Cardiovascular

Question 1

Angina

Answer 1

severe, constricting pain caused by reduced arterial blood to myocardium –> reduced o2 to myocardial cells –> ischemia and sharp precordial pain

refers to angina pectoris

Question 2

Atherosclerotic heart disease

Answer 2

Narrowing vessels

Question 3

Bruit

Answer 3

musical or harsh auscultatory sound, abnormal

Question 4

Cardiac tamponade

Answer 4

fluid collection between pericardium and heart

Question 5

Cor pulmonale

Answer 5

enlargement of right ventricle secondary to chronic lung disease

Question 6

thrill

Answer 6

fine, palpable sensation

Question 7

Where to listen for each valve

Answer 7

Aortic valve: right 2nd IC
Pulmonic valve: left 2nd
Erb's: left third
Mitral: Apex, 5th IC mid-clav
Tricuspid: 4th IC, left sternal border

Question 8

Heart muscle layers

Answer 8

• epicardium: thin/outermost covering, extends to great vessels, aka visceral pericardium
• myocardium: thick muscular layer, pumping action, most metabolically active so tends to necrose during MI
• endocardium: inner lining of each chamber, valves, chordae tendineae

Question 9

Ventricular pressure cycle

Answer 9

• most important

- left ventricular pressure cycle

Question 10

S1

Answer 10

• first heart sound, when mitral and tricuspid valves closed
• atrial pressure higher during diastole
• ventricle contracts, blood flow reverses, mitral valve closes, - pressure high in left ventricle

Question 11

S2

Answer 11

• 2nd heart sound, aortic and pulmonic valves closed
• ventricular pressure > atrial pressure so blood pumped into aorta and when the ventircle < aortic pressure, valves close –> S2 sound

Question 12

S3

Answer 12

• Filling of ventricle from atria
• OS = opening snap, rarely heard, can be normal
• pathologic in older pts

Question 13

S4

Answer 13

• murmurs in diastole, pathologic
• turbulent flow as atrium contracts into a large or restricted ventricle
• sound = blood hitting ventricle abnormally
• atrial kick at end of diastole

Question 14

Split heart sounds

Answer 14

Sounds on right side may lag behind those of left side due to lower pressures

Question 15

Sudden death in young people

Answer 15

• Most common = asymmetric hypertrophic cardiomyopathy

- second: arrhythmia

Question 16

Ask if skipped beats are related to…

Answer 16

nicotine or caffeine, illicit drugs, exercise worsen/helps

Question 17

PROS

Answer 17

General: fatigue/F
HEENT: negative
Resp: cough, sputum, blood, pillows, orthopnea, paroxysmal nocturnal dyspnea
GI: heartburn, food related, epigastric pain, waterbrash
Other: rash, trauma, psych

Question 18

how many of THE CHADS can present as chest pain

Answer 18

7 - stroke does not present as cp

Question 19

History/risk factors for CP

Answer 19

1. cigarettes
2. poor diet
3. inactivity
4. obesity
5. htn
6. hyperlip
7. DM
8. CAD
9. CVA
10. fmhx - <65 1st degree female
11. scarlet fever
12. mitral prolapse
13. alcohol
14. illicits
    Other: caffeine intake, stimulant, salt, stress (illness, starvation, death, job loss, anxiety)

Question 20

PE - inspection

Answer 20

shape, scars, pacemaker, JVD, cyanosis

Question 21

Xanthoma

Answer 21

yellow patches on eye - risk factor for hyperlipidiema and CAD

Question 22

PMI

Answer 22

commonly used for cardiac exam
5th interspace at mid-clavicular line, lean forward

less common - thrill/hyper-dynamic motion

Question 23

Percussion

Answer 23

seldom used in cardiac exam

Question 24

Diaphragm used for

Answer 24

higher pitched sounds
S1
S2
Breaths

Question 25

Bell used for

Answer 25

low pitched sounds
murmurs
S3
S4

Question 26

Mitral valve prolapse

Answer 26

associated with midsystolic clikc over mitral area and sot mid to late systolic murmur

“click-murmur” syndrome

Question 27

Positioning

Answer 27

• low pitched filling sounds in diastole are made stronger by laying pt on left lateral recumbent
• pericarditis feels worse cp when supine - prefer to sit up

Question 28

Naming a murmur

Answer 28

1. Grade - out of 6
2. where in cycle - systolic can be normal, pathologic if diastolic
3. Sound shape - crescendo/decrescendo
4. Sound quality - harsh, rumbling, machine like, soft
5. Heard loudest - regions, ex R/L IC
6. radiation - lateral chest wall, carotids

Question 29

Aortic ejection sound

Answer 29

heard in early systole, high pitched, radiates up into carotids, not affected by respiration

Question 30

Pulmonic ejection sound

Answer 30

heard in early systole, less intense than aortic ejection sounds, intensifies on expiration, decreases on inspiration

Question 31

Opening snap

Answer 31

• diastolic event that si the sound of a pathologically deformed mitral valve (stenosis)
• heard briefly in diastole, before an S3 is heard
• high pitched, sharp snap or click, not affected by respiration, easily confused with S2

Question 32

Pericardial friction rub

Answer 32

intense, grating sound, loud enough to mimic murmur, best heard at apex, both systole and diastole

Question 33

Normal PE

Answer 33

• jugular venous pulse <3cm about the sternala ngle with head of bed at 45 degrees
• carotid upstrokes are brisk, no bruits
• point of maximal impulse is tapping at mdiclavicular line in 5th IC
• crisp S1 and S2
• base: S2 is greater than S1 and physiologically split with A2 before P2
• apex: S1 is greater than S2 and constsnt
• no murmurs, S3 or S4

Question 34

CHF PE

Answer 34

• JVP is 5cm above sternal angle with head of bed at 50 degrees
• pulses out of sync with atrial contraction
• carotid upstrokes brisk, bruit sometimes heard over left
• PMI is diffuse, at the anterior axillary line and in the 6th IC
• S1 and S2 are soft, S3 present at apex
• high pitched harsh 2/6 holosystolic murmur best heard at apex, radiates to axilla
• S4 shows up with fluid…