Cardiovascular Flashcards
Stable Angina
most common, begins slowly and worsens over minutes, usually w/ exercise
Unstable Angina
sudden onset, worse over tie, lasts >15min, occurs w/o cause, unresponsive to nitroglycerin, associated with SOB and drop in BP
Variant (Printzmetal’s Angina)
coronary artery spasm, sudden and temporary, related to dec bloodflow, occurse same time daily
Myocardial Infarction
loss of cardiac muscle due to lack of oxygenation
Ischemia
lack of oxygen, not necessarily dead tissue
Mitral Valve Prolapse (Regurgitation)
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
Pericarditis
inflammation of the pericardium caused by pathogen, pain is pleuritic or crushing, changes in EKG, friction or rub heard
Dissecting aneurysm
tearing of atrial intima, begins suddenly, tearing quality, sharp pain radiating to back of neck, rapid
Pulmonary embolism
dyspnea common, may be asymptomatic
Pleurisy
inflammation of lining, worse with breathing, disappears when hold breath
Pulmonary Hypertension
dyspnea, pain as discomfort, non-radiating tight band across chest
pneumothorax
air in pleural cavity, collapsed lung
Mediastinal Emphysema
free air in mediastinum, chest tightness and dyspnea, Hamman’s sign (snap crackle pop)
Costochondritis
common on young adults, point pressure reproduces pain, inflammation of rib joints with tenderness,
Herpes Zoster
pain precedes rash, dermatome distributions
Fibromyalgia
2nd chostochondral joint tenderness in 85% of pts
Esophageal Spasm
substernal pain and dyspnea, may mimic angina
Esophageal reflux
substernal burning, cramping, radiating to arms neck and jaw, relieved by antacids
Gallstone Colic
RUQ pain radiating to back or R shoulder
Dyspnea
SOB, uncomfortable awareness of breathing
Orthopnea
lying down, relieved by sitting up, multiple pillows at night. Assoc with COPD, CHF, mitral stenosis/regurg
Paroxysmal Nocturnal Dyspnea
dyspnea after lying 1-2 hrs, awaken from pain not easily relieved, early sign of pulm. edema or CHF,
Valvular heart disease
dyspnea symptom of: mitral stenosis, late mitral regurgitation, late aortic stenosis or regurg.
Dyspnea: PULMONARY vs Cardiac
dyspnea w/ cough, sputum - COPD, expectoration relieving, gradual onset
Dyspnea: pulmonary vs CARDIAC
relief sitting up (redistributed), develops over hours or days
Edema
excess serious fluid, gradually worse in evening, pitting (1+, 2+, 3+), common cause CHF (R side)
Hemoptysis
sign of pulmonary disesase
mitral valve stenosis: inc pulm venous congestion –> reuptured blood vessels or pulmonary infarct
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)
Framingham Risk Score
Risk calculator for cardiovascular disease and dislipidemia
Dislipidemia
statins for all at increased risk
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
Carotid pulse
normal: brisk
delayed: aortic stenosis
bounding: aortic insufficiency
Amplitude
weak: cardiogenic shock
Pulsus Alternans
L ventricular failure
Paradoxical pulse
dec >10mmhg, pericardial tamponade, constrictive pericarditis, or obstructive lung disease
JVP
3-4cm normal above sternal angle
Hepatic Jugular Reflex
positive sign= pulmonary artery pressure indicated fluid overload, usually from R sided failure
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
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
Split S2
Physiologic: inspiration can prolong right sided filling, common in kids, pulmonic area
Pathologic: expiration, pulmonic stenosis, septal defect
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
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
Extra Heart Sound (S4)
Atrial Gallop, immediately before S1, atrial kick, soft low pitch, with bell, apex with pt in Left lateral position
Extra heart sound (Mid-systolic click)
mitral valve prolapse, sharp high pitched, at apex with murmur
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
Murmur: Systolic
between S1 and S2
Murmur: Diastolic
after S2 and before S1
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
Holosystolic murmur
plateau sound, ex. mitral regurgiltation
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
Systolic Murmurs
MR PASS (Mitral regurg, pulm aortic systolic stenosis)
Physiologic:
Aortic Stenosis
Pulmonic Stenosis
Mitral Regugitation
Patholigic:
Tricuspid Regurgitation
Diastolic Murmurs
MS ARD (mitral stenosis, aortic regurg are diastolic)
Physiologic:
Aortic Regugitation
Mitral Stenosis
Pathologic:
Pulmonic Regurgitation
Tricuspid Stenosis
Mid Systolic Ejection Murmur
most common
Start after S2 and peak near midsystole, stop before S2
gap helps distinguish midsystolic from pansystolic
- Innocent - peds, no physio or structural abnormalities
- Physiologic - physiologic changes, pregnancy or anemia
- pathologic - structural abn with heart or vessels
assoc with blood flow across semilunar valves (aortic/pulmonic)
Innocent/Physiologic
disappear when sitting, heard when lying down
no assoc symptoms or CVD
Aortic Stenosis
loud,harsh, midsystolic
radiates
calcification of cusps leads to LVH
heard sitting and leaning forward
Pulmonic stenosis
mid-systolic, radiates
thrill, ejection click, wide split s2, r ventricular afterload
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
Mitral Regurgitation
pansystolic, loud, blowing, radiating
Symptoms: fatigue, palpitation, orthopnea, PND
results in volume overload on LV with dilation and hypertrophy
Tricuspid Regurgitation
Engorged pulsating neck veins, hepatomegaly
Hypertrophic Cardiomyopathy
genetic disorder of heart causes left ventricular hypertrophy, risk for sudden death/arrythmias LV outflow obstruction dec with squatting early systolic
Diastolic
usually indicate heart disease
early crescendo = regurg, semilunar valve -aortic
mid or late= stenosis of AV, mitral
Aortic Regurgitation
diastolic
minor symptoms, then rapid deterioration
Mitral Stenosis
diastolic murmur
Pericardial Friction Rub
inflammation of pericardium
High-pitch, scratchy scraping sound
Peripheral Vascular Disease risk factors
- <50 yrs if diabetic, smoker, dyslipidemia, HTN, homocysteinemia (vitD deficiency)
- 50-69 hx smoking or diabetes
- > 70 regardless of hx
- leg symptoms with exertion or ischemic rest pain
- abnormal lower extremity pulses
- known atherosclerotic coronary, carotid, or renal artery disease
PAD warning signs
- Fatigue, aching, numbness, or pain that limits walking or exertion in legs
- poor healing/non-healing of wound
- abd pain after meals, food fears, wt loss
- first degree relative with AAA
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)
Arterial Disorder: Intermittent Claudication
episodic muscular ischemia induced by exertion
due to atherosclerosis
brief pain, forced to rest, resolves within 10min
Arterial Disorder: Rest Pain
episodic muscular ischemia at rest
distal pain, worse at night
aggravated with elevated feet
dependent better
Acute Arterial Occlusion
EMERGENCY
embolism of thrombosis
distal pain, sudden
coldness, numbness, weakness, absent distal pulses
Assess viability
5Ps: Pain, Pulseless, Pallor, Parasthesia, Paralysis
5 Ps
Pain, Pulseless, Pallor, Parasthesia, Paralysis
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
Arterial Insufficiency Testing
Pale- on elevation
Rubor- on dependency
Raynaud’s Phenomena
response to cold/stress
symmetric
no evidence of PVD
may be autoimmune
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
Deep Venous Thrombosis
Risk factors:
Physical: swelling, pain, edema of LE
difference in calf diameter
US for diagnostic
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
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
PVD common findings
Varicose Veins
Superficial dilated veins
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
