Cardiovascular

Question 1

Danger signs MI

Answer 1

Middle age or older man c/o gradual onset of intense and steady chest discomfort or pain that is describes as squeezing, crushing, heavy pressure, or band-like. Pain provoked with exertion or eating a heavy meal. Pain radiates to left side of the neck, jaw, and left arm. Pain continues at rest. Patient may be diaphoretic with cool, clammy skin. Women and those who are elderly present with nonspecific symptoms such as SOB, dyspnea, weakness, nausea, vomiting, fatigue, and syncope. May complain of back pain instead of anterior chest pain.

Question 2

Danger signs Congested Heart Failure (CHF)

Answer 2

Older paint c/o acute onset of dyspnea, fatigue, dry cough, and swollen feet and ankles. Sudden increase in weight. Lung exam will reveal crackles on both bases (bibasilar crackles) with an S3 heart sound. H/o preexisting CAD, angina, prior MI, or previous episode of CHG. Usually taking diuretics and other antihypertensive drugs.

Question 3

Danger signs Infections Endocarditis (IE)

Answer 3

Presents with fever, chills, and malaise that is associated with new onset of murmur. Associated skin findings are found on fingers, hands, and toes/feet. Subungual hemorrhages petechia on the palate, painful violate-colored nodules on fingers or feet, and nontender red spots on the palms/soles. Fundoscopic exam may show Roth spots or retinal hemorrhages.

Question 4

Danger signs of dissecting Abdominal Aortic Aneurysm (AAA)

Answer 4

Elderly white male w/ c/o sudden onset severe, sharp, excruciating pain located in the abdomen, flank, and/or back. Accompanied by distended abdominal and abnormal vital signs (hypotension). Older male patients are smokes with HTN are higher risk. CXR show widened mediastinum, tracheal deviation, and obliteration of the aortic knob.

Question 5

What is the S1 heart sound

Answer 5

• “lub” of “lub-dub”
• Closure of the mitral and
  tricuspid valves
• AV valves
• (MOTIVATED)

Question 6

What is the S2 heart sound

Answer 6

• “dub” of the “lub-dub”
• Closure of the aortic and
  pulmonic valves
• Semilunar valves
• APPLES

Question 7

What is the S3 heart sound

Answer 7

• Occurs during early systolic
• Sounds like “Kentucky”
• Usually indicative of CHF
• Always abnormal if heard over the age of 35 or 40
• Can be considered normal
  in children, pregnant
  woman, and some athletes
  over the age of 35

Question 8

What is the S4 heart sound

Answer 8

• Occurs in late diastole
• Sounds like Tennessee
• Best heard at apex
• Increased resistance due
  to stiff left ventricle (LVH)
• Considered normal in some
  elderly

Question 9

Systolic Murmurs

Answer 9

MR. ASS
Heard during S1 (holosystolic)
Mitral regurgitation, Aortic Stenosis

Question 10

Diastolic Murmurs

Answer 10

MS. ARD
Head during S2
Mitral stenosis
Aortic regurgitation
Always indicative of heart disease