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PE midterm > Cardio 1 > Flashcards

Cardio 1 Flashcards

1
Q

Where is the apical impulse heard?

A

5th ICS, 7-9cm from sternum medial to midclavicular line

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2
Q

Where is the apical impulse in pregnancy?

A

higher

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3
Q

Where is the apical impulse in LVH?

A

more lateral

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4
Q

What occurs during diastole?

A

tricuspid/mitral valves open, atrial contraction

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5
Q

What occurs during systole?

A

pulmonary/aortic valves open, ventricular contraction

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6
Q

what is stroke volume?

A

the volume of blood ejected in one heartbeat/contraction. End-diastolic volume - end-systolic volume

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7
Q

what is average stroke volume?

A

70ml

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8
Q

what is ejection fraction?

A

functional measurement of stroke volume (SV/EDV)

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9
Q

What is normal ejection fraction?

A

60%

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10
Q

What is CO?

A

the volume of blood ejected from each ventricle in a one minute interval (SV X HR)

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11
Q

What factors affect SV?

A

preload, myocardial contractility, afterload

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12
Q

What is preload?

A

volume of load that stretches the cardiac muscle prior to contraction

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13
Q

What are causes of increased preload?

A

increased venous return, reduced HR, ventricular/systolic failure, aortic or pulmonic dysfunction

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14
Q

What are causes of decreased preload?

A

decreased venous return, impaired atrial function, diastolic failure, mitral or tricuspid dysfunction

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15
Q

If there is increased preload, what does it mean for SV?

A

ihigh pre-load = larger stretch = larger contraction = higher SV

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16
Q

Inotropy

A

the ability of the heart to contract in response to preload

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17
Q

An increase in inotropy can cause an increase in?

A

ejection fraction

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18
Q

What is afterload?

A

the load the heart pumps against

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19
Q

What factors affect afterload?

A

resistance, aortic/pulmonic valve stenosis

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20
Q

A decreased afterload leads to?

A

decreased preload

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21
Q

Where is the aortic valve best heard?

A

2nd ICS, right sternal border

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22
Q

Where is the pulmonic valve best heard?

A

2nd ICS, left sternal border

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23
Q

Where is Erb’s point?

A

3rd ICS, left sternal border

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24
Q

Where is the tricuspid valve best heard?

A

4-5th ICS, left sternal border

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25
Q

Where is the mitral valve best heard?

A

5th ICS, left mid-clavicular line - apex

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26
Q

What does S1 represent?

A

closure of the AV valves (particularly the mitral valve)

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27
Q

What does S2 represent?

A

closure of the semilunar valves (particularly aortic)

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28
Q

What part of the stethescope best hears S1 and S2?

A

diaphragm

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29
Q

Where is S1 best heard?

A

at the apex over the mitral area

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30
Q

What is responsible for the intensity of S1?

A

the speed of the mitral valve closing

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31
Q

Loud S1 means?

A

mitral stenosis

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32
Q

Soft S1 means?

A

CHF, severely calcified mitral valve

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33
Q

Variable S1 means?

A

heart block or Afib

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34
Q

Where is S2 best heard?

A

upper sternal border (base)

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35
Q

What causes physiological splitting of S2?

A

during inspiration when there is decreased intrathoracic pressure (increased RV preload and systole = delayed P2, decreased LV preload and systole = earlier A2)

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36
Q

what is wide splitting?

A

S2 splitting gets progressively wider with inspiration

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37
Q

What is fixed splitting?

A

S2 splitting is with with inhalation and exhalation, pathologic

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38
Q

What is normal splitting?

A

wider S2 splitting on inhalation

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39
Q

What is paradoxical splitting?

A

on inhalation, the P2 comes before the A2

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40
Q

What can cause wide splitting?

A

delayed RV contraction, premature LV contraction, Increased RV afterload, decreased LV afterload

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41
Q

Examples of diseases with wide splitting

A

RBBB, WPW, PAH, massive PE, severe mitral regurgitation, restrictive pericarditis

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42
Q

What diseases are associated with fixed splitting?

A

ASD, RV failure

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43
Q

What can cause paradoxical splitting?

A

delay in closure of aortic valve

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44
Q

What diseases are associated with paradoxical splitting?

A

LBBB, aortic valve disease, LV outflow obstruction

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45
Q

What are the “gallops”?

A

S3 and S4

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46
Q

When does S3 occur?

A

early in diastole, low pitched

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47
Q

Where is S3 best heard?

A

apex (left lateral decubitus)

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48
Q

What causes S3?

A

reapid ventricular filling

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49
Q

Can S3 be normal?

A

yes, in children and adults

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50
Q

wha can S3 indicate in older adults?

A

(>40) abnormal ventricular compliance associated with CHF; also mitral regurgitation, VSD, stiff/dilated ventricle

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51
Q

Is S4 ever normal?

A

No, always pathological

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52
Q

When does S4 occur?

A

immediately before S1 in late diastole (“pre-systolic”)

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53
Q

What does an S4 gallop suggest?

A

atrial contraction into a stiff, non-compliant ventricle associated with LVH, HTN, aortic stenosis (resistance to ventricular filling

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54
Q

Where do S3 and S4 usually originate?

A

the left side of the heart

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55
Q

what is a summation gallop?

A

when S3 and S4 are both present in tachycardia making them indistinguishable

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56
Q

What do ejection clicks and opening snaps usually indicate?

A

valvular stenosis

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57
Q

What do ejection clicks and opening snaps sound like?

A

S3 and S4 sounds, brief and crisp, (snaps heard in diastole)

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58
Q

When is an aortic ejection click heard?

A

early systole, everyhwere, not effected by standing

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59
Q

When is a mitral valve prolapse heard?

A

mid systole, best at apex, will occur earlier with standing

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60
Q

When do opening snaps occur?

A

early diastole, low pitched, due to opening of abnormal valves (usually mitral stenosis)

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61
Q

What is a murmur?

A

result of turbulent blood flow through vessels, AKA bruit outside the heart

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62
Q

What type of murmur is most common?

A

systolic murmurs

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63
Q

What can cause a continuous murmur?

A

patent ductus arteriosus, venous hum

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64
Q

what murmurs are “flow” murmurs?

A

systolic

65
Q

What can cause systolic murmurs?

A

semilunar stenosis, AV regurgitation, MVP, VSD, HOCM, insufficient AV valves, turbulent ejection of blood from a ventricle

66
Q

What can cause diastolic murmurs?

A

semilunar regurgitation (Aortic), AV stenosis

67
Q

What would be found on PE of mitral valve prolapse?

A

murmur associated with mitral regurgitation, mid-systolic click (sudden tensing of the mitral valve as it prolapses into the atrium)

68
Q

What type of murmur can be crescendo-decrescendo?

A

midsystolic (semilunar stenosis)

69
Q

What type of murmur can be pansystolic/holosystolic?

A

AV regurgitation through the entire systolic cycle

70
Q

What type of murmur can be crescendo?

A

Mitral stenosis

71
Q

Decrescendo murmurs occur in?

A

diastole (aortic regurgitation)

72
Q

Crescendo-decrescendo murmurs occur in?

A

systole (semilunar stenosis)

73
Q

Plateau murmurs occur as?

A

holosystolic murmurs, mitral regurgitation

74
Q

where does aortic stenosis radiate to?

A

carotids

75
Q

Where might mitral regurgitation radiate to?

A

left axillae

76
Q

What is a thrill?

A

a palpable vibration at a site of partial obstruction noted with murmurs graded 4/6

77
Q

Grade 1 intesnsity is defined as..

A

very faint, heard after listener is “tuned in”, might not be heard in all positions

78
Q

Grade 2 intensity is defined as?

A

quiet, don’t need to “tune in” to hear it

79
Q

Grade 3 intensity is defined as?

A

moderately loud

80
Q

Grade 4 intensity is defined as?

A

loud, with palpable thrill

81
Q

Grade 5 intensty is defined as?

A

very loud with a thrill, may be heard when the stethescope is partly off the chest

82
Q

Grade 6 intensity is defined as?

A

Very loud, with a thrill, may be heard with the stethescope entirely off the chest

83
Q

Give an example of a high pitched heart sound

A

VSD (high pressure gradient)

84
Q

Give an example of a low pitched heart sound

A

Mitral stenosis (large volume of blood over a low pressure gradient)

85
Q

Give an example of a harsh heart sound

A

combination of both high and low pitches (aortic/pulmonic stenosis)

86
Q

What heart sounds could be “blowing”?

A

semilunar regurgitation, mitral regurgitation

87
Q

What heart sound could be rumbling

A

mitral/tricuspid stenosis

88
Q

what heart sounds could be musical?

A

aortic stenosis, still’s murmur

89
Q

What heart sounds could be machine-like?

A

PDA

90
Q

What is the purpose of the handgrip maneuver?

A

patient clenches fist which increases after load and increases regurgitation murmurs. Could differentiate between MR and AS

91
Q

What heart sounds might be increased with the handgrip maneuver?

A

AR, MR, VSD, delayed MVP

92
Q

What heart sound might have decreased intensity wth the handgrip maneuver?

A

aortic stenosis, HOCM

93
Q

What is the purpose of suatting or supine quickly?

A

increased venous return = increased preload = increased SV

94
Q

What murmurs might be increased with squatting or laying supine quickly?

A

AS, PS, TR

95
Q

What murmur might be delayed when squatting or laying supine quickly?

A

MVP

96
Q

What is the purpose of standing quickly or doing the valsalve maneuver?

A

decreased venous return = decreased SV, decreased murmur of AS, PS, TR

97
Q

What effect does inspiration have on murmurs?

A

increases RV preload, decreases LV preload, increases right heart murmurs

98
Q

What effects does exhalation have on murmurs?

A

increases LV preload, decreases RV preload, increased left heart murmurs

99
Q

What position enhances the murmur associated with aortic regurgitation?

A

lean forward and hold breath on full inspiration

100
Q

Description of aortic regurgitation

A

Early diastolic, high-pitched, blowing, decrescendo, best heard at 2nd RICS, increased with leaning forward and holding breath on full inspiration, increased with handgrip maneuver

101
Q

Description of pulmonary regurgitation

A

early diastolic, high-pitched, blowing, decrescendo, best heard at 2-3 LICS, increased with handgrip maneuver

102
Q

Decscription of mitral stenosis

A

mid-diastolic, rumbling (bell), PMI, increased in left lateral decubitus position, crescendo associated with opening snap

103
Q

Description of tricuspid stenosis

A

mid-diastolic, rumbling, may increase with inspiration, wide splitting of S1

104
Q

Description of aortic stenosis

A

mid-systolic, crescendo-decrescendo, usually harsh but can be musical, best heard at 2nd RICS, may radiate to carotis and decreased with standing or valsalve or handgrip maneuvers

105
Q

Description of pulmonic stenosis

A

mid systolic, crescendo-decrescendo, harsh, best heard at 2nd LICS and may radiate to left neck, may cause wide S2 splitting

106
Q

Description of mitral valve prolapse

A

late systole and may be preceded by clicks, best heard over the apex with the diaphragm

107
Q

Description of tricuspid valve prolapse

A

uncommon except in the rpesence of MVP

108
Q

What is Carvallo’s sign?

A

Tricuspid insufficiency/regurg increased with respiration

109
Q

Description of mitral regurgitation

A

apex in left lateral decubitus position, high pitched, no change with respiration, may radiate to axillae

110
Q

Description of VSD

A

left 3-4 ICS along sternal border, increased with handgrip maneuver

111
Q

What are some innocent murmurs in children?

A

still’s murmur, physiologic systolic ejection murmur, cervical venous hum

112
Q

What can cause innocent murmurs in adults?

A

pregnancy, anemia, thyroid conditions, exercise

113
Q

Characteristics of innocent murmurs?

A

short, valsalva maneuver decreases intensity

114
Q

Red flags not indicative of innocent murmurs?

A

pansystolic murmurs, diastolic murmurs, loud murmurs (>3/6), evidence of heart disease, SOB, fatigue, failure to thrive, cyanosis, pulse deficits

115
Q

Austin flint murmur

A

mid to late diastolic rumbe associated with AR (can mimic MS)

116
Q

Graham Steell murmur

A

PR murmur specifically associated with pulmonary HTN, high-pitched, blowing

117
Q

Carey Coombs murmur

A

mid diastolic murmur heard at the apex during rheumatic fever

118
Q

What are friction rubs?

A

pathgnomic for pericarditis, leathery/raspy sound, best heard when pt is leaning forward at end of expiration

119
Q

what is an anacrotic pulse?

A

characterized by two waveforms in the ascending limb of the pulse tracing

120
Q

what might cause an anacrotic pulse?

A

pulsus parvus et tardus (slow, weak pulse), aortic stenosis

121
Q

what is the dicrotic notch?

A

normal, marks the end of systole

122
Q

What is bisferiens?

A

percussion wave followed by a tidal wave seen in AR

123
Q

What is a collapsing pulse AKA?

A

corrigan’s/water-hammer; pistol, shot-like sound heard in AR or in PDA

124
Q

What is quinckes?

A

see pulse in fingernail

125
Q

Pulsus paradoxus

A

lose pulse on inhalation

126
Q

pulsus alternans

A

regular alternation of weak and strong beats

127
Q

What are the 6 P’s of acute peripheral pulse defecits?

A

pain, pallor, pulselessness, poikilothermia, paresthesias, paralysis

128
Q

What is found on PE of someone with chronic peripheral pulse defecits?

A

decreased capillary refill, decreased hair, growth/shiny appearance to skin, ulcers, pallor/dependent rubor

129
Q

how soon should color return in capillary refill test?

A

2 seconds, delayed return = PVD

130
Q

What is the ABI?

A

testing for PAD, systolic pressure from both ankles and both brachial areas using doppler ankle pressure / brachial pressure

131
Q

what is a normal ABI?

A

1-1.4

132
Q

What is borderline ABI?

A

0.9-0.99

133
Q

What ABI indicates moderate arterial disease?

A

<0.9

134
Q

What ABI indicates severe arterial disease?

A

<0.5

135
Q

What are patients with carotid artery stenosis at higher risk of?

A

stroke

136
Q

Treatment of carotid artery stenosis?

A

antiplatelets, endarterectomy, stent

137
Q

Where are the carotids located?

A

between the larynx and anterior border of the SCM at the level of the cricoid cartilage

138
Q

what is a normal carotid artery exam?

A

smooth rapid upstroke with slower downstroke - no bruits

139
Q

If there is a bruit on carotid artery exam, what does it indicate?

A

at least 60% block - auscultated with the bell

140
Q

what factors affect venous pressure?

A

left ventricular output/blood volume, right ventricular insufficiency

141
Q

What are early signs of chronic venous insufficiency?

A

varicose veins, tan/reddish skin changes, weepy/excoriated skin, pedal edema

142
Q

What are later signs of chronic venous insufficiency?

A

lipodermatosclerosis

143
Q

What are late signs of chronic venous insufficiency?

A

venous stasis ulcers

144
Q

How is superficial phlebitis/thrombophlebitis treated?

A

superficial veins, warm compresses, anti-inflammatories

145
Q

PE findings in DVT

A

tenderness in calf, swelling, palpable cord, Homan’s sign

146
Q

What is homan’s sign?

A

can be performed supine or prone, examiner passively flexes the ankle and can gently squeeze the calf

147
Q

What are splinter hemorrhages?

A

seen in the fingernails due to bacterial endocarditis

148
Q

What is clubbing?

A

softening of the nailbed due to hypoxic conditions and subacute bacterial endocarditis

149
Q

What eye changes can occur with cardiac dysfunction?

A

xanthelasma, corneal arcus (lipi deposits in anterior sclera), conjunctival pallor (in anemia)

150
Q

what heart condition is anemia associated with?

A

CHF

151
Q

What oral changes can be associated withc ardiac dysfunction?

A

angular stomatitis (sores at the corners of the mouth)

152
Q

where is S4 heard best?

A

base

153
Q

what does the presence of S4 indicate?

A

diastolic CHF

154
Q

what diseases are associated with systolic murmurs?

A

thin chest wall, fever, anemia, pregnancy, hyperthyroidism

155
Q

true or false: systolic murmurs are physiologic

A

TRUE

156
Q

true or false: diastolic/pansystolic murmurs are pathologic

A

TRUE

157
Q

MS. ARD

A

mitral stenosis, aortic regurgitation, diastolic

158
Q

MR. PASS

A

mitral regurgitation, physiologic, aortic stenosis, systolic

PE midterm (10 decks)

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