Cardiovascular Flashcards
Angina
severe, constricting pain caused by reduced arterial blood to myocardium –> reduced o2 to myocardial cells –> ischemia and sharp precordial pain
refers to angina pectoris
Atherosclerotic heart disease
Narrowing vessels
Bruit
musical or harsh auscultatory sound, abnormal
Cardiac tamponade
fluid collection between pericardium and heart
Cor pulmonale
enlargement of right ventricle secondary to chronic lung disease
thrill
fine, palpable sensation
Where to listen for each valve
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
Heart muscle layers
- 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
Ventricular pressure cycle
- most important
- left ventricular pressure cycle
S1
- 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
S2
- 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
S3
- Filling of ventricle from atria
- OS = opening snap, rarely heard, can be normal
- pathologic in older pts
S4
- 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
Split heart sounds
Sounds on right side may lag behind those of left side due to lower pressures
Sudden death in young people
- Most common = asymmetric hypertrophic cardiomyopathy
- second: arrhythmia
Ask if skipped beats are related to…
nicotine or caffeine, illicit drugs, exercise worsen/helps
PROS
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
how many of THE CHADS can present as chest pain
7 - stroke does not present as cp
History/risk factors for CP
- cigarettes
- poor diet
- inactivity
- obesity
- htn
- hyperlip
- DM
- CAD
- CVA
- fmhx - <65 1st degree female
- scarlet fever
- mitral prolapse
- alcohol
- illicits
Other: caffeine intake, stimulant, salt, stress (illness, starvation, death, job loss, anxiety)
PE - inspection
shape, scars, pacemaker, JVD, cyanosis
Xanthoma
yellow patches on eye - risk factor for hyperlipidiema and CAD
PMI
commonly used for cardiac exam
5th interspace at mid-clavicular line, lean forward
less common - thrill/hyper-dynamic motion
Percussion
seldom used in cardiac exam
Diaphragm used for
higher pitched sounds
S1
S2
Breaths
Bell used for
low pitched sounds
murmurs
S3
S4
Mitral valve prolapse
associated with midsystolic clikc over mitral area and sot mid to late systolic murmur
“click-murmur” syndrome
Positioning
- 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
Naming a murmur
- Grade - out of 6
- where in cycle - systolic can be normal, pathologic if diastolic
- Sound shape - crescendo/decrescendo
- Sound quality - harsh, rumbling, machine like, soft
- Heard loudest - regions, ex R/L IC
- radiation - lateral chest wall, carotids
Aortic ejection sound
heard in early systole, high pitched, radiates up into carotids, not affected by respiration
Pulmonic ejection sound
heard in early systole, less intense than aortic ejection sounds, intensifies on expiration, decreases on inspiration
Opening snap
- 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
Pericardial friction rub
intense, grating sound, loud enough to mimic murmur, best heard at apex, both systole and diastole
Normal PE
- 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
CHF PE
- 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…
