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internal deases > Cardio vascular 1-2 L > Flashcards

Cardio vascular 1-2 L Flashcards

1
Q

Basic complaints of CVS

A

*Pain: - coronarogenic (ischaemic) – angina pectoris
- non-coronarogenic - cardialgia
*Interruptions in the work of the heart and palpitation
*Shortness of breath (dyspnea), suffocation
*Edema
*Coughing, hemoptysis
*Headache
*Dizziness, flickering flies before the eyes
*Syncope

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2
Q

signs of heart attack

A

Heart attack signs and symptoms in men and women: Chest pain or discomfort; Shortness of breath; Pain or discomfort in the jaw, neck, back, arm, or shoulder; Feeling nauseous, light-headed, or unusually tired.

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3
Q

Distinguishing between
angina pectoris and cardialgia

A

– angina pectoris :
1-Quality/Character : Pressing, squeezing
2-Location : Retrosternal
3-Radiation : Left shoulder, scapula
4-Setting : Physical exercise
5-Nitroglycerin effect : Stops the pain
—-cardialgia:
1-Quality/Character : Pricking, nagging
2-Location : At the apex, in the shoulder, along the ribs
3-Radiation : No
4-Setting : Other reasons: no association with exercise. Ma be provoked by meals, movements
5-Nitroglycerin effect : No effect

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4
Q

explain the Dizziness, flickering flies before the eyes

A
  • permanent or periodic
  • relationship with changes in body
    position, interruptions in the work of the
    heart, relationship with the rise or fall of
    blood pressure
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5
Q

explain the Syncope

A
  • frequency of occurrence
  • aggravating-alleviating factors:
    stuffy room, unpleasant odors,
    stress, menses, interruptions in the
    work of the heart
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6
Q

explain the Physical examination of CVS

A

—-General information:
- Consciousness
- Position in bed (forced - AHF)
- The patient’s face
- Skin covers
- Subcutaneous fat
—-Local:
- Heart Area
- Vessel areas (arteries, veins, capillaries)
—Skin covers:
1-Colors of skin
- coffee with milk
- pale
- acrocyanosis
2-Skin rashes and formations:
xanthoma trophic changes , acrocyanosis , ulceration
—Subcutaneous fat :
*Degree of development by BMI
*Type of subcutaneous fat
*Presence of edema:
- legs: ankles, shins, feet;
- ascites (abdomen cavity),
- hydrothorax (pleural cavity)

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7
Q

Heart area examination

A

*Apex beat
*Cardiac (right ventricular) beat
*Epigastric pulsation
*Pulsation due to contractions of the abdominal
aorta

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8
Q

explain the Apex beat

A

Location in the V intercostal space, 1,5 cm medial to the
mediaclavicular line
*Mechanism: due to the impact of the apex of the heart on
the chest wall
*Pathology: “Negative push” - with adhesive
(constrictive) percarditis

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9
Q

explain the Cardiac (right ventricular) beat

A

*Location in the III - IV intercostal space to the left of the sternum extends to the epigastric region
*Mechanism - reduction of enlarged right ventricle

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10
Q

explain the Epigastric pulsation

A

Elevation and lowering of the anterior abdominal wall in the epigastric region, synchronous to the contractions of the heart
*Mechanism:
- pulsation of the heart (right ventricle)
- pulsation of the abdominal aorta
- pulsation of enlarged liver

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11
Q

explain Pulsation due to contractions of the
abdominal aorta

A

*Location - below the xiphoid process, with deep inspiration visible worse
*Appears when:
- exhaustion;
- asthenic type of constitution;
- relaxed abdominal wall;
- omission of internal organs;
- aneurysm of the abdominal aorta

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12
Q

+explain the Pulsation due to enlarged liver
(hepatic pulsation)

A

–The true (hepatic venous pulse)
When the hands grasp the protruding edge of the liver with
each pulse stroke, it increases in all directions
Fingers pressed to the liver, with each pulse stroke, not only
rise, but also diverge
–Transmission
When grasping the protruding edge of the liver with each
pulse of the pulse, it does not increase, but only moves in
one direction
Fingers pressed to the liver, with each pulse stroke only
rise, but do not diverge

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13
Q

explain the Arterial pulse

A

Pulse is the rhythmical vibration of the arterial walls caused by contractions of the heart, blood discharge into the arterial system, and changes in pressure in this system during systole and diastole

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14
Q

what is the Properties of arterial pulse

A
  • Symmetry:
    symmetrical/asymmetrical
  • Rhythm: regular/irregular
  • Pulse rate:
  • normal (60-90 per min)
  • bradicardia (<60 per min)
  • tachycardia (>90 per min)
  • Pulse pressure:
  • pulsus durus (hard or high-tension pulse)
  • pulsus mollis (soft)
  • normal pulse
  • Volume of pulse:
  • pulsus plenus (full)
  • ulsus vacuus
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15
Q

Assessment of pulse

A

Pulsus differens
Different volume and force between arms Causes:
- unilateral atherosclerosis of major arteries
- compression of major arteries
(tumors, aortic aneurisms)

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16
Q

Methods of BP measurement and its phases

A
  1. Direct (invasive)
  2. Non-invasive:
    - auscultatory (Korotkoff`s method)
    - cyclometric
    –Office
  3. Ambulatory: HBPM ABPM
  4. Self-monitoring of BP 24-h monitoring
    —phases
    1 phase – first quiet tones – Systolic BP
    2 phase – short compression murmurs
    3 phase – loud systolic murmurs
    4 phase – decreasing intensity of tones
    5 phase – disappearance of tones – Diastolic BP
17
Q

Rules of BP measurement

A
  1. Rest before the
    measurement (5 min. and
    more)
  2. No coffee intake or
    smoking before the
    measurement
  3. Selecting the right cuff
  4. Supporting of elbow on the table
  5. Legs shouldn’t be crossed
  6. Bulb and cuff at heart
    level
  7. Keep silence
18
Q

Classification of BP levels in adults

A

–Category Systolic BP Diastolic BP
Optimal <120 and <80
Normal 120-129 and/or 80-84
High normal 130-139 and/or 85-89
1st degree AH 140-159 and/or 90-99
2nd degree AH 160-179 and/or 100-109
3rd degree AH ≥180 and/or ≥110
ISH* ≥140 and <90

19
Q

Percussion of the heart

A

t
*relative cardiac dullness borders
*absolute cardiac dullness borders
*vascular bundle
*heart configuration
*diameter of the heart
*heart length

20
Q

Topography of the heart

A

The axis of the heart is
located:
- top down;
- from right to left;
- from back to front
*From all sides the heart is
partially covered with lungs
*The part that is not obstructed
by the lungs is localized in
the IV intercostal space, is
represented by the right
ventricle

21
Q

Contours of the heart

A

*Right:
- up to the 3rd rib the ascending part of the aorta;
- lower - right atrium
*Left:
- descending part of the aorta;
- pulmonary trunk;
- ear of the left atrium;
- left ventricle

22
Q

Borders of relative cardiac dullness

A

*Represents the true size of the heart
*Use a quiet percussion
*Define three boundaries:
- the right;
- the left;
- the upper

23
Q

Causes of an increase in the right atrium

A

*Diseases of the lungs.
*Stenosis of the right AV-hole.
*Tricuspid regurgitation, or
lack of tricuspid valve.
*Pulmonary embolism.
*Congenital heart diseases.
*Hypertrophy of the right
ventricle.

24
Q

Causes of an increase in the right ventricle

A

*Pulmonary hypertension.
*The tetrad of Fallot.
*Stenosis of the pulmonary artery mouth.
*Defect of interventricular septum

25
Q

Defining the left border

A

*Palpation of apex impulse (heart pump)
*The finger-plessimeter is installed vertically
*Percussion from the anterior axillary line along the
intercostal space, in which the apical impulse is located
*The left border is located 1-1,5 cm inward from the midclavicular line
*Moves to the left with an increase in the left ventricle

26
Q

Causes of an increase in the left ventricle

A

*High blood pressure
(hypertension).
*Insufficient mitral valve.
*Stenosis of the aortic valve (AV).
*Hypertrophic cardiomyopathy.
*Physical exercise.
*Obesity

27
Q

Defining of the upper border

A

Percussion from top to bottom, retreating 1cm outside of the left breast line
*The finger plessimeter is installed horizontally
*The upper border is normally located at level III of the rib
*Shifts up as the left atrium increases

28
Q

Causes of increase of the left atrium

A

*Obesity.
*Insufficient mitral valve.
*Mitral stenosis.
*Hypertrophic cardiomyopathy.
*Aortic stenosis.
*High blood pressure.
*Pulmonary diseases.
*Stress.

29
Q

Borders of absolute dullness of the heart

A

*Part of the heart not
covered by the lungs
*Use the quietest
percussion
*Three boundaries are
defined
*Percussion from the
boundaries of relative
dullness

30
Q

The width of the vascular bundle

A

*It is defined on the II intercostal space
*Use the quietest percussion
*Normally it is 5-6 cm

31
Q

The width of the vascular
bundle increases with:

A
  1. Aneurysm of the pulmonary artery
  2. Aortic aneurysm
  3. Tumors of the mediastinum
32
Q

Heart configuration

A

*It is defined with quiet percussion on 3-5 intercostal
spaces on the left and on the right
- the normal heart configuration
- the mitral configuration
- the aortic configuration
- the triangular configuration
- “Bull’s heart

33
Q

Normal heart configuration

A

“Waist of the heart” - the angle between the left atrium
appendage and the left ventricle. Normally blunt and not
pronounced sharply

34
Q

Mitral configuration

A

The mitral configuration - the “waist of the heart” disappears.

35
Q

Aortic configuration (“boot”, “sitting duck”)

A

The aortic configuration or “boot”, “sitting duck” - “the
waist of the heart” is underlined, the angle is almost
straight

internal deases (19 decks)

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