Cardio Flashcards
1
Q
clenched fist over sternum indicates ?
A
Angina pectoris
2
Q
finger pointing to the tender spot on chest=?
A
MSK pain
3
Q
Hand moving from neck to epigastrum =?
A
heartburn
4
Q
what causes pain in myocardium
A
angina pectoris
MI
myocarditis
5
Q
what causes pain in pericardium
A
pericarditis
6
Q
what causes pain in the aorta
A
aortic dissection
7
Q
what causes pain in chest wall
A
costochondritis
herpes zoster
8
Q
+clubbing indication of?
A
chronic hypoxia
-R–>L shunting
or
disesease state
9
Q
splinter hemorrhages?
A
bac endocarditis
10
Q
painful red papules on ends of fingers
A
oslar nodes
*bac endoacrditis
11
Q
painless red macules on palms
A
janeway lesions
*bac ednocarditis
12
Q
De Musset’s sign
define
indicates?
A
rhythmic nodding of head (in rhyhtm with HB)
aortic regurgitation
13
Q
Maylor flush indicative of?
A
flushing on face
mitral stenosis
14
Q
corneal arcus?
define
indicative of?
A
hyperlipidemia
gray-white discoloration of cornea
15
Q
PMI is palpated where
A
5th intercostal space at or just medial to left midclavicular line
16
Q
parasternal heave indicates?
A
right ventricular enlargement
17
Q
S1 =?
A
tricuspid and mitral valves closing
*start of systole
18
Q
S2=?
A
aortic and pulmonic valves closing
*end of systole/beginning of diastole
19
Q
where do hear aortic valve?
A
2nd ICS on the right sternal edge
20
Q
where do hear pulmonic valve?
A
2nd ICS on the left sternal edge
21
Q
Tricuspid vavle where to hear?
A
4th or 5th ICS on left sternal edge
22
Q
where to hear mitral valve?
A
5th ICS on Midclavicular line
23
Q
diaphgram best for___ sounds
Bell best for ____sounds
A
dia= high frequney sounds like s1 and s2
bell=low freq sounds like s3 and s4
24
Q
when you are listening over aortic area–what heart sound are you hearing?
A
S2
25
when you are listening over pulmonic area--what heart sound are you hearing?
S2
26
when you are listening over tricuspid area--what heart sound are you hearing?
S1
27
when you are listening over mitral area--what heart sound are you hearing?
S1
28
use what part of scope to ausculate carotid arteries?
bell
29
define murmur
turbulent and abnormal blood flow across a valve
30
define gallops
more than 2 heart sounds in a row
31
what causes murmurs
stenosis--valve narrowing
regurgitation--backflow of blood across valve
32
systolic murmurs can be ____ in younger ppl
benign
33
MC murmurs are involving which valve(s)
mitral and aortic
34
explain aortic stenosis
harsh sounding
SYSTOLIC
Crescendo-Decrescendo
35
harsh sounding
SYSTOLIC
Crescendo-Decrescendo
aortic stenosis
36
which murmur radiates to carotid arteries?
aortic stenosis
37
where does aortic stenosis murmur radiate to?
carotid arteries
38
explain aortic regurg
slow blowing
early DIASTOLIC
Decrescendo
39
slow blowing
early DIASTOLIC
Decrescendo
aortic regurg
40
explain mitral regurg
blowing
| pansystolic or holosystolic
41
which murmur radiate towards axilla?
mitral regurg
42
where does mitral regurg murmur radiate to?
axilla
43
explain mitral stenosis
low frequency
rumbling
mid-diastolic
44
low frequency
rumbling
mid-diastolic
mitral stenosis
45
continuous machine like murmur
PDA
46
S3 gallop
low pitch
early diastole
cause: blood entering ventricle
47
s4 gallop
heard in late diastole
caused by ventricular filling of a stiff ventricle
48
s3 is indicative of?
advanced HF
OR
normal in young PT
49
S4 is heard in presence of ?
HF
or
LVH
50
S2 split heard during insp
| -means?
INSPIRATION
*NORMAL!!
its called physioloic split
51
what is the physiologic split?
splitting of S2 during inspiration
52
S2 split during expiration?
means?
caused?
paradoxical split
* *prolonged left ventricular phase such as:
- LBBB
- hypertrophic cardiomyopathy
53
define fixed split
| -heard in ?
split of s2 throughout entire resp cycle aka heard on insp and epiration
heard in:
-atrial septal defect
54
do you always palpate the PMI?
not always palpable--even in healthy
55
describe location of LV
behind RV, to the left,
56
cardiac apex?
the tappered inferior tip--of LV
57
what is PMI
point of maximal impulse---produced MAX impulse
58
what happens if PMI is located on right side of chest?
situs inversus or dextrocardia
59
what is the normal size for PMI
1-2.5 cm
60
PMI > 2.5 cm?
LVH from HTN or aortic stenosis
61
what does it mean if PMI is lateral to midclavicular line OR >10 cm lateral to midsternal line
LVH and ventric dilation from MI or HF
62
name the AV valves
tricuspid and mitral
63
name the Semilunar valves
pulmonic and aortic *half moon shape
64
which side has greater pressure
left
65
which side has louder heart sounds and why
left heart sounds are louder bc pressure is greater on L vs R
66
systole=?
ventricular contraction
67
diastole=?
ventric relaxation
68
what is early systolic ejection sound?
extra sound accompanying opening of Aortic valve
69
opening snap
- define
- assoc with?
sound of mitral valve opening (normally silent)
| *MITRAL STENOSIS*
70
S3
| benign or pathologic?
benign in:
| <40 and peds
71
what causes S3
rapid deceleration of blood against ventricular wall
| *after MV opens-->rapid ventricular filling occurs
72
S3 gallop
pathologic change in ventricular compliance
| **seen in adults
73
S4
- precedes___?
- can mean___?
precedes: immediately after S1
can be pathologic chance in ventricular compliance
74
splitting of S2?
- define
- benign or pathologic?
Aortic valve closure is heard just before pulmonic valve closure---->A2 + P2
*can be physiologically normal OR pathologic
NORMAL: when its occuring during inspiration
75
explain the process of the normal physiologic process of why S2 splits during inspiration
inspire-->incr R heart filling time-->incr ventric SV-->incr duringation of R ventricular ejection-->delaying closure of P2
76
which component of a split S2 is usually louder---A2 or P2..WHY?
aortic sound
| *since left sounds usually louder*
77
Murmurs are distinguished by??
pitch
| longer duration
78
what causes murmur
| what is MC diagnostic of?
turbulent blood flow
| diagnostic of valve disease
79
define stenosis
valve orifice narrow--obstructs blood flow
| *difficulty in opening
80
define regurgitatioin
valve fails to fully close--blood leaks backward/RETROgrade
81
"PASS"
pulmonic & aortic stenosis=SYSTOLIC
82
"PARD"
pulmonic & aortic regurg=DIASTOLIC
83
list the systolic murmurs
aortic and pulmonic stenosis
| tri and mitral regurg
84
list the diastolic murmurs
aortic and pulmonic regurg
| tricuspid and mitral stenosis
85
At or near the lower left sternal border
tricuspid valve
86
right 2nd ICS to the apex
Aortic valve
87
Left 2nd and 3rd Interspaces close to sternum---also at higher or lower levels
pulmonic valve
88
at and around the cardiac apex
mitral valve
89
primary pacemaker??
| -makes ___ contract
SA node
| *makes atria contract
90
lcoation of SA node
RA
91
SA node discharges impulses at a rate....
60-90 BPM
92
location of AV node
| -makes ___ contract
lower RA
| *makes ventriles contract
93
preload?
load that stretches cardiac muscle before contraction
- volume of blood in RV at end of diastole
* **VOLUME
94
load that stretches cardiac muscle before contraction
| -volume of blood in RV at end of diastole
Preload
95
myocardial contractility?
ability of cardiac muscle to shorten when given a load--ventricles contract during systole
96
ability of cardiac muscle to shorten when given a load--ventricles contract during systole
myocardial contractility
97
afterload?
degree of vascular resistance to ventricular contraction
| ****PRESSURE
98
degree of vascular resistance to ventricular contraction
afterload
99
cardiac out=?
SV X HR
100
BP=?
CO X systemic vasc resistance
101
three things that affect stroke volume
contractility
preload
afterload
102
SV will increase with:
increase contractility
increase preload
decrease afterload
103
what drug class do we use to lower preload? aka volume overload?
venous vasodilators--NITRO
104
what drug class do we use to decr afterload? aka presure overload?
arterial vasodilators--EX hydralazine
105
chronic HTN will cause?
LVH
106
pulse pressure?
difference between SBP and DBP
107
4 factors affecting BP
1. LV stroke vol
2. Distensibility of aorta and lrg arteries
3. Peripheral vasc resistance
4. vol of blood in arterial system
108
what is the MC symptom of coronary heart disease CHD?
Chest pain
109
transient skips and "flip Flops"-----?
PVC
110
PAC?
| PVC?
PAC--early beat of atrial origin
| PVC---early ventric beat
111
sinus arrythmia--speeds up with____?
inspiration
112
SVT rate is over?
>150 to be SVT
| *below is Sinus tach
113
ETOH withdrawl can precipitate___?
afib
114
sudden dyspnea-- want to think of?
PE
Spont Pnx
anxiety
115
orthopnea
dyspnea when supine
| bettter with sitting up
116
PND?
episodes of sudden dyspnea and orthopnea that awaken PT from sleep
-prompting PT to sit/stand up
117
PND can indicate?
LVHF
mitral stenosis
lung dx
118
define edema
excessive fluid in extravascular interstitial space
119
causes for edema?
```
R and/or L ventricular failure
pulm HTN
COPD
nutritional dx---hypalbuminemia
positional
```
120
pitting edema occurs when?
occurs after 10% wt. gain
121
Dependent edema means?
edema is in the lowest part of the body----flows with gravity
122
periorbital puffiness can indicate?
nephrotic syndrome
123
enlarged waistline can indicate?
ascities
| liver failure
124
MC cause of syncope?
vasovagal
125
other causes of syncope
neurologic
| cardiac---only in 20% of PTs
126
jugular veins reflect____?
right artrial pressure
127
JVP lowers with?
blood loss
dehydration
decrease vasc tone
128
what position would you place a septic or hypovolemic PT to see veins?
supine
129
Increase JVP with?
right or left HF--acute an chronic
pulm HTN
incr vasc tone
130
how to place the head of a PT with volume overload?
raised!!
| do not lay them down****
131
delayed upstroke of carotid can indicate?
aortic stenosis
132
bounding upstroke of carotid can indicate?
aortic insufficiency
133
describe a normal cartoid upstroke
brisk
smooth
rapid
and follows S1 immediately
134
pulsus alternans
deinfe
indicates?
reg rhythm but force alternates b/w beats---- strong and weak
can indicate severe LV dysfunction
135
Paradoxical pulse
define
indicates?
greater than normal drop in SBP during inspiration
MC cause is acute asthma, also occurs in pericardial tampondae
136
thrills?
vibrations felt in carotid pulse
137
bruits?
murmur like sound heard in carotids
138
+carotid brutis indicates?
aortic stenosis
139
if the carotid pulse is small thready or weak---indicates?
cardiogenic shock
140
what does it mean is PMI is tapping?
normal
141
what does it mean if PMI is sustained
LVH from HTN or aortic stenosis
142
what does it mean if PMI is diffuse
dilated ventricle from CHF or cardiomyopathy
143
assessing PMI's? (4)
location
amplitude
duration
diameter
144
when assessing a pt for apical impulse (PMI) which is least imp to assess?
rhythm
we assess: location, amplitude, duration and diameter
145
diaphragm of the stethescope detects?
high pitch sounds
| S1 S2 and S4 and msot murmurs
146
bell of the stethescpe detects?
low pitch sounds
| S3 and rumble of mitral stenosis
147
Harsh 2/6 medium-pitched holosystolic murmur best heard at the apex describes
mitral regurgitation
148
Soft, blowing 3/6 decrescendo diastolic murmur best heard at the lower left sternal border describes
aortic regurg
149
crescendo-decrescendo systolic murmur
aortic stenosis
