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Physical Assessment > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Stable Angina

A

most common, begins slowly and worsens over minutes, usually w/ exercise

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2
Q

Unstable Angina

A

sudden onset, worse over tie, lasts >15min, occurs w/o cause, unresponsive to nitroglycerin, associated with SOB and drop in BP

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3
Q

Variant (Printzmetal’s Angina)

A

coronary artery spasm, sudden and temporary, related to dec bloodflow, occurse same time daily

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4
Q

Myocardial Infarction

A

loss of cardiac muscle due to lack of oxygenation

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5
Q

Ischemia

A

lack of oxygen, not necessarily dead tissue

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6
Q

Mitral Valve Prolapse (Regurgitation)

A

one or both mitral valve flaps prolapse allowing blood to flow back into atria during systole. chest pain, SOB, murmur, acute problems related to left side not compensating

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7
Q

Pericarditis

A

inflammation of the pericardium caused by pathogen, pain is pleuritic or crushing, changes in EKG, friction or rub heard

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8
Q

Dissecting aneurysm

A

tearing of atrial intima, begins suddenly, tearing quality, sharp pain radiating to back of neck, rapid

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9
Q

Pulmonary embolism

A

dyspnea common, may be asymptomatic

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10
Q

Pleurisy

A

inflammation of lining, worse with breathing, disappears when hold breath

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11
Q

Pulmonary Hypertension

A

dyspnea, pain as discomfort, non-radiating tight band across chest

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12
Q

pneumothorax

A

air in pleural cavity, collapsed lung

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13
Q

Mediastinal Emphysema

A

free air in mediastinum, chest tightness and dyspnea, Hamman’s sign (snap crackle pop)

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14
Q

Costochondritis

A

common on young adults, point pressure reproduces pain, inflammation of rib joints with tenderness,

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15
Q

Herpes Zoster

A

pain precedes rash, dermatome distributions

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16
Q

Fibromyalgia

A

2nd chostochondral joint tenderness in 85% of pts

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17
Q

Esophageal Spasm

A

substernal pain and dyspnea, may mimic angina

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18
Q

Esophageal reflux

A

substernal burning, cramping, radiating to arms neck and jaw, relieved by antacids

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19
Q

Gallstone Colic

A

RUQ pain radiating to back or R shoulder

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20
Q

Dyspnea

A

SOB, uncomfortable awareness of breathing

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21
Q

Orthopnea

A

lying down, relieved by sitting up, multiple pillows at night. Assoc with COPD, CHF, mitral stenosis/regurg

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22
Q

Paroxysmal Nocturnal Dyspnea

A

dyspnea after lying 1-2 hrs, awaken from pain not easily relieved, early sign of pulm. edema or CHF,

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23
Q

Valvular heart disease

A

dyspnea symptom of: mitral stenosis, late mitral regurgitation, late aortic stenosis or regurg.

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24
Q

Dyspnea: PULMONARY vs Cardiac

A

dyspnea w/ cough, sputum - COPD, expectoration relieving, gradual onset

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25
Dyspnea: pulmonary vs CARDIAC
relief sitting up (redistributed), develops over hours or days
26
Edema
excess serious fluid, gradually worse in evening, pitting (1+, 2+, 3+), common cause CHF (R side)
27
Hemoptysis
sign of pulmonary disesase | mitral valve stenosis: inc pulm venous congestion --> reuptured blood vessels or pulmonary infarct
28
Cyanosis: Central or Peripheral
Central: drop in pulm. venous saturation, duet o arterial unsaturation leads to reduced hemoglobin Peripheral: normal saturation but dec flow through capillaries from dec cardiac output (shock, CHF, Raynaud's)
29
Framingham Risk Score
Risk calculator for cardiovascular disease and dislipidemia
30
Dislipidemia
statins for all at increased risk
31
Lifestyle modifications
``` BMI: 18.5-24.9 <2.4 g Na/day exercise 30 min/day ETOH men <2 women <1 Vit D supplement Diet: high veg, low fat, no processed ```
32
Carotid pulse
normal: brisk delayed: aortic stenosis bounding: aortic insufficiency
33
Amplitude
weak: cardiogenic shock
34
Pulsus Alternans
L ventricular failure
35
Paradoxical pulse
dec >10mmhg, pericardial tamponade, constrictive pericarditis, or obstructive lung disease
36
JVP
3-4cm normal above sternal angle
37
Hepatic Jugular Reflex
positive sign= pulmonary artery pressure indicated fluid overload, usually from R sided failure
38
PMI (Point of Maximum impulse)
located 5th interstitial space, 5cm midsternal line Tapping = normal Sustained = LV hypertrophy from hypertension or aortic stenosis Diffuse= dilated ventricle from congestive heart failure or cardiomyopathy Displaced - LV hypertrophy
39
Heart sounds (S1 and S2)
``` S1 = closure of mitral valve and tricuspid valve (AV valves), heard at apex, coincide with carotid pulse, R wave on EKG S2 = closure of aortic and pulmonic valves (semilunar), first aortic then pulmonic heard simultaneously, except in split S2, heard at base ```
40
Split S2
Physiologic: inspiration can prolong right sided filling, common in kids, pulmonic area Pathologic: expiration, pulmonic stenosis, septal defect
41
Split S2 memory
Normal: Inspirational --Lo Pressure: Pulmonic Procrastinates Abnormal --Wide: Pulmonic Stenosis, pulmonic procrastinates more --Paradoxical: Aortic stenosis, Exhale - aortic delayed past pulmonic --Fixed: Atrial Septal defect, splits during in/exhale
42
Extra Heart Sounds (S3)
ventricular gallop, just after S2, due to rapid ventricular filling, dull soft low pitch sound, heard with bell at apex, *fluid overload
43
Extra Heart Sound (S4)
Atrial Gallop, immediately before S1, atrial kick, soft low pitch, with bell, apex with pt in Left lateral position
44
Extra heart sound (Mid-systolic click)
mitral valve prolapse, sharp high pitched, at apex with murmur
45
Extra Heart Sound (Early systolic ejection)
- opening of semilunar valves (Aortic pulmonic) usually quiet - aortic stenosis or pulmonic stenosis opening make sounds - Right after AV valve close (S1), hear click of aortic and pulmonic reopening
46
Murmur: Systolic
between S1 and S2
47
Murmur: Diastolic
after S2 and before S1
48
Murmur, assess
``` Timing: systolic or diastolic Location: apex, LSB, base Shape: crescendo/decrescendo Pitch: high, medium low Quality: musical, blowing, harsh Intensity: grade I-VI Radiation: to axillae, neck ```
49
Holosystolic murmur
plateau sound, ex. mitral regurgiltation
50
Grading Murmur
``` I: faintest II: faint but readily identifiable III: moderately loud IV: loud and associated with thrill V: very loud, cannot be heard without stethoscope VI: loudest, heard without scope ```
51
Systolic Murmurs
MR PASS (Mitral regurg, pulm aortic systolic stenosis) Physiologic: Aortic Stenosis Pulmonic Stenosis Mitral Regugitation Patholigic: Tricuspid Regurgitation
52
Diastolic Murmurs
MS ARD (mitral stenosis, aortic regurg are diastolic) Physiologic: Aortic Regugitation Mitral Stenosis Pathologic: Pulmonic Regurgitation Tricuspid Stenosis
53
Mid Systolic Ejection Murmur
most common Start after S2 and peak near midsystole, stop before S2 gap helps distinguish midsystolic from pansystolic 1. Innocent - peds, no physio or structural abnormalities 2. Physiologic - physiologic changes, pregnancy or anemia 3. pathologic - structural abn with heart or vessels assoc with blood flow across semilunar valves (aortic/pulmonic)
54
Innocent/Physiologic
disappear when sitting, heard when lying down | no assoc symptoms or CVD
55
Aortic Stenosis
loud,harsh, midsystolic radiates calcification of cusps leads to LVH heard sitting and leaning forward
56
Pulmonic stenosis
mid-systolic, radiates | thrill, ejection click, wide split s2, r ventricular afterload
57
Pansystolic or Holosystolic
murmurs are pathologic blood flow from chambers with high pressure to lower pressure through valve or other opening that should be closed begins immediately with S1 and continues to S2
58
Mitral Regurgitation
pansystolic, loud, blowing, radiating Symptoms: fatigue, palpitation, orthopnea, PND results in volume overload on LV with dilation and hypertrophy
59
Tricuspid Regurgitation
Engorged pulsating neck veins, hepatomegaly
60
Hypertrophic Cardiomyopathy
``` genetic disorder of heart causes left ventricular hypertrophy, risk for sudden death/arrythmias LV outflow obstruction dec with squatting early systolic ```
61
Diastolic
usually indicate heart disease early crescendo = regurg, semilunar valve -aortic mid or late= stenosis of AV, mitral
62
Aortic Regurgitation
diastolic | minor symptoms, then rapid deterioration
63
Mitral Stenosis
diastolic murmur
64
Pericardial Friction Rub
inflammation of pericardium | High-pitch, scratchy scraping sound
65
Peripheral Vascular Disease risk factors
1. <50 yrs if diabetic, smoker, dyslipidemia, HTN, homocysteinemia (vitD deficiency) 2. 50-69 hx smoking or diabetes 3. >70 regardless of hx 4. leg symptoms with exertion or ischemic rest pain 5. abnormal lower extremity pulses 6. known atherosclerotic coronary, carotid, or renal artery disease
66
PAD warning signs
1. Fatigue, aching, numbness, or pain that limits walking or exertion in legs 2. poor healing/non-healing of wound 3. abd pain after meals, food fears, wt loss 4. first degree relative with AAA
67
Evaluating for Pain
``` Arterial Disorders: --artherosclerosis (intermittent claudication, rest pain) --Acute arterial occlusion --Raynaud's disease Venous Disorders --Supercifical thrombophlebitis --DVT --Chronic venous insifficiency Thromboangiitis Obliterans (Buerger's) Acute Lymphangitis Mimics (acute cellulitis, erythema nodosum) ```
68
Arterial Disorder: Intermittent Claudication
episodic muscular ischemia induced by exertion due to atherosclerosis brief pain, forced to rest, resolves within 10min
69
Arterial Disorder: Rest Pain
episodic muscular ischemia at rest distal pain, worse at night aggravated with elevated feet dependent better
70
Acute Arterial Occlusion
EMERGENCY embolism of thrombosis distal pain, sudden coldness, numbness, weakness, absent distal pulses Assess viability 5Ps: Pain, Pulseless, Pallor, Parasthesia, Paralysis
71
5 Ps
Pain, Pulseless, Pallor, Parasthesia, Paralysis
72
Chronic Arterial Insufficiency
intermittent, progressing to pain at rest dec or absent pulses pale elevated, dusky red dependent cool temperature usually no edema trophic skin changes (thin, skiny, atrophic skin, loss of hair over foot and toes, nails thickend and ridged) gangrene may develop
73
Arterial Insufficiency Testing
Pale- on elevation | Rubor- on dependency
74
Raynaud's Phenomena
response to cold/stress symmetric no evidence of PVD may be autoimmune
75
Venous Disorders: Superficial Thrombophlebitis
pain, tenderness, induration and erythema along course of superficial vein due to inflammation or thrombosis benign self-limiting inc risk for DVT or PE
76
Deep Venous Thrombosis
Risk factors: Physical: swelling, pain, edema of LE difference in calf diameter US for diagnostic
77
Chronic Venous Insufficiency
``` no pain normal pulses cyanotic on dependency, petechia and then brown pigmentation with chronicity temp normal edema present, marked skin changes around ankle, narrowing of leg ulceration medially at ankle no gangrene ```
78
Thromboangitis obliterans/Buergers Disease
inflammation and thrombotic occlusions of small arteries and veins smokers rest pain in fingers and toes, recurrent aggravated by exercise, relieved with rest gangrene or ulceration of topes
79
PVD common findings
Varicose Veins | Superficial dilated veins
80
Ankle Brachial Index
test for pts >70, abn pulses, 50-69 hrs hx smoking or DM ABI= Pleg/Parm >.9 normal .6 = mild PAD .4 = Moderate

Physical Assessment (5 decks)

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