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Clin Skills > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Should normal valves make a sound when opening?

A

No - silent

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2
Q

Where do normal heart sounds come from?

A

closing

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3
Q

What is S1?

A

closure of mitral valve

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4
Q

What is S2?

A

closure of aortic valve

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5
Q

What is systole?

A

period of ventricular contraction, aortic valve is open, mitral valve is closed

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6
Q

What is diastole?

A

period of ventricular relaxation, fills with blood; aortic valve is closed, mitral valve is open

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7
Q

In a healthy patient, which part of the heart has the strongest contraction?

A

left ventricle

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8
Q

How can you remember the diastolic murmurs?

A

ArMsPT
Aortic regurgitation
Mitral stenosis
Pulmonic regurgitation
Tricupsid stenosis

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9
Q

What is stenosis?

A

stenotic open valve

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10
Q

What is regurgitation?

A

regurgitant closed valve

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11
Q

What is the Ar for ArMSPT?

A

aortic regurgitation

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12
Q

What is the M in ARMSPT?

A

mitral stenosis

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13
Q

What is the P in ARMSPT?

A

pulmonic regurgitation

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14
Q

What is the T in ARMSPT?

A

tricupsid stenosis

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15
Q

What are the systolic murmurs?

A

aortic stenosis
mitral regurg
pulmonic stenosis
tricupsid regurg
ventricular septal defect

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16
Q

What is S3?

A

when mitral valve pops open again to begin a new diastole right after S2. Healthy in young people <40 and pregnancy, athletes

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17
Q

When is S3 concerning?

A

pathologic/concerning in elderly in which it means heart failure issue

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18
Q

Where can you hear S3 best?

A

using bell at the apex in left lateral decubitus position

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19
Q

How is split S2 different from S3?

A

high pitched (diaphragm) and heard best at the pulmonic valve. Split s2 is common in inspiration while s3 is abnormal.

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20
Q

What is S4?

A

atrial contraction at the end of diastole right before S1; which reflects a pathological change in compliance

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21
Q

Where can you hear S4?

A

low pitched (bell) and heard at the apex with patient in left lateral decubitus

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22
Q

When is a split S2 normal?

A

during inspiration only

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23
Q

What is split S2 made up of?

A

aortic and pulmonic valve closure; split is when they do not close at the same time

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24
Q

What is the most common murmur?

A

midsystolic ejection murmur, with no associated pathology, just temporary changes in metabolism from pregnancy, fever, hyperthyroidism, anemia

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25
Q

Where can you hear a midsystolic ejection?

A

2nd and 4th ICS

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26
Q

What does a midsystolic ejection sound like?

A

crescendo-decresendo, no radiation; loud with a thrill

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27
Q

Where can you hear aortic stenosis?

A

2nd intercostal space in midsystolic timing

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28
Q

How would you describe aortic stenosis?

A

crescendo-decrescendo, often loud with a thrill, ejection click, harsh, medium, radiating to the carotids

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29
Q

What helps you hear an aortic stenosis better?

A

sitting and leaning forward

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30
Q

Where can you hear hypertrophic cardiomyopathy?

A

3rd and 4th intercostal space in midsystolic timing

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31
Q

How would you describe hypertrophic cardiomyopathy?

A

crescendo-decrescendo with radiation down left sternal border to the apex; harsh, medium

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32
Q

How can you maneuver to hear hypertrophic cardiomyopathy?

A

decreases with any increase in venous return (squatting)
increases with any decrease in venous return (standing)

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33
Q

Where can you hear a pulmonic stenosis?

A

2nd and 3rd intercostal space with midsystolic timing

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34
Q

How would you describe a pulmonic stenosis?

A

crescendo-decrescendo soft to loud, loud with a thrill; medium pitch, radiating to left shoulder and neck

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35
Q

Where can you hear mitral regurgitation?

A

apex in holosystolic timing

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36
Q

How would you describe mitral regurgitation?

A

soft to loud if loud, apical thrill with high pitched blowing; radiation to left axilla and left sternal border

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37
Q

Where can you hear a mitral valve prolapse?

A

apex

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38
Q

How would you describe a mitral valve prolapse?

A

mid systolic click in holosystolic; soft to loud with apical thrill and high pitched blowing w/ click.
Radiates to left axilla and left sternal border

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39
Q

Where can you hear tricupsid regurgitation?

A

lower left sternal border (possibly apex) in the holosystolic timing

40
Q

How can you describe a tricuspid regurgitation?

A

soft to loud with medium blowing; tap and blow, tap and drag, radiating to right of sternum to xiphoid

41
Q

What do we all have a little bit of?

A

tricupsid regurgitation

42
Q

What can you do to hear a tricuspid regurgitation better?

A

intensity increases with inspiration

43
Q

Where can you hear VSD?

A

3rd, 4th, 5th intercostal spaces in holosystolic; high pitched (smaller the hole the higher the pitch), HARSH; radiation wide and all over

44
Q

Which murmurs are considered worse?

A

diastolic

45
Q

Where can you hear aortic regurgitation?

A

left 2nd and 4th intercostal spaces in diastolic

46
Q

How would you describe aortic regurgitation?

A

decrescendo with HIGH pitch (diaphragm) hit and drag, radiation to the apex

47
Q

How can you hear aortic regurgitation better?

A

sitting and leaning forward

48
Q

Where can you hear a mitral stenosis?

A

apex in diastolic

49
Q

How would you describe mitral stenosis?

A

decrescendo with a low pitched rumble and “presystolic accentuation” often described as an opening snap and “snapping in and out”

50
Q

How can you hear a mitral stenosis better?

A

left lateral decubitus position at PMI, or hand grip and during exhalation

51
Q

What would a venous hum sound like?

A

continuous humming roaring and low-pitched above middle third of clavicles bilaterally

52
Q

What would a pericardial friction rub sound like?

A

coarse grating sound, scratchy, scraping, high pitched in the left 3rd intercostal spaces

53
Q

What would help you hear a pericardial friction rub better?

A

sitting and leaning forward, breath held after forced expiration

54
Q

What can cause a pericardial friction rub?

A

pericarditis, inflammation of visceral and parietal pericardium

55
Q

what does the JVP help tell us?

A

index for right heart pressure, hydration, and cardiac function

56
Q

What does the JVP reflect?

A

atrial pressure, central venous pressure, right end diastolic pressure

57
Q

What is at the sternal angle of Louis?

A

RATPLANT
2nd rib
aorta
trachea
pulmonary trunk
left recurrent laryngeal nerve
azygos vein
nerves (cardiac plexus)
thoracic duct

58
Q

What increases JVP?

A

heart failure, pulmonary HTN, tricuspid stenosis, pericardial compression

59
Q

What is a normal value for jugular vein measurement?

A

<4

60
Q

What other test can you utilize to see if there is increased venous pressure?

A

hepatojugular reflux test

61
Q

What is the hepatojugular reflux test?

A

placing hands on RUQ, press firmly upward under RCM, 15 seconds of pressure, see if anything happens at jugular veins
abnormal = >3cm rise

62
Q

What is important ROS for cardio?

A

chest pain, palpitations, SOB, edema, claudication, syncope

63
Q

What’s important to ask patients when referring to their shortness of breath?

A

their baseline activity and how it’s changed after symptoms onset

64
Q

What are classic symptoms of CHD?

A

exertional CP, chest pressure, heaviness, discomfort

65
Q

how can women present differently in an MI?

A

upper back pain, neck or jaw pain, dyspnea, PND, N/V, fatigue

66
Q

Does ventricular fibrillation or ventricular tachycardia produce palpations?

A

no…scary

67
Q

What is a specific SOB complaint common in heart and lung problems?

A

paroxysmal nocturnal dyspnea

68
Q

How much can the interstitial space absorb of fluid before observant peripheral pitting edema?

A

5L of fluid (10% of weight)

69
Q

What is the most common cause of synocpe?

A

neurocardiogenic; pure cardiac is only 20% of the time

70
Q

What are the three general techniques of cardiac exam?

A

inspect, palpate, auscultate
(no percussion)

71
Q

What side can you not take BP for?

A

anything with mastectomy or AV fistula

72
Q

How will you have to adjust the bed with JVP abnormalities?

A

low JVP = lower HOB
high JVP = raise HOB to see it

73
Q

What’s the difference between a carotid thrill and carotid bruit?

A

thrill = felt as vibration during palpation
bruit = HEARD during auscultation

74
Q

What is pulsus alternans?

A

rhythm is regular but force alternates

75
Q

What is a paradoxical pulse?

A

pulse that varies in amplitude with respiration

76
Q

What are you looking for in a cardiac inspection?

A

shape of thorax, symmetry, scars, bruising, pacemaker, pale or cyanotic; look for PMI (lighting helps)

77
Q

How do you palpate in the cardiac exam?

A

palm, ball, fingerpads in all places! APETM

78
Q

What are you palpating for?

A

lifts/heaves (sustained palpable impulses by enlarged ventricles or atriums) felt by FINGERPADS and thrills (buzzing or vibratory sensation) felt by PALM and apical impulse/location of PMI

79
Q

What can help locate the PMI?

A

left lateral decubitus position

80
Q

What should you always note when finding an abnormality?

A

location, diameter, amplitude, duration

81
Q

When can a PMI migration occur?

A

pregnancy, heart failure, cardiomyopathy, ischemic heart disease

82
Q

What does displacement laterally to the MCL mean?

A

enlarged heart, heart failure

83
Q

What’s the order of auscultation?

A

diaphragm then bell

84
Q

Where can you hear S1&S2 equally?

A

erb’s point, and where you can hear aortic regurgitation and mitral stenosis (we think this is wrong)

85
Q

What are the grades of murmurs?

A

1-6, with 6 you can hear with no stethoscope, and 1 being very faint

86
Q

What are characteristics of murmurs?

A

timing, location, manuever matching, shape, grade, associated features, radiation

87
Q

What is valsalva?

A

blowing through a straw

88
Q

What are you looking for in left lateral decubitus?

A

S3 and S4, mitral murmurs especially mitral stenosis

89
Q

What are you looking for in sitting up and leaning the pt forward?

A

aortic regurgitation

90
Q

What are you looking for in standing and squatting?

A

mitral valve prolapse, hypertrophic cardiomypathy vs aortic stenosis

91
Q

What are you looking for with an isometric hand grip?

A

MR, AR, VSD, also pulmonic and mitral stenosis

92
Q

What are you looking for with transient arterial occlusion?

A

enhancing mitral regurg, aortic regurg, and VSD

93
Q

What is the only murmur that increases with strain in valsava and confirm your diagnosis?

A

hypertrophic cardiomyopathy

94
Q

What are common murmurs in children?

A

jugular venous hum, cervical systolic murmur, patent ductus arteriosis (loud, harsh, machinery-like, associated thrill), innocent/still’s murmur

95
Q

What are the four possible valvular systolic murmurs?

A

aortic stenosis, mitral regurgitation, pulmonic stenosis, tricuspid regurgitation

96
Q

What are the four possible diastolic murmurs?

A

aortic regurgitation, mitral stenosis, pulmonary regurgitation, tricuspid stenosis

Clin Skills (9 decks)

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