Cardiac PE Flashcards
1
Q
Where is the sternal angle located?
A
at about T4/T5
also where the corina is located (where the trachea divides)
2
Q
Where/Why does cardiac pain refer?
A
- the dermatome of C3,C4, and C5
- and the phrenic nerve
- cholecystitis may refer to the shoulder
- and the phrenic nerve
- C3,C4, C5 keep the diaphragm alive
- referred pain to the jaw or arm
3
Q
Somatic vs Visceral pain
A
- Somatic pain associated with pericardium
- will usually have point pain
-
visceral pain of the direct heart is non-specific
- will usually have chest pressure or discomfort
4
Q
S1
A
- contraction of the ventricles during systole
- forced opening of the aoritc and pulmonic valves as blood is ejected into the arteries
- causes closure of the tricuspid and mitral valves
- best heard:
- tricuspid is best heard at the L 4th intercostal space
- mitral is best heard at the R 5th intercostal space
5
Q
S2
A
- occurs during diastole
- relaxation of the heart, the ventricles start to refill
- the tricuspid and mitral valves open
-
closure of the aortic and pulmonary valves
- aortic best heard on the R 2nd intercostal space
- pulmonary best heard on the L 2nd intercostal space
- they may not close at the same time →split S2
- pulmonary valve closes after the aortic valve
- this is normal
- best heard upon inspiration
6
Q
S3
A
- the sound is created by the passive filling of the ventricles in early diastole
-
can be normal in young adults and athletes
- in older people associated with heart failure
- sudden deceleration of blood flow into the left ventricle from the atrium
- in older people associated with heart failure
- very close after S2
- caused by the distension of the ventricular walls during filling that makes vibrations
7
Q
S4
A
- the sound is created by the second phase of the ventricles filling when the atria contact
- never normal
8
Q
Grading of peripheral Edema
A
- 0+ = no pitting edema
- 1+ = mild pitting edema, 2mm depression that disappears quickly
- 2+ = moderate pitting edema. 4mm depressin that disappears in 10-15 seconds
- 3+ = moderately severe pitting edema, 6mm depression that lasts more than a minute
- 4+ = severe pitting edema, 8mm edema that can last more than 2 min
9
Q
Aortic Stenosis
A
- crescendo-decrescendo
- heard at the aortic area
- systolic murmur
- can follow it into the aorta and possibly the carotids
- often associated with weak and delayed peripheral pulses
- common causes:
- calcified and bicuspid aortic valve
- S2 is often diminished or absent in severe aortic stenosis
10
Q
Mitral regurgitation
A
- plateau murmur: same intensity throughout
- holosystolic murmur
- heard in the mitral area
- can radiate to the axilla
- common causes:
- ischemic heart disease
- mitral valve prolapse
- rheumatic fever
11
Q
Aortic regurgitation
A
- decrescendo murmur: gets softer
- heard at Erb’s point
- diastolic murmur: occurs right after S2
- often presents with bounding or wide pulse pressure
- Common causes:
- bicuspid aortic valve
- endocarditis
- rheumatic fever
12
Q
Grading murmurs: systolic vs diastolic murmurs
A
- Systolic murmurs:
- 1-6
- 4+ would be considered a thrill
- 1-6
- Diastolic murmurs:
- 1-4
13
Q
Thrill
A
- a palpable murmur, only systolic murmurs that are 4+
- common cause:
- vigorous blood flow through any narrowed opening
- common cause:
14
Q
Lift/Heave
A
- when you can feel the heart pounding through the chest
- common causes:
- ventricular hypertrophy or hyperdynamic ventricular activity
- common causes:
15
Q
Cardiac Chamber Pressures
A
- Aorta: 120/80
- pulmonary artery: <25/10
- L ventricle: 120/10
- L atrium: <12
- R ventricle: <25/<5
- R atrium: <5
16
Q
Where to ausculate the heart and why
A
Aortic, Pulmonic, Erb’s point, Triscupid, Mitral
Always Phone ETs Mom
17
Q
S1 vs S2
A
18
Q
Arteries of the Abdomen
A
20
Q
Pressure and Volume of the heart chambers during a heart beat (Graph).
A
