Cardiology Flashcards by Monica Cabrera

Surface landmarks

Midsternal line, midclavicular line, anterior axillary line, midaxillary line

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Circulation

SVC and IVC —> RA —> RV —> pulmonary arteries —> LA —> LV —> aorta, aortic arch

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Auscultation

R sternal border 2nd ICS - aortic valve

L sternal border 2nd ICS- pulmonary valve

L sternal border 3rd ICS- Erb’s Point (pulmonic and aortic valve)

L sternal border 4th ICS- Tricuspid valve

L mid-clavicular line - 5th ICS- mitral valve

“All physicians eagerly take money”

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Systole - S1, Lub

Ventricles contract
R ventricle pump blood into pulmonary artery. Pulmonic valve open

L ventricle pumps blood into aorta. Aortic valve is open.

Tricuspid and mitral valve close

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Diastole (S2, Dub)

Ventricles Relax
Blood flow from RA to RV. Tricuspid valve is open

Blood flow from LA to LV. Mitral valve is open.

Pulmonic and aortic valves closed

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Preload, contractility, afterload, CO, BP

Preload —> volume overload (stretch)

Contractility: ventricles contract during systole

Afterload —> pressure overload

Cardiac output: SV x HR

Blood pressure: CO x SVR

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Systolic blood pressure

Presssure generated by LV during systole, when LV ejects blood into aorta

Pressure waves in arteries create pulses

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Diastolic blood pressure

Pressure generated by load remaining in arteries during diastole (ventricles relax)

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Blood pressure

Select proper cuff size. Position patient properly. Make sure there is brachial pulse. Apply cuff correctly. Assess blood pressure for hypertension

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Jugular venous pressure (JVP)

Jugular veins reflect right atrial pressure
Measure the distance of the topmost point of JV pulsation above sternal angle.
3-4 cm normal
High JVD suggests CHF, SVC/IVC blockage, tricuspid stenosis

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Carotid pulse

Auscultate listening for bruits. Then palpate upstroke. Don’t palpate both sides at the same time.
Brisk- normal
Delayed- suggest aortic stenosis
Bounding- suggest aortic insufficiency

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Palpate the chest wall

Finger pads- palpate for heaves and lifts from abnormal ventricular movements
Use ball of hand- palpate for thrills

Chest wall- aortic, pulmonic, left parasternal, and apical areas

Thrills- turbulence transmitted to chest wall surface by damaged heart valve ***** TQ!!!

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Assess Point of Maximal Impulse (PMI)

Tapping- normal
Sustained- suggest LV hypertrophy from HTN or aortic stenosis
Diffuse- suggest dilated ventricle from CHF or cardiomyopathy
Assess- location, amplitude, duration and diameter

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When examining a patient for PMI, which of the following is least important to assess?

Rhythm

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Auscultation of the heart

Listen in 6 listening areas for S1 and S2 using diaphragm of stethoscope then the bell

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Diaphragm

Best for detecting high pitched sounds like S1, S2, and S4 and most murmurs

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Bell

Best for detecting low pitched sounds like S3 and rumble of mitral stenosis

Identify and describe murmurs - cause, timing, Dx, duration, pitch

Murmur: sounds from turbulent blood flow. Caused by stenosis or regurgitation of valves

Timing: are the murmurs systolic or diastolic?

Dx by palpating carotid upstroke (occur in systole) as you listen

Determine duration- early/mid/late systole or diastole

Pitch- high, medium or low pitched

Murmur shape

Crescendo, decrescendo, or both (diamond shaped), or plateau (machinery)

Crescendo-decrescendo (both) murmur —> aortic stenosis

Plateau - holosystolic murmur of mitral regurgitation

Murmur intensity

Grade 1: very faint, heard only after listener tuned in w/ stethoscope

Grade 2: quiet, heard immediately after placing stethoscope on chest

Grade 3: moderately loud

Grade 4: loud with palpable thrill

Grade 5: very loud with thrill, heard with stethoscope partly off chest

Grade 6: very loud with thrills heard without stethoscope

Grade 4-6 must have accompanying thrill ***** TQ!!!

Ex. Harsh 2/6 medium-pitched holosystolic murmur heard at the apex describes

Mitral regurgitation

Soft bowing 3/6 decrescendo diastolic murmur heard at lower left sternal border describes

Aortic regurgitation

Midsystolic click

Mitral valve prolapse

Main cause of PMI displacement

Pregnancy, cardiac enlargement, cardiomyopathy, ischemic heart disease

Systolic murmur

Occur between S1 and S2. Associated with ventricular ejection. Coincide with carotid upstroke. May indicate valve disease

Diastolic murmur

Occur between S2 and S1. Associated with ventricular relaxation and filling. Caused by aortic/pulmonic regurgitation or mitral/tricuspid stenosis

Speeding of heart during inspiration

Sinus arrhythmia. Speeds up with inspiration, slows down with expiration. Heart sounds normal. S1 may vary with heart rate

Splitting of S2 heart sounds ***** TQ!

Happens when RV filling time increases during inspiration. Increases RV ejection time. Causes delay of closing pulmonic valve. Hear both pulmonic and aortic closing separating, P2 and A2. During expiration, 2 sounds fuse into a single sound Found at 2nd and 3rd ICS close to sternum

Cause of S3

Hearing sound of rapid LV filling when mitral valve opens Causes- common in children, young adults, pregnancy Adults- indicate changes in ventricular compliance, decreased myocardial contractability, CHF, volume overload

Cause of S4

Atrial contraction. Indicate decrease ventricular compliance. Left side caused by HTN, CAD, aortic stenosis. R side caused by pulmonary HTN or pulmonic stenosis

Systolic murmurs

Between S1 and S2 Midsystolic - after S1 up to S2. Goes from soft to louder to softer. Caused by blood across semilunar valves ie aortic stenosis Pansystolic- begin at S1, ends at S2. Occur with regurgitatant flow across M/T valve **** TQ!! Late systolic, opening snap- mid to late systole, persists to S2. Caused by mitral valve stenosis/prolapse

Diastolic murmurs

Occur after S2 Early- start after S2 (no gap). Fades before S3. Caused by regurgitant blood flow across semilunar valves ie Aortic regurgitation Mid- after S2 (short gap). Fade before S1. Caused by turbulent flow across M/T valves Late- starts late in diastole, continues to S1 (no gap)

Functional Murmur

Short, early, midsystolic, decrease in intensity with actions that reduce LV volume. When standing, BP, SV, LV volume decrease. Squatting, opposite happens. Can identify prolapsed mitral valve, distinguish hypertrophic cardiomyopathy from aortic stenosis Viscero-somatic reflexes: T1-T5 on left side

Mitral valve prolapse

Mid to late systolic click Opening snap Caused by anxiety, panic attacks, coffee Accentuate findings with valsalva maneuver

PMI

5th interspace midclavicular line, 8 cm lateral to midsternal border

Palpitations-

Palpitations- atrial fibrillation (irregularly irregular), paroxysmal supraventricular tachycardia (regular, rapid, sudden, offset), sinus tachycardia

Dyspnea (SOB)

Dyspnea (SOB)- pulmonary embolus, spontaneous pneumothorax, anxiety

Paroxysmal nocturnal dyspnea (SOB when sleeping)

Paroxysmal nocturnal dyspnea (SOB when sleeping). Left ventricular heart failure, mitral stenosis

Edema

Edema (excessive fluid in interstitial tissue spaces)- renal and liver disease

Dependent edema

Dependent edema- CHF, hypoalbuminemia

Chest pain. Dx meaning-

Chest pain. Dx meaning- angina pectoris, MI, coronary heart disease, aortic aneurism