Cardio PE and Lab findings Flashcards
You hear high pitched decrescendo diastolic murmur that is loudest at 3rd/4th left IS. Even better with pt leaning forward with held expiration.
Aortic Regurgitation
You hear loud rough systolic crescendo-decrescendo murmur at the upper right sternal border. When pt leans forward and it radiates to the right clavicle and neck with a thrill.
Aortic Stenosis
You hear Late systolic murmur and midsystolic click
MVP
You hear blowing holosystolic murmur best heard at the apex, with th pt in the left lateral decubitus position
Mitral Valve Regurgitation
You hear an opening snap, diastolic murmur, loud S1
Mitral Stenosis
You hear a high pitched diastolic murmur, upper left sternal border
Pulmonic regurgitation
You hear widened splitting of S2, may hear early systolic click. Harsh crescendo-decrescendo murmur at left 2nd parasteral IS with no radiation, louder with inspiration
Pulmonic Stenosis
You hear pansystolic blowing murmur loudest on inspiration, best heard at right of left lower sternal border
tricuspid regurgitation
You hear a short, scratchy diastolic murmur that increases with inspiration. Heard best in lower right and left parasternal borders
Tricuspid stenosis
EKG: normal P wave and QRS with a long PR interval. Which heart block?
first degree av block
EKG: progressive delay in PR interval until a normal impulse is dropped. Which heart block?
second degree av block/ mobitz I or wenkebach phenomena
EKG: constant PR interval with intermittent dropped QRS complexes. Which heart block?
second degree av block/ mobitz II
EKG: appearance depends on the area initiating conducted beats
third degree av block (complete) with av dissociation
EKG: 2 R wave peaks and modest QRS widening. maybe wide s2 splitting.
bundle branch/fascicular blocks
What test do you order for all valvular disorders?
echocardiogram
In which two valvular disorders would you also want a doppler with the echo?
Aortic Regurgitation, Aortic stenosis
How do you dx MVP?
echo, holter monitoring or EKG
Someone presents with anxiety, what valvular disorder should come to mind?
MVP. Sometimes caused by anxiety, sometimes causes anxiety
How do you dx mitral valve regurgitation?
echo, EKG, CXR, catheterization on if surgery is required to repair/replace valve
How do you dx mitral stenosis?
echo and EKG. Notched or wide P wave due to atrial hypertrophy
how do you dx pulmonic regurgitation?
echo. EKG may show RV enlargement and CXR may show pulmonary hypertension
How do you dx pulmonic stenosis?
echo, duh. But an EKG may also show RV hypertrophy
What population has a particularly high occurrence of IE?
IV Drug Users
Name 5 predisposing factors for IE.
congenital heart defects rheumatic valve disease bicuspid/calcified aortic valves MVP hypertrophic cardiomyopathy
What causes 50% of community-aquired native valve IE?
Strep viridans
Does IE occur more commonly on the right or left side of the heart?
Left (80%-90%)
Right (30%-70%) - more common with IV drug use
Name 4 potential consequences of IE.
myocardial abscess
conduction abnormalities
heart failure
death!!!
When would you give antibx to prevent IE?
prosthetic valve replacements/repairs
previous IE
Certain congenital heart disease
cardiac transplant recipients with valvulopathy
s/sx IE.
unexplainable fever with murmur
positive blood cultures in pts with valve disease and IV drug users
How do you Dx IE? 4 main things.
hx PE 3 serial blood cultures in 24 hr period echo mb also see anemia, high WBC, elevated ESR/CRP
SBE. Where would you look and what would you find?
General: fever, tachycardia
Skin: pallor
Eyes: roth spots
Digits: petechiae, mb osler’s spots, janeway lesions and splinter hemorrhages (on nails)
Cause of ABE?
Staph/strep
mb fungi after valve replacement
What are 3 causes of noninfectious endocarditis?
catheter injury to valves
SLE immune complexes
anti-phospholipid syndrome
What are 5 causes of pericarditis?
Idiopathic Infections, mostly viral (EBV) Post-MI Connective tissue dz (SLE) Tumors
What are commonly the first sxs of acute pericarditis?
chest pain
dyspnea
pericardial friction rub
How do you Dx pericarditis?
Must have 2 of 4: chest pain pericardial friction rub suggestive EKG changes new/worsening pericardial effusion
How do you Dx pericardial effusion?
CXR
EKG
how do you dx tamponade?
EKG
Echo if there is time
otherwise, Pericardiocentesis for dx and tx
how do you dx constrictive pericarditis?
CXR shows pericardial calcification
Catheterization confirms
High WBC and ESR
EKG, Echo are non-specific
Name 5 risk factors for abdominal aortic aneurysms (AAA)?
atherosclerosis smoking HTN old age white male
Prevalence of AAA?
3/4 of aortic aneurysms
3x greater in men
PE findings of AAA?
pulsatile mass in abd. or abd. pain
Dx AAA?
US or CT
prevalence of thoracic aneurysms?
1/4 of all aortic aneurysms
affect men and women equally
Name 5 sxs that would make you think thoracic aneurysm?
chest/back pain cough dyspnea hoarsness hemoptysis abd pain mb horner's syn.
name 5 predisposing factors for aortic dissection
cocaine use smoking htn CT disorders Iatrogenic trauma
PE findings for aortic dissection?
sudden severe pain, looks like MI pulses may wax and wane differing limp bps aortic regurg. murmur in 50% ummm...i don't think we're going to see these much.
what testing would you do if you suspect aortic dissection?
CXR EKG D-dimer TEE, CTA, MRA once pt is stable CK-MB and troponin to ddx with MI Consult with a cardiothoracic surgeon
Where does erythromelalgia occur?
hands and feet
Name 5 conditions that could lead to secondary erythromelalgia?
DM SLE RA gout MS
What group is most at risk for peripheral arterial aneurysms?
men (20:1) age 65
What are risk factors for Peripheral arterial aneurysms?
atherosclerosis, popliteal artery entrapment, septic emboli
What testing would you order if you suspected peripheral arterial aneurysm?
US
MRI
CT
What causes peripheral arterial dz?
atherosclerosis resulting in lower limb ischemia. same risk factors as atherosclerosis.
What is the patient picture for peripheral arterial dz?
pain on exertion, relieved by rest (intermittent claudication)
numbness and tingling
if severe, ulceration
What would you expect to find on PE with PVD?
reduced pulses in feet
severely ischemic feet are cold, blue, painful or numb
No edema usually
how would you dx PVD?
ankle brachial index.
doppler US
angiography
labs: lipid levels, CRP-hs, homocysteine, fibrinogen, bleeding time
What might Raynaud’s be secondary to?
CT disease endocrine disorders drug use infections trauma
what is the typical pt population for primary raynauds?
<40 yo, often women
no abnormal PE or Hx findings that suggest another cause
what is the typical pt population for secondary raynauds?
> 30 yo
severe painful attacks, ischemia lesions
hx and pe suggest underlying disorder
What is commonly seen with Raynaud’s?
migraine HA, variant angina and pulmonary HTN
What most aggravates Buerger’s dz?
tobacco
What are 5 risk factors for chronic venous insufficiency?
DVT venous HTN sedentary lifestyle trauma obesity
What is the progression of Chronic venous insufficiency?
no change>varicose veins>stasis derm>mb ulceration
4 s/sx of chronic venous insufficiency?
sense of fullness
heaviness
aching
paresthesias
What do you want to rule out when dx chronic venous insufficiency?
DVT, done with US
What most commonly causes superficial venous thrombosis?
IV catheterization in upper extremities
varicose veins in lower extremities
What would PE reveal with superficial venous thrombosis?
palpated as a linear indurated cord with local inflammation
mb tenderness, erythema mottling and warmth
What makes varicose veins feel better?
elevation of the legs
What is the best position to assess varicose veins? What else do you want to check?
standing
Diabetic neuropathy
look for ulcerations
look for other sources of pain such as arthritis, arterial insufficiency and intermittent claudication
what are 3 complications of varicosities?
edema
eczema
painful ulcerations
What 5 potential causes of lymphedema?
surgery trauma radiation therapy tumors infection
What are the complications of lymphedema?
lymphangitis
What is the main cause of sudden cardiac death in athletes?
hypertrophic cardiomyopathy
Athletic heart syndrome is usually asx. What might you see on PE?
bradycardia
laterally displaced PMI
ejection murmur
additional heart sounds
What testing might you suggest to an athlete with s/sx of athletic heart syndrome?
EKG
Echo
Stress testing
