Cardiology Flashcards
location of heart apex
used to palpate precordium to find apical impulse.
= in 4th or 5th intercostal spaces, along mid-clavicular line (in supine patient)
Jugular venous pressure
horizontal distance from sternal angle (aorta) to height of jugular distention (in neck).
Normal = 8 cm
Above normal –> CHF, tamponade, …
apical impulse
gentle pressure ("tap") felt at apex of heart, = 1st 1/3 of systole
diastolic murmur
low sound heard with bell,
= from mitral stenosis
sounds heard with bell of stethoscope
LOW sounds
- Rumble = diastolic murmur/mitral stenosis
- gallop = S3 and S4
sounds heard with diaphragm of stethoscope
HIGH pitched sounds,
- S1 and S2 (normal)
- ejection/mid-systolic clicks
- aortic regurgitation murmur
S1 heart sound
= mitral and tricuspid valves closing (AV valves),
normal. before carotid pulse. loudest at apex.
* changes w/ leaflet mobility & rate of L ventricular rise
Abnormal: short P-R interval, mitral stenosis
S2 heart sound
= semilunar valves closing (aortic and pulmonic)
normal. loudest at base. after carotid pulse.
* physiologic splitting: w/ exhale A closes before P closes
Abnormal:
- wide split w/ exhale: RBB block or pulm. valve stenosis
- wide, fixed split: atrial septal defect
- paradoxical/reverse splitting: LBBB, left ventricular failure, or hypertensive cardiovascular disease
Gallop heart sounds
abnormal. = S3 and S4,
S3 = rapid LV filling (LA P < LV P), after S2.
S4 = vigorous LA contraction, before S1, @ max. LA pressure.
* sign of heart failure.
C-reactive protein
non-specific serum marker of inflammation,
*hsCRP assay (high sensitivity) to ID risk of atherosclerosis
BUT CRP does not CAUSE IHD
** also high CRP if: lupus, rheumatiod arthritis **
(so not useful atherosclerosis test in these patients)
current biomarkers for MI
1. Troponins (I or T):
rise 2-3 hrs after, peak 24 hrs, stay for 10-14 days 2. creatine kinase (CK-MB). Also (older): Myoglobin, White cell count, AST
Forward heart failure
inability of the heart to pump blood forward sufficiently to meet metabolic demands of the body
Backward heart failure
inability of the heart to pump sufficient blood to body to meet metabolic demands EXCEPT when cardiac filling pressures are abnormally high.
preload
ventricular wall tension at the end of diastole.
= end diastolic Pressure
– if high => increased CO
afterload
degree of pressure to overcome during systole.
= wall stress during systole [= (P x r)/(2 x thickness)]
–> measure as systolic pressure
systolic Heart Failure
impaired ventricular contractility
- -> increased afterload
1. normal filling (but enlarged ventricles),
2. decreased % blood pumped out
diastolic heart failure
impaired ventricular filling;
- stiff ventricles –> reduced filling (less volume in)
- ~same % pumped out, but since total volume = less, still less blood out to body
concentric hypertropy
add muscle fibers in parallel, so get thick walls.
can be from:
- Aortic stenosis (HTN)
- pulmonary stenosis (pulm. HTN)
eccentric hypertrophy
add myocyte fibers in series, so dilate chambers (walls not thicker),
from: aortic insufficiency, mitral regurgitation, pulmonic insufficiency, tricuspid regurgitation, shunts
calcific aortic stenosis pathogenesis
increased LDL combines with inflammatory cells, and interacts w/ myocytes –> causes smooth muscle cell proliferation and ossification of cardiac tissue (by osteopontin).
aortic stenosis clinical picture
Sx: syncope, angina, dyspnea
Test findings:
- echo: reduced valve opening, dilated chambers, calcified valve
- ECG: ???
Tx: diuretics, inotropes, vasodilators;
* need surgery to replace valve if have Sx!
3 possible causes of aortic stenosis
- bicuspid stenosis
- calcific stenosis
- rheumatic stenosis
3 main types of lesions in congenital heart defects
- Left to right shunt - increased BF to lungs
- Right to Left shunt
- Obstruction(s)
Left to right shunt (a congenital heart defect)
shunt of oxygenated blood into pulmonary flow, => increase pulmonary BF
ie: ventricular septal defect, atrial septal defect, patent ductus arteriosus
Long-term: pulmonary HTN (w/ sm m hypertrophy) –> SWITCH to Right-Left Shunt (BAD!)