Cardiovascular

Question 1

Precordium

Answer 1

area on anterior chest overlying the heart and lower thorax

Question 2

Order of heart valves

Answer 2

tricuspid, pulmonic, mitral, aortic

Try Pulling My Arm

Question 3

Systole

Answer 3

S1 (tricuspid, mitral valves close) aortic and pulmonic valves open, ventricles contract

Question 4

Diastole

Answer 4

S2 (pulmonic, aortic valves close), tricuspid and mitral valves open, blood fills ventricles, atria contract

Question 5

Preload

Answer 5

end of diastolic pressure, ventricles stretched to greatest dimensions

Question 6

Afterload

Answer 6

the stress /tension developed in wall of left ventricle during ejection

Question 7

S1

Answer 7

tricuspid, mitral valves close; loudest at apex of heart

Question 8

S2

Answer 8

pulmonic, aortic valves close; loudest at base of heart (Erb’s point in particular)

Question 9

S3

Answer 9

blood fills ventricles

Question 10

S4

Answer 10

atria contract

Question 11

Mumur

Answer 11

extra heart sounds, disruption of blood flow

Question 12

Point of maximal impulse (PMI)

Answer 12

generated by the apex maybe produced by enlarged ventricle, dilated aorta/dialted pulmonary artery, or an LV wall motion abnormality. Should be less than 1 cm in diameter

Question 13

Thrill

Answer 13

a fine, plapable, rushing vibration (a palpable murmur usually over the base of the heart, indicates turbulence or disruption of expected blood flow). Signifies that the murmur is grade 4 or higher

Question 14

Heave

Answer 14

a more pronunced lift /lift- RV hypertrophy

Question 15

Gallop

Answer 15

S3, when you hear this third heart sound it mimics a “gallop”

Question 16

Rub

Answer 16

friction rub, inflammation of pericardial sac (pericarditis), heard toward apex

Question 17

Click

Answer 17

high pitched sounds that occur at maximal opening of aortic/pulmonary valves, heard just after S1

Question 18

Snap

Answer 18

opening of mitral valve

Question 19

Aortic surface point

Answer 19

Right 2nd ICS; hear S2

Question 20

Pulmonic surface point

Answer 20

Left 2nd and 3rd ICS; hear S2

Question 21

Erb’s point

Answer 21

Left 3rd ICS; BEST hearing of S2

Question 22

Tricuspid surface point

Answer 22

Left 4th ICS/Lower left sternal border

Question 23

Mitral surface point

Answer 23

Left 4-5th ICS in midclavicular line; S1 heard here at apex

Question 24

Physiologic splitting

Answer 24

i. During expiration, the pulmonic valve closes only 30 ms after the aortic valve, S2 is heard as one sound
ii. During inspiration, the chest expands (vacuum -> inspiration), this decrease in pressure increases venous return to the right atrium and ventricle, the extra blood volume causes a delay in ejection, and the pulmonic valve closes later. The delay can be heard as a split S2 - especially common in young people.

Question 25

Fixed splitting

Answer 25

splitting that does not vary with inspiration/expiration, usually due to a septal defect, that is, a shunt between septa, either an ASD (atrial septal defect) or VSD (ventricular septal defect)

Question 26

Paradoxic splitting

Answer 26

pulmonic valve closes before aortic valve, determined on exam because splitting increases during expiration, rather than inspiration. Caused by conditions that delay left ventricular emptying (aortic stenosis, etc.)

Question 27

Chest pain

Answer 27

Many differential diagnoses for chest pain not just CV! Angina pectoris- pressure or choking sensation sub- sternal &/or into neck, jaw. Levine’s sign (hand over chest)= ischemic pain.When assoc. w/ breathing= called pleuritic chest pain. Chest pain in children & adolescents seldom due to cardiac problem, also- not usually related to heart when it’s a constant all day achiness, or a sharp jab that only lasts 1-2 seconds

Question 28

Fatigue

Answer 28

Worse w/ exertion, unable to keep up w/ peers, persistent, chronic hypoxia, body working hard to compensate

Question 29

Dyspnea

Answer 29

Difficult & labored breathing w/ shortness of breath, worse w/ exertion, better w/ rest- propped w pillows, Increases w/ severity of pulmonary and cardiovascular disease

Question 30

Diaphoresis

Answer 30

Often w/ anxiety, sympathetic response to stress, seen in MIs

Question 31

Syncope

Answer 31

Fainting-temporary loss of consciousness, brief lack of blood flow to brain- also associated w/ palps, exertion, dysrhythmia, sudden neck turning, or change in posture, common CV symptom in older patients, seen in hypovolemia, low BP, bradycardia, & valve stenosis

Question 32

Cyanosis

Answer 32

Due to hypoxia, nails (peripheral cyanosis occurs first) periorbital (in kids esp during eating), also in kids- characteristic of congenital heart defects allowing mixture of arterial & venous blood or prevented oxygenated blood.

Question 33

Cough

Answer 33

Dry, wet, nighttime, worse lying down, maybe assoc. w/ valvular disease

Question 34

Orthopnea

Answer 34

Shortness of breath that begins or increases w/ lying down, relieved by sitting or standing, ask if pt sleeps w/ pillows propping, associated w/ heart failure

Question 35

Claudication

Answer 35

Pain, burning, fatigue in legs/ buttocks, occurs w/ walking, better with rest, symptom of narrowing of artery or blockage, may be able to hear bruit (atherosclerosis is the most common cause of arterial blockage which can cause claudication)

Question 36

Paroxymal nocturnal dyspnea

Answer 36

Sudden onset of shortness of breath after a period of sleep, issues with pulmonary function related to CV disease, congestion, better w/ sitting up

Question 37

Xanthelasma

Answer 37

Yellow waxy deposits around eyes, occurs with extreme hyper-cholesterolemia, hyper-lipedmia which are related CV health risks

Question 38

Which other systems should you examine when evaluating a CV complaint?

Answer 38

1. GI Evaluation- Could be GERD or heartburn 2. Respiratory 3. Peripheral Vascular Exam 3. Musculoskeletal- could be joint pain around precordium area 4. Psych- Could be anxiety

Question 39

Hypotension

Answer 39

low blood pressure, systolic

Question 40

Postural / orthostatic hypotension

Answer 40

abnormal decrease in blood pressure from sitting to standing. Systolic chance > 20 mmHg or diastolic change >10 mmHg noted as significant.

Question 41

Hypertension

Answer 41

high blood pressure, 2 stages. Stage I: systolic 140-159 mmHg, diastolic 90-99 mmHg Stage II: systolic >160 mmHg, diastolic >100 mmHg

Question 42

Normotension

Answer 42

normal blood pressure systolic: 90-140 diastolic: 60-90

Question 43

Seven dimensions of hear murmur

Answer 43

1. timing and duration 2. pitch 3. intensity 4. pattern 5. location 6. radiation 7. respiratory phase variations