Cardiology-Intro Flashcards
Cardiomegaly enlarges and widens with CHF, where is PMI?
PMI in 5th ICS, left ant axillary line
b/c 5th is nl space but cardiomegaly has moved it to ANTERIOR axillary line
Chest Pain/Angina
“substernal crushing pressure” - sometimes may not have CP, may just have “sob”
OPQRST
Onset/Provoking Quality Radiation of pain Severity and site Timing/Duration Associated sx: SOB, DOE, N/v diaphoresis
Syncope
decreased cerebral flow
may be arrhythmia, low BP or low CO
Test: BP, EKG, holter, tilt table
Edema = ? side heart failure
right side
Bed bound-sacral edema
Upright-pedal edema
Dry cough - pulm or cards?
if dry cough do not forget heart failure, may also be taking an ACE I
Arrhythmia that is thyroid in nature
A Fib
Orthostatic BP changes
Lying to standing. Drops >20 mm systolic
Irregular peripheral pulses
a fib
Normal peripheral pulses
2+
Bruit
Audible murmur over a blood vessel
Bifed/bisferiens pulse
Double beat in systole
hypertrophic cardiomyopathy, aortic regurg
Dicrotic pulse
exaggerated early diastolic wave seen in HF, 2 “humps”
Pulses alternans
alternating strong/weak pulse seen in HF
Paradoxical pulse
> 10 mm Hg drop during inspiration seen in Obstructive lung disease and tamponade
Abdominal aorta - nl
65 with htn, smoking, renal dz and CAD
Jugular Venous Pulsations
right heart fxn
+hepato jugular reflex (press on liver and watch neck) = +right HF
+JVP
a wave -
V wave-
A-tricuspid synosis
V-tricuspid regurg
To hear mitral stenosis
use the bell, roll to left lateral position, low frequency sounds
to hear aortic regurg
sit up and lean forward, press firmly with diaphram (high frequency sounds)
ASD -sound
fixed split S2
normal split S2
with inspiration
Split during expiration of S2
Lbbb, LVH, AS
S3 gallop
Early rapid filling LV, normal in young
LV overload, CHF
Best heard at apex, LL decubitus, bell, low pitch
“kentucky”
S4
vigorous atrial contraction into stiff LV LVH, MI LL decubitus with bell Tennessee Never hear in a fib
Mitral valve prolapse sounds
Midsystolic click, LLSB, diaphragm
Opening snap
diastolic rumble
Mitral Valve stenosis
diastolic murmur
always disease present
Grades
1-barely audible 2, 3 getting louder 4-with thrill 5-heard with edge of stethoscope 6-stethoscope off chest
Innocent murmur
cresecendo/decresendo
normal hearts
2/6 decreases sitting up
holosystolic or pansystolic
AV valve regurg
MR OR TR
VSD
PDA murmur
machinery quality continuous
Contraindication to exercise stress test
aortic stenosis
Gold standard to treat CAD
Cardiac cath
