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Clinical Lecture Series 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

Which patients typically have a PMI in the xiphoid or epigastric area?

A

COPD patients who have a right ventricular hypertrophy

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2
Q

What produces the sounds S1 and S2?

A

S1 – closure of mitral (AV) valve

S2 – closure of aortic (semilunar) valve

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3
Q

What produces an S3 sound?

A

Deceleration of inflow into left ventricle across mitral valve (due to dilated ventricle)

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4
Q

What produces an S4 sound?

A

Blood entering a ventricle with decreased compliance (diastolic stiffness)

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5
Q

What does systolic blood pressure measure?

A

Maximal left ventricular pressure

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6
Q

Which generally occurs first, right sided heart sounds or left sided heart sounds?

A

Left side heart sounds usually occur slightly before right side heart sounds

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7
Q

What effect does inspiration have on right heart filling time and heart sound?

A

It increases right heart filling time causing delayed closure of pulmonic valve, sometimes resulting in a split S2

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8
Q

What does a PMI greater than 2.5 cm indicate?

A

Left ventricular hypertrophy often seen in hypertension, aortic stenosis

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9
Q

Where on the chest are you most likely to hear a split S1?

A

The lower left sternal border where the tricuspid valve sound is heard (not at apex)

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10
Q

Where are you likely to hear the loudest S1 sound?

A

At the cardiac apex

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11
Q

What are the two main causes of heart murmurs?

A

Stenosis and regurgitation

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12
Q

Where can you best hear murmurs arising from the pulmonic valve?

A

Second left interspace close to the sternum

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13
Q

Where can you best hear murmurs arising from the aortic valve?

A

Second right interspace

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14
Q

Outline the pathway of electrical conduction

A

SA node – AV node – bundle of His – right and left bundle branch – Purkinje fibers – ventricular myocardium

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15
Q

Which three pressures is jugular venous pressure indicative of?

A

Right atrial pressure, central venous pressure, right ventricular end-diastolic pressure

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16
Q

Which vein is used to determine JVP?

A

Right internal jugular vein

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17
Q

What is considered an elevated JVP?

A

> 3cm above sternal angle

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18
Q

What bed angle should JVP be measured?

A

30°

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19
Q

How does bed adjustment differ when assessing JVP in hypovolemic and hypervolemic patients?

A

Hypovolemic – lower head of bed ( possibly to 0°)

Hypervolemic – raise head of bed (to 60°)

20
Q

How far does the sternal angle lie above the right atrium?

A

4-5 cm

21
Q

What landmark should be used if no pulsations in internal jugular vein can be found?

A

The point above which the external jugular vein appears to collapse

22
Q

Which component of the cardiologic exam should be done in left lateral decubitus position?

A

PMI (apical impulse)

23
Q

Contrast sounds and murmurs heard at the same time as carotid upstroke and murmurs heard after carotid upstroke

A

Murmurs heard during upstroke – systolic murmurs

Murmurs heard after upstroke – diastolic murmurs

24
Q

Contrast sounds and murmurs heard at the same time as carotid upstroke and murmurs heard after carotid upstroke

A

Murmurs heard during upstroke – systolic murmurs

Murmurs heard after upstroke – diastolic murmurs

25
Q

What does a palpable S2 suggest?

A

Hypertension (pulmonary if over left 2nd interspace, systemic if over right 2nd interspace)

26
Q

Which heart sound is loudest where?

A

S1 loudest at apex

S2 loudest at base

27
Q

Which sounds are better heard by the diaphragm?

A

High-pitched (S,1 S2, aortic and mitral regurgitation, and friction rubs)

28
Q

Which sounds are better heard by the bell?

A

Low pitched sounds (S3 and S4, mitral stenosis)

29
Q

Which abnormal heart sounds are best heard in left lateral decubitus position?

A

S3, S4, and mitral murmurs

30
Q

What abnormal heart sounds are best heard with patient sitting leaning forward?

A

Aortic murmurs (regurgitation)

31
Q

Compare the timing of systolic and diastolic murmurs

A

Systolic murmurs fall between S1 and S2

Diastolic murmurs fall between S2 and S1

32
Q

Contrast midsystolic murmurs and pansystolic (holosystolic) murmurs

A

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)

33
Q

What is usually the cause of a midsystolic murmur?

A

Blood flow across aortic and pulmonic (semilunar) valves

34
Q

What usually causes pansystolic murmurs?

A

Atrioventricular valve regurgitation

35
Q

What usually causes late systolic murmurs?

A

Mitral valve prolapse

36
Q

List five factors that cause chest pain patients to be high-risk

A

Age greater than 75, systolic blood pressure less than 100, anterior wall occlusion, concurrent congestive heart failure, bundle branch block

37
Q

What immediate treatment should be given to patients with suspected MI?

A

MONAB – morphine, oxygen, nitroglycerin, aspirin, beta blocker

38
Q

Which patients need extra precaution with nitroglycerin administration?

A

Those with hypotension or inferior infarction, or patients who have taken Viagra (sildenafil) within 24 hours

39
Q

What is a typical goal door-to-balloon time?

A

90 minutes

40
Q

What is the preferred thrombolytic drug in patients with MI?

A

Streptokinase – lowest rate of interest cerebral bleeding

41
Q

Describe the TIMI risk score scale for NSTEMI or unstable angina patients

A

0 to 2 – low risk
3 to 4 – intermediate risk
5 to 7 – high-risk
(factors seven prognostic variables)

42
Q

Which beta blockers are preferred for treatment of angina?

A

Acebutolol and metoprolol

43
Q

What is the normal length (in seconds) of a PR interval?

A

0.12–0.20 seconds

44
Q

What is the normal length of a QRS complex in seconds?

A

Less than 0.12 seconds

45
Q

List three causes of sick sinus syndrome

A

Sinoatrial block, sinus arrest, bradycardia – tachycardia syndrome

Clinical Lecture Series 1 (9 decks)

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