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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
Q

Dyspnea: pulmonary vs CARDIAC

A

relief sitting up (redistributed), develops over hours or days

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26
Q

Edema

A

excess serious fluid, gradually worse in evening, pitting (1+, 2+, 3+), common cause CHF (R side)

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27
Q

Hemoptysis

A

sign of pulmonary disesase

mitral valve stenosis: inc pulm venous congestion –> reuptured blood vessels or pulmonary infarct

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28
Q

Cyanosis: Central or Peripheral

A

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)

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29
Q

Framingham Risk Score

A

Risk calculator for cardiovascular disease and dislipidemia

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30
Q

Dislipidemia

A

statins for all at increased risk

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31
Q

Lifestyle modifications

A 
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
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32
Q

Carotid pulse

A

normal: brisk
delayed: aortic stenosis
bounding: aortic insufficiency

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33
Q

Amplitude

A

weak: cardiogenic shock

34
Q

Pulsus Alternans

A

L ventricular failure

35
Q

Paradoxical pulse

A

dec >10mmhg, pericardial tamponade, constrictive pericarditis, or obstructive lung disease

36
Q

JVP

A

3-4cm normal above sternal angle

37
Q

Hepatic Jugular Reflex

A

positive sign= pulmonary artery pressure indicated fluid overload, usually from R sided failure

38
Q

PMI (Point of Maximum impulse)

A

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
Q

Heart sounds (S1 and S2)

A 
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
Q

Split S2

A

Physiologic: inspiration can prolong right sided filling, common in kids, pulmonic area
Pathologic: expiration, pulmonic stenosis, septal defect

41
Q

Split S2 memory

A

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
Q

Extra Heart Sounds (S3)

A

ventricular gallop, just after S2, due to rapid ventricular filling, dull soft low pitch sound, heard with bell at apex, *fluid overload

43
Q

Extra Heart Sound (S4)

A

Atrial Gallop, immediately before S1, atrial kick, soft low pitch, with bell, apex with pt in Left lateral position

44
Q

Extra heart sound (Mid-systolic click)

A

mitral valve prolapse, sharp high pitched, at apex with murmur

45
Q

Extra Heart Sound (Early systolic ejection)

A
  • 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
Q

Murmur: Systolic

A

between S1 and S2

47
Q

Murmur: Diastolic

A

after S2 and before S1

48
Q

Murmur, assess

A 
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
Q

Holosystolic murmur

A

plateau sound, ex. mitral regurgiltation

50
Q

Grading Murmur

A 
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
Q

Systolic Murmurs

A

MR PASS (Mitral regurg, pulm aortic systolic stenosis)

Physiologic:
Aortic Stenosis
Pulmonic Stenosis
Mitral Regugitation

Patholigic:
Tricuspid Regurgitation

52
Q

Diastolic Murmurs

A

MS ARD (mitral stenosis, aortic regurg are diastolic)

Physiologic:
Aortic Regugitation
Mitral Stenosis

Pathologic:
Pulmonic Regurgitation
Tricuspid Stenosis

53
Q

Mid Systolic Ejection Murmur

A

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
Q

Innocent/Physiologic

A

disappear when sitting, heard when lying down

no assoc symptoms or CVD

55
Q

Aortic Stenosis

A

loud,harsh, midsystolic
radiates
calcification of cusps leads to LVH
heard sitting and leaning forward

56
Q

Pulmonic stenosis

A

mid-systolic, radiates

thrill, ejection click, wide split s2, r ventricular afterload

57
Q

Pansystolic or Holosystolic

A

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
Q

Mitral Regurgitation

A

pansystolic, loud, blowing, radiating
Symptoms: fatigue, palpitation, orthopnea, PND
results in volume overload on LV with dilation and hypertrophy

59
Q

Tricuspid Regurgitation

A

Engorged pulsating neck veins, hepatomegaly

60
Q

Hypertrophic Cardiomyopathy

A 
genetic disorder of heart
causes left ventricular hypertrophy, risk for sudden death/arrythmias
LV outflow obstruction
dec with squatting
early systolic
61
Q

Diastolic

A

usually indicate heart disease
early crescendo = regurg, semilunar valve -aortic
mid or late= stenosis of AV, mitral

62
Q

Aortic Regurgitation

A

diastolic

minor symptoms, then rapid deterioration

63
Q

Mitral Stenosis

A

diastolic murmur

64
Q

Pericardial Friction Rub

A

inflammation of pericardium

High-pitch, scratchy scraping sound

65
Q

Peripheral Vascular Disease risk factors

A
  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
Q

PAD warning signs

A
  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
Q

Evaluating for Pain

A 
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
Q

Arterial Disorder: Intermittent Claudication

A

episodic muscular ischemia induced by exertion
due to atherosclerosis
brief pain, forced to rest, resolves within 10min

69
Q

Arterial Disorder: Rest Pain

A

episodic muscular ischemia at rest
distal pain, worse at night
aggravated with elevated feet
dependent better

70
Q

Acute Arterial Occlusion

A

EMERGENCY
embolism of thrombosis
distal pain, sudden
coldness, numbness, weakness, absent distal pulses
Assess viability
5Ps: Pain, Pulseless, Pallor, Parasthesia, Paralysis

71
Q

5 Ps

A

Pain, Pulseless, Pallor, Parasthesia, Paralysis

72
Q

Chronic Arterial Insufficiency

A

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
Q

Arterial Insufficiency Testing

A

Pale- on elevation

Rubor- on dependency

74
Q

Raynaud’s Phenomena

A

response to cold/stress
symmetric
no evidence of PVD
may be autoimmune

75
Q

Venous Disorders: Superficial Thrombophlebitis

A

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
Q

Deep Venous Thrombosis

A

Risk factors:
Physical: swelling, pain, edema of LE
difference in calf diameter
US for diagnostic

77
Q

Chronic Venous Insufficiency

A 
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
Q

Thromboangitis obliterans/Buergers Disease

A

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
Q

PVD common findings

A

Varicose Veins

Superficial dilated veins

80
Q

Ankle Brachial Index

A

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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