would the vitals be for a pt presenting with acute CHF?

A

uncontrolled HTN > 140/90
HR either tachy or brady
tachypnea

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29
Q

JVD is a finding on exam that is seen in patients with _____ failure

A

right sided

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30
Q

S3 is an abnormal heart sound that is heard early in diastole and is more common in ____ heart failure

A

systolic

-Related to increased preload and increased afterload

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31
Q

what insufficiencies are related to S3?

A

valvular regurgitation

  • mitral
  • aortic
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32
Q

___ (heart sound) is related to an abnormal filling of non-compliant ventricles and is most common in ___ heart failure

A

S4

-diastolic

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33
Q

where is hepatojugular reflex seen on exam and if positive, what can it indicate?

A

abdomen

evaluates for fluid overload -> right ventricle cannot accommodate an increased venous return

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34
Q

what pathologies are associated with a positive hepatojugular reflex?

A
  • Constrictive pericarditis
  • Right ventricular failure
  • Tricuspid regurgitation
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35
Q

when evaluating for hepatojugular reflex, the patient should be ___ and you should palpate the ___ of the abdomen while evaluating for baseline ____

A

supine at 30-45 degrees

RUQ (at least 15 seconds - 1 min)

JVD > 3cm

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36
Q

what diagnostics should be ordered when suspecting CHF in a patient and why?

A 
EKG: r/o ischemia, arrhythmias, low voltage
• Cardiac enzymes 
• CBC 
• Metabolic panel 
• LFTs 
• BNP
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37
Q

pericarditis causes irritation to the _____ adjacent to the pericardium

A

parietal pleura

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38
Q

a pt suspected to have pericarditis will have ____ or ____ chest pain

A

precordial

retrosternal

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39
Q

if a pt is suspected to have pericarditis, their pain is ___ with breathing, changing positions (such as laying), coughing, swallowing

A

worse

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40
Q

pericardial irritation is caused by ______

A

infectious etiology

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41
Q

if a pt presents w/ retrosternal chest pain and is sitting forward when you first evaluate them, what should you suspect? why are they in this position?

A

pericarditis

-pain improves leaning forward d/t intrathoracic pressure

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42
Q

what is an underlying cause of pericarditis?

A

autoimmune

HIV

43
Q

pericarditis has been noted to have some increased incidents with ____ patients and ____ chest pain admissions

A

hospitalized

-non-ischemic

44
Q

what differential diagnoses should be considered when working up a pt w/ suspected pericarditis?

A
  • Acute coronary syndrome
  • Aortic dissection
  • Costochondritis
  • Pericardial tamponade
  • Gastritis
  • GERD
45
Q

a ___ on cardiac exam is a superficial scratchy and squeaky sound that can wax and wane in intensity

A

pericardial friction rub

46
Q

True or false: A pericardial friction rub auscultated on exam is diagnostic in assessing for pericarditis.

A

False

-not 100% diagnostic, only a possibility

47
Q

True or false: Adventitious breath sounds are heard on exam in a pt w/ suspected pericarditis.

A

False

-pt will not want to take deep breaths d/t intensification of pain

48
Q

what is the hallmark sign in evaluating diagnostics that is an indication of pericarditis?

A

widespread ST changes

49
Q

what are the 4 findings that are c/w pericarditis? how many of these findings must a pt have to diagnose pericarditis?

A

2 of the 4

  1. Sharp, pleuritic chest pain that improves when leaning forward
  2. Pericardial friction rub
  3. Diffuse ST wave changes
  4. New or worsening pericardial effusion
50
Q

____ is an accumulation of pericardial fluid under pressure

A

pericardial tamponade

51
Q

how does pericarditis differ from pericardial tamponade?

A

pericarditis involves the inflammation of the pericardial sac itself

52
Q

____ is impeded by an external force when a pt has pericardial tamponade

A

cardiac filling

53
Q

what happens to the pericardium when reserve volume is exceeded?

A

the pericardium stiffens

-> prevents heart from filling & dilating in diastole

54
Q

patients that have ____ or have been _____ are at risk for developing pericardial tamponade

A

cancers (neoplastic disease)

-recently hospitalized

55
Q

subacute symptoms of pericardial tamponade are ____ in onset and consist of ____

A

longer in onset- dyspnea, chest discomfort or fullness, peripheral edema, fatigue

56
Q

an acute onset of chest pain, tachypnea, & dyspnea less than ____ hour(s) is suspicious for pericardial tamponade and can be _____

A

2

-life threatening

57
Q

____ is an abnormally large decrease in systolic blood pressure (>10 mmHg) on inspiration seen in patients with pericardial tamponade

A

pulses paradoxus

58
Q

what symptoms are seen in Beck’s triad which are specific to pericardial tamponade?

A 
• low arterial blood pressure 
 -narrow pulse pressure
-d/t limited stroke volume
• dilated neck veins 
 -JVD
• muffled heart sounds
 - S1 & S2 are not heard well d/t fluid accumulation
59
Q

why is JVD seen in patients with pericardial tamponade?

A

increased pressure in R atrium -> limitation of heart filling -> back up of fluid due to lack of ventricles expanding
&raquo_space; fluid overload

60
Q

what differential diagnoses should be considered when suspecting pericardial tamponade?

A

ACS

pulmonary embolism

61
Q

CXR findings of patients with suspected pericardial tamponade will appear to have __. why does this happen?

A

cardiomegaly

-sac of fluid causes increased portion of heart

62
Q

what are EKG findings associated with pericardial tamponade?

A

Low voltage EKG

PR depression

63
Q

_____ diagnosis is crucial for patients with suspected aortic dissection.

A

Early & accurate

64
Q

aortic dissection is the ____ within the layers of the aortic wall

A

splitting

65
Q

rupture of the dissection into the pericardium can precipitate _____

A

cardiac tamponade

66
Q

acute dissection into the aortic valvular annulus can lead to severe _____. this will increase ___ in the left ventricle.

A

aortic regurgitation

-afterload

67
Q

obstruction of the coronary artery ostia with an aortic dissection can lead to _____

A

myocardial infarction

68
Q

if an aortic dissection involves an abdominal aortic branch vessel, what organs can be affected and what is the severity?

A

kidneys

|&raquo_space; end-organ failure

69
Q

what genetic disorders are related to aortic dissection?

A

Marfan syndrome
-Ehlers-Danlos syndrome

*connective tissue disorders

70
Q

what antibiotic is associated with incidence of aortic dissection?

A

Fluoroquinolone use

71
Q

what is the age range for incidence of aortic dissection?

A

ages 60-80

72
Q

what are risk factors for aortic dissection?

A 
Male 
• Age: 60 – 80 years old 
•HTN 
• Bicuspid aortic valve 
• Prior history of aortic aneurysm 
• Aortic instrumentation and/or surgery 
• Coarctation of the aorta 
• Trauma 
• Pregnancy/Delivery
73
Q

what kind of trauma can put patients at risk for an aortic dissection?

A

MVA

74
Q

what is a hallmark symptom of an aortic dissection?

A

Ripping or tearing anterior/posterior chest pain radiating to the back/neck

75
Q

what new heart murmur should lead you to suspect aortic dissection in a patient?

A

aortic regurgitation

-special auscultatory maneuver

76
Q

on physical exam of a pt suspected to have an aortic dissection, what would the vital signs be?

A

hypotension in upper extremities
-pulse deficit
-abnl BP readings
&raquo_space; SBP > 20mmHg when comparing upper extremities

77
Q

what is the main diagnostic used to confirm aortic dissection?

A

widening of aortic silhouette

78
Q

why should an EKG be ordered for a pt suspected to have aortic dissection?

A

helpful in distinguishing from Acute MI if negative.

*dissection can still lead to ischemia if it involves coronary artery ostia

79
Q

what are the clinical triads in diagnosis of aortic dissection?

A
  1. Abrupt onset of thoracic or abdominal pain with a sharp, tearing, and/or ripping character
  2. variation in pulse (absence of a proximal extremity or carotid pulse) and/or blood pressure (>20mmHg difference between the right and left arm)
  3. Mediastinal and/or aortic widening on chest radiograph
80
Q

what is coarctation of the aorta & where does it occur in the body?

A

narrowing of the descending aorta
-typically located at the insertion of the ductus arteriosus
just distal to the left subclavian artery

81
Q

what are risk factors for aortic coarctation?

A
  • Male > female
  • Bicupsid aortic valve (accounts for 30 – 40 % of cases)
  • Turner’s syndrome
  • Brain aneursym
82
Q

in severe cases for infants found to have coarctation of the aorta, ___ will be found

A

CHF

83
Q

infants with ___ can be asymptomatic with coarctation of the aorta

A

patent ductus arteriosus

84
Q

what symptoms are common in coarctation of the aorta?

A

Claudication with activities
• Cold extremities
• HTN in upper extremities
> compare to BLE

85
Q

what differential diagnoses should be considered when suspecting coarctation of the aorta?

A
  • Obstructive peripheral arterial disease
  • Aortic dissection
  • Neonatal cardiac abnormality
86
Q

____ pulse is absent or delayed in coarctation of the aorta.

A

femoral

87
Q

these heart sounds from a bicuspid aortic valve are highly suspicious for coarctation of the aorta

A

ejection systolic click and a systolic ejection murmur

88
Q

there is ____ SBP in the BLE compared with BUE. ___ artery to femoral pulse delay will also be present

A

reduced

-radial

89
Q

what are the classic findings of CoA?

A
  • systolic hypertension in the upper extremities
  • diminished or delayed femoral pulses (brachial-femoral delay)
  • low or unobtainable arterial blood pressure in the lower extremities
90
Q

what should be ordered when suspecting CoA?

A

echocardiogram

CTA chest

91
Q

what physical exam findings can be seen in patients with hypertrophic cardiomyopathy?

A
  • fourth heart sound (d/t LV dysfunction)
  • systolic murmur
  • LV lift
92
Q

what should be ordered when assessing for HCM?

A
  • EKG
  • ECHO
  • Cardiac MRI (if ECHO is suboptimal)
  • Holter monitor
  • Stress testing
93
Q

what echo finding will be seen in patients with HCM?

A

LV hypertrophy (LVH)

94
Q

True or false: Most patients with hypertrophic cardiomyopathy are asymptomatic.
When is this detected?

A

true

-screening

95
Q

if a pt w/ HCM is symptomatic, what can they present with?

A
  • Fatigue
  • Chest pain
  • Syncope or near-syncope
  • Palpitations
  • Dyspnea (most common symptom)
96
Q

hypertrophic cardiomyopathy is a ____ disorder that affects the ____ of the heart

A

autosomal dominant disorder

-contractility

97
Q

depending on the affected site & extent of the cardiac hypertrophy, patients with HCM usually develop one or more of the following: myocardial infarction, mitral regurgitation, ________, & _________

A
  • LV outflow obstruction

* Diastolic dysfunction

98
Q

True or false: In patients with HCM, often no abnormalities detected.

A

True

99
Q

what differentials should be considered when working up a pt with HCM?

A
  • HTN
  • Aortic stenosis
  • Arrhythmias
  • Anemia
100
Q

when auscultating the lungs, there is evidence of crackles on exam. CXR shows pulmonary edema. what diagnosis. might this indicate?

A

left sided heart failure

101
Q

when assessing the peripheral pulses, you should be evaluating for _____ & _____

A

strength

symmetry

102
Q

abdominal bruits indicate turbulent flow in the ____, renal arteries, & possible the splenic artery

A

aorta

103
Q

liver enlargement can indicate passive ____ on palpation of the abdomen which is consistent with ______ (disease)

A

congestion

-right sided heart failure

Physical Diagnosis & Assessment (7 decks)

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