Cardio Flashcards
Which patients typically have a PMI in the xiphoid or epigastric area?
COPD patients who have a right ventricular hypertrophy
What produces the sounds S1 and S2?
S1 – closure of mitral (AV) valve
S2 – closure of aortic (semilunar) valve
What produces an S3 sound?
Deceleration of inflow into left ventricle across mitral valve (due to dilated ventricle)
What produces an S4 sound?
Blood entering a ventricle with decreased compliance (diastolic stiffness)
What does systolic blood pressure measure?
Maximal left ventricular pressure
Which generally occurs first, right sided heart sounds or left sided heart sounds?
Left side heart sounds usually occur slightly before right side heart sounds
What effect does inspiration have on right heart filling time and heart sound?
It increases right heart filling time causing delayed closure of pulmonic valve, sometimes resulting in a split S2
What does a PMI greater than 2.5 cm indicate?
Left ventricular hypertrophy often seen in hypertension, aortic stenosis
Where on the chest are you most likely to hear a split S1?
The lower left sternal border where the tricuspid valve sound is heard (not at apex)
Where are you likely to hear the loudest S1 sound?
At the cardiac apex
What are the two main causes of heart murmurs?
Stenosis and regurgitation
Where can you best hear murmurs arising from the pulmonic valve?
Second left interspace close to the sternum
Where can you best hear murmurs arising from the aortic valve?
Second right interspace
Outline the pathway of electrical conduction
SA node – AV node – bundle of His – right and left bundle branch – Purkinje fibers – ventricular myocardium
Which three pressures is jugular venous pressure indicative of?
Right atrial pressure, central venous pressure, right ventricular end-diastolic pressure
Which vein is used to determine JVP?
Right internal jugular vein
What is considered an elevated JVP?
> 3cm above sternal angle
What bed angle should JVP be measured?
30°
How does bed adjustment differ when assessing JVP in hypovolemic and hypervolemic patients?
Hypovolemic – lower head of bed ( possibly to 0°)
Hypervolemic – raise head of bed (to 60°)
How far does the sternal angle lie above the right atrium?
4-5 cm
What landmark should be used if no pulsations in internal jugular vein can be found?
The point above which the external jugular vein appears to collapse
Which component of the cardiologic exam should be done in left lateral decubitus position?
PMI (apical impulse)
Contrast sounds and murmurs heard at the same time as carotid upstroke and murmurs heard after carotid upstroke
Murmurs heard during upstroke – systolic murmurs
Murmurs heard after upstroke – diastolic murmurs
Contrast sounds and murmurs heard at the same time as carotid upstroke and murmurs heard after carotid upstroke
Murmurs heard during upstroke – systolic murmurs
Murmurs heard after upstroke – diastolic murmurs
What does a palpable S2 suggest?
Hypertension (pulmonary if over left 2nd interspace, systemic if over right 2nd interspace)
Which heart sound is loudest where?
S1 loudest at apex
S2 loudest at base
Which sounds are better heard by the diaphragm?
High-pitched (S,1 S2, aortic and mitral regurgitation, and friction rubs)
Which sounds are better heard by the bell?
Low pitched sounds (S3 and S4, mitral stenosis)
Which abnormal heart sounds are best heard in left lateral decubitus position?
S3, S4, and mitral murmurs
What abnormal heart sounds are best heard with patient sitting leaning forward?
Aortic murmurs (regurgitation)
Compare the timing of systolic and diastolic murmurs
Systolic murmurs fall between S1 and S2
Diastolic murmurs fall between S2 and S1
Contrast midsystolic murmurs and pansystolic (holosystolic) murmurs
Midsystolic murmurs begin after S1 and stop before S2 (in diamond shape)
Pansystolic or holosystolic murmur start with S1 and stop with S2 (at same continuous volume)
What is usually the cause of a midsystolic murmur?
Blood flow across aortic and pulmonic (semilunar) valves
What usually causes pansystolic murmurs?
Atrioventricular valve regurgitation
What usually causes late systolic murmurs?
Mitral valve prolapse
List five factors that cause chest pain patients to be high-risk
Age greater than 75, systolic blood pressure less than 100, anterior wall occlusion, concurrent congestive heart failure, bundle branch block
What immediate treatment should be given to patients with suspected MI?
MONAB – morphine, oxygen, nitroglycerin, aspirin, beta blocker
Which patients need extra precaution with nitroglycerin administration?
Those with hypotension or inferior infarction, or patients who have taken Viagra (sildenafil) within 24 hours
What is a typical goal door-to-balloon time?
90 minutes
What is the preferred thrombolytic drug in patients with MI?
Streptokinase – lowest rate of interest cerebral bleeding
Describe the TIMI risk score scale for NSTEMI or unstable angina patients
0 to 2 – low risk
3 to 4 – intermediate risk
5 to 7 – high-risk
(factors seven prognostic variables)
Which beta blockers are preferred for treatment of angina?
Acebutolol and metoprolol
What is the normal length (in seconds) of a PR interval?
0.12–0.20 seconds
What is the normal length of a QRS complex in seconds?
Less than 0.12 seconds
List three causes of sick sinus syndrome
Sinoatrial block, sinus arrest, bradycardia – tachycardia syndrome
