Cardiac & Vascular Flashcards
1
Q
What is the PMI? Where is it?
A
Point of maximum impulse; should be located at about the 7th intercostal space
2
Q
What is happening during diastole?
A
Ventricular filling/relaxation
Tricuspid/Mitral valves open
Atrial contraction
3
Q
What is happening during systole?
A
Ventricular contraction
Pulmonary/Aortic valves open
Atrial filling/relaxation
4
Q
The volume of blood ejected in one heartbeat/contraction (70mL is average)
A
Stroke volume
5
Q
Functional measurement of stroke volume
A
Ejection Fraction
6
Q
The volume of blood ejected from each ventricle in a one minute interval
A
Cardiac Output
7
Q
If the EF is below 60% the most likely cause is…
A
CHF
8
Q
Factors that effect the stroke volume are…
A
PRELOAD
MYOCARDIAL CONTRACTILITY
AFTERLOAD
9
Q
Volume or load that stretches the cardiac muscle prior to contraction
A
Preload
10
Q
Increased preload may be associated with…
A
Increased venous return, reduced HR, ventricular/systolic failure, pathologic valves (aortic or pulmonic)
11
Q
Decreased preload may be associate with…
A
Decreased venous return, impaired atrial function, diastolic failure, pathological valves (mitral or tricuspid)
12
Q
Not all the blood gets pumped out, more blood sitting in the chamber, increased stretching of the chamber when filled
A
Ventricular/Systolic Failure
13
Q
The ability of the heart muscle to contract in response to preload
A
Ionotropy
14
Q
Increased ionotropy may…
A
Increase the contractility of the cardiac muscle
15
Q
How are ionotropy and EF related?
A
Increased ionotropy = increased EF
16
Q
The load that the heart must pump against
A
Afterload
17
Q
What factors effect the afterload?
A
Resistance in the arteries/peripheral vascular system & Aortic/Pulmonic valve stenosis
18
Q
Aortic “zone” of the heart
A
2nd intercostal space; right sternal border
19
Q
Pulmonic “zone” of the heart
A
2nd intercostal space; left sternal border
20
Q
Erb’s point “zone” of the heart
A
3rd intercostal space; left sternal border
21
Q
Tricuspid “zone” of the heart
A
4-5th intercostal space; left sternal border
22
Q
Mitral “zone” of the heart
A
5th intercostal space; left mid-clavicular line
23
Q
S1 represents…
A
Closure of AV valves (particularly mitral) at the end of diastole/beginning of systole
24
Q
S2 represents…
A
Closure of semilunar valves (particularly aortic) at the end of systole which occurs as ventricular pressure falls below that of aortic pressure
25
Where is S1 loudest?
At apex (over mitral area)
26
Intensity of S1 is due to...
The speed that the mitral valve closes
27
Loud S1 is indicitive of...
Mitral stenosis; Elevated atrial contraction forces the valve open; Early indicator of disease
28
Soft S1 is indicitive of...
CHF, severely calcified mitral valve
29
Variable S1 is indicitive of...
Heart block or atrial fibrillation
30
Where is S2 best heard?
Over the upper sternal border in the Aortic & Pulmonary locations
31
Closure of the valves that is not simultaneous is called...
Splitting
32
Splitting can be either...
Physiological (normal) or Pathological
33
When should physiological splitting be heard? What does it represent?
Should only be present during S2, due to change in pressure in the thoracic cavity during inspiration that causes the right side of the heart a fraction of a second longer to contract than the left side
34
Wide splitting may be caused by...
Delayed RV contraction
Premature LV contraction
Increased RV afterload
Decreased LV afterload
35
Fixed splitting may be caused by...
ASD, RV failure
36
Paradoxical Splitting may be caused by...
Delay in closure of the Aortic valve (LBBB, Aortic, valve disease, LV outflow obstruction)
37
S3 and S4 are also called...
Gallops
38
S3 typically occurs...
Early in diastole, low pitched
39
S3 is best heard at ______ in the _______ position
The apex in left lateral decubitus
40
S3 is a sign of...
Rapid ventricular filling
41
S3 may be normal in...
Children and young adults
42
S3 is typically associated with what condition?
Congestive heart failure
43
S4 occurs immediately before...
S1 in late diastole
44
S4 is often considered to be...
“pre-systolic”
45
S4 marks....
Atrial contraction into a stiff, non-compliant ventricle
46
S4 is associated with what condition?
LVH due to systemic HTN & aortic stenosis
47
What sounds may be present with a summation gallop?
S3 & S4
48
These sounds are high frequency, best heard with the diaphragm, usually indicate valvular stenosis, are difficult to distinguish from S3/S4 sounds, and are brief and crisp
Ejection Clicks and Opening Snaps
49
Sound that occurs early systole, is heard everywhere, and not affected by standing
Aortic ejection click
50
Sound that occurs mid systole, is heard best at apex, and will occur earlier with standing
Mitral valve prolapse
51
Sound that occurs in early diastole, is low pitched, and is due to opening of abnormal valves (AV- usually mitral stenosis)
Opening snap
52
Murmurs are the result of...
Turbulent blood flow through vessels
53
The most common type of murmurs are?
Systolic murmurs, Comprise ~95% of all murmurs
54
The most common cause of murmurs is?
Mitral valve prolapse
55
Midsystolic murmur is due to...
Aortic/Pulmonic Stenosis
56
Pansystolic murmur is due to...
Mitral/Tricuspid Regurgitation
57
Late systolic murmur is due to...
Mitral Valve Prolapse
58
Early Diastolic murmur is due to...
Aortic Regurgitation
59
Mid-diastolic murmur is due to...
Mitral/Tricuspid Stenosis
60
Late Diastolic murmur is due to...
Mitral/Tricuspid Stenosis
61
Murmurs that start loud and get quieter are...
Decrescendo
62
Murmurs that get louder then softer are...
Crescendo – Decrescendo
63
Murmurs that start quiet and get louder are...
Crescendo
64
Murmurs that remain constant throughout are...
Plateau or uniform
65
Decrescendo murmurs typically occur in...
Diastole
66
Crescendo-decrescendo murmurs typically occur in...
Systole
67
Plateau murmurs typically occur as...
Holosystolic murmurs
68
Crescendo murmurs may be seen with....
Mitral stenosis
69
Decrescendo murmurs may be seen with....
Aortic regurgitation
70
Crescendo-Decrescendo murmurs may be seen with....
Aortic stenosis, Pulmonic stenosis
71
Plateau murmurs may be seen with....
Mitral regurgitation
72
Murmu from Aortic Stenosis may radiate to...
The carotids
73
Mitral regurgitation may radiate to...
The left axillae
74
Murmurs are graded on a scale of...
1-6
75
Most murmurs are grade _______
Grade 2
76
Murmurs accompanied by thrills are graded as...
Grade 4-6
77
Murmurs that can be heard without assistance are grade _____
Grade 6
78
A murmur that is blowing may be a sign of...
Aortic/pulmonic regurgitation, mitral regurgitation
79
A murmur that is harsh may be a sign of...
Aortic/pulmonic stenosis
80
A murmur that is rumbling may be a sign of...
Mitral/tricuspid stenosis
81
A murmur that is musical may be a sign of...
Occasionally aortic stenosis, Still’s murmur
82
A murmur that is machine-like may be a sign of...
PDA
83
The handgrip maneuver may be usefull to...
Differentiate between mitral regurgitation (increased intensity) and aortic stenosis (decreased intensity)
84
Leaning forward enhances the murmur associated with...
Aortic regurgitation (lean forward and hold breath in full expiration)
85
Mitral murmurs are best heard in what position?
Left lateral decubitus position
86
Mid to late diastolic rumble associated with AR (can mimic MS)
Austin Flint Murmur
87
PR murmur specifically associated with pulmonary htn; high pitched, blowing
Graham Steell murmur
88
Mid diastolic murmur heard at the apex during rheumatic fever
Carey Coombs murmur
89
What pulse has an upward slope that peaks at systole
A normal pulse
90
In a pulse waveform, the ____________ marks closing of the AV valves and then falls away and diastole begins
Dicrotic notch
91
What pulse has a much flatter volume and less pronounced dicrotic notch
An anacrotic pulse
92
An anacrotic pulse is often associated with what conditions?
Aortic stenosis or narrowing over the aortic valve
93
Aortic stenosis may also cause what type of pulse?
A pulsus parvus et tardus or weak and slow
94
This pulse is a double-peaked pulse
Bisferiens pulse
95
With what conditions might you see a Bisferiens pulse?
Occurs with severe aortic regurgitation or floppy aortic valve
96
When do the two peaks of Bisferiens pulse occur?
During systole or contraction
97
What are the two peaks of Bisferiens referred to?
```
First = percussion wave
Second = tidal wave
```
98
Pulse that occurs when the systemic arterial pressure falls less than 10 mmHg and is not detectable in the peripheral pulses
Pulsus Paradoxus
99
Pulse where there is cariability of the pulse amplitude from beat-to-beat; thought to be related to changes in the action potential duration during contraction
Pulsus alternans
100
What condition is Pulsus alternans seen with?
Severe left ventricular systolic failure
101
What are the 6 P's of peripheral pulse deficits?
Pain, Pallor, Pulselessness, Poikilothermia, Paresthesias, Paralysis
102
With the capilly refill test (nail beds), how fast should the color return?
Within 2 seconds
103
What is a "normal" ratio value for the ankle-brachial index?
Normal = 1.0 - 1.4
104
Up to ___ % of strokes are caused by carotid artery disease
50%
105
If you hear bruits while auscultating the carotid arteries (with the bell) then there is a ____ % chance there is an occlusion
60% chance
106
What are early signs of chronic venous insufficiency?
Varicose veins
Tan/reddish skin changes
Weepy/excoriated skin
Pedal edema
107
Venous insufficiency that occurs in the superficial veins; becomes red, inflamed, warm, and may be painful; treat with warm compress & NSAIDS
Phlebitis/Thromboplebitis
108
Upon PE you find calf tenderness, lower leg swelling, palpable cord, and Homan’s sign. What is the pt presenting with?
DVT
109
Splinter hemorrhages are seen with what condition?
Bacterial endocarditis
110
Softening of the nail bed that is associated with hypoxic conditions and subacute bacterial endocarditis
Clubbing
111
Yellow plaques around the eyelids associated with elevated lipid levels
Xanthelasma
112
Lipid deposits in the anterior sclera; Very uncommon
Corneal arcus
113
Angular Stomatitis and Conjunctival pallor are associated with what condition?
Anemia
114
What are the 4 areas/zones/regions of the heart for auscultation?
Aortic, pulmonic, tricuspid, mitral
115
Strong heart beat, can see the heart beating through the chest; similar to a lift
Heave
116
S1 best heard at the...
Apex of the heart
117
S2 best heard at the...
Base of the heart
118
S2 splitting is best heard at the...
Base with inspiration
119
S3 best heard at the...
Apex of the heart
120
Sounds like “KEN-TUC-KY”
S3
121
Sounds like “TEN-ES-SEE”
S4
122
What does MS. ARD stand for
Mitral stenosis & Aortic regurgitation = Diastolic murmurs
123
What does MR. PASS stand for
Mitral regurgitation, Physiologic, & Aortic stenosis = Systolic murmurs
124
Mitral regurgitation may radiate to the...
Left axial area
125
Aortic stenosis may radiate up to the...
Carotid area
126
Veins in the scrotum become varicosed, leads to accumulation of blood in the testes, completely reversible with operation, may lead to infertility in ~50% of men
Varicoscele
127
You palpate the skin of the leg and it is cold. This is a sign of....
Arterial disease
128
Edema that does not pit cannot be...
Lymphedema
129
The most common grade of pitting edema is...
2+ pitting
130
Generalized edema is called...
Anecarca
131
Parasitic infiltration of lymphatic system due to a tropical disease, causes severe lymphedema
Elephantiasis
132
Redness/flushing
Rubor
133
What is a normal JVD test result
5cm or less
134
What is a normal pulse graded as?
Normal = 2+
135
Erectile dysfunction is often the first warning sign of...
PVD & atherosclerotic disease
136
Vascular disease described as painful, punched out, smaller, pulses are diminished, distal coldness, and nail changes
Chronic arterial ulcer
137
Vascular disease that is punched out over malleoli and plantar feet, painless, and more common on plantar or side of foot
Diabetic foot ulcer
138
Pt comes in with suspected DVT however, after exam you don't think that's the case. What do you need to rule out the DVT?
2 ultrasounds must be negative
139
With AAAs when should you increase screening? at what point should intervention occur?
Increased screening once > 3cm
| Intervene once > 5cm (5.5 ideal)
