cardiovascular exam #2 Flashcards
aortic stenosis, what kind of murmur?
ejection systolic murmur
crescendo - decrescendo
mitral regurgitation… what kind of murmur?
pan-systolic murmur
loudest at apex
parasternal heave
peripheral edema
mitral stenosis… what kind of murmur?
the mid-diastolic murmur
loudest at apex
malar flush
tapping apex beat
aortic regurgitation
the early diastolic murmur
collapsing pulse
wide pulse pressure
displaced apex beat
know the “APT M” pneumonic
Aortic - right 2nd intercostal space
Pulmonic - left 2nd intercostal space
Tricuspid - left 4th intercostal space
Mitral - Apex
pulses alternans
“alternans” think alteration
there’s an alteration of the pressure pulse amplitude
associated with very poor LV systolic function
pulses bisferiens
see the prefix, “bi”
characterized by two systolic peaks
associated with severe aortic regurg or HOCM
pulsus paradoxus
exaggeration of normal decrease in systolic blood pressure. to be considered abnormal, drop must be greater than 10mmHg
associated with cardiac tamponade
pulsus parvus et tardus
small, weak, late peaking pulse.. associated with valvular aortic stenosisd
displacement of point of maximal impulse
point of maximal impulse measures less than 2 to 3 cm in diameter and confined to single intercostal space. Displacement downward and to left indicates usu an enlarged heart
edema
rated from 1+ to 4+
peripheral edema is associated with right heart failure
pulmonary edema is associated with left heart failure
left parasternal lift
due to anterior displacement of the right ventricle due to a large left atrium; may be found in patients with severe, chronic mitral regurg
left ventricular thrust
left ventricular hypertrophy results in exaggerated amplitude and duration of normal left ventricular thrust. associated with aortic stenosis, hypertrophic cardiomyopathy, systemic hypertension
left ventricular systolic bulge
a left ventricular systolic bulge is a larger than normal area of pulsation of the left ventricular apex. Associated with left ventricular aneurysm
Thrills
palpable manifestation of loud, harsh murmurs with low frequency components. Asssociated with aortic stenosis, pulmonic stenosis, and VSD
Angina
cheat pain due to myocardial ischemia. Chest pain in general may indicate presence of pericarditis, dissecting aortic aneurysm, pulmonary embolus, pneumothorax, gastrointestinal problems or acute anxiety
cachexia
state of ill health, malnutrition and wasting; associated with long standing heart dz
clubbing
condition that affects fingers and toes; lateral and longitudinal curvature of the nails accompanied by soft tissue enlargement. Associated with cyanotic heart dz
congestive heart failure
from failure of heart to maintain adequate circulation of blood. Causes of congestive heart failure include myocardial dysfunction, pressure overload, volume overload, diastolic dysfunction, increased metabolic demands
cor pulmonale
defined as combo of hypertrophy and dilatation of right ventricle caused by pulmonary hypertension that results from process intrinsic to lungcy
cyanosis
blush discoloration of skin/mucuos membranes. Associated with right to left cardiac shunts or pulmonary dz
Dyspnea
Abnormal uncomfortable awareness of breathing; main symptom for cardiac and pulmonary dz. 2 types that may indicate cardiac origin:
1. orthopnea - dyspnea while lying flat (associated with congestive heart failure)
2. paroxysmal nocturnal dyspnea (dyspnea that interrupts sleep) usually caused by pulmonary edema secondary to left ventricular failure
edema
accumulation of fluid in cells, tissues or cavities. Hypertension, left ventricular failure, and increased venous pressure secondary to right heart failure are possible causes of cardiac related edema
fever/chills
history of fever and chills is common in patients with history of infective endocarditishe
hepatomegaly
enlargement of liver and assoc with right heart failure
hemoptysis
appearance of blood in sputum due to pulmonary hemorrhage.. associated with mitral stenosis
jugular venous distention
indicates high pressure in right heart
nocturia
excessive urination at night and associated with congestive heart failure
palpitations
cardiac arrhythmias, smoking, exercise, stress, excessive consumption of caffeine
pectus excavatum/carinatum
forward projection of sternum; is backward displacement of lower sternum and xiphoid cartilage causing a hollow area over lower sternum. Thoracic cage abnormalities are associated with Marfan’s syndromee and mitral valve prolapse
Syncope
fainting, light headedness, problems in pts with cardiac dz… includes arrhythmias, angina, myocardial infarction, left ventricular outflow tract obstruction, hypotension, pacemaker failure
Which of the following is incorrect when describing the auscultation areas for the cardiac valves?
a. aortic: right upper sternal border
b. pulmonic: left upper sternal border
c. mitral: lower left sternal border
d. tricuspid: xiphoid area
mitral: lower left sternal border
A grade 1 murmur is a murmur that is
barely heard
a grade 2 murmur is a murmur that is
faintly heard
a grade 3 murmur is a murmur that is
moderately loud
a grade 4 murmur is a murmur that is
loud
a grade 5 murmur is a murmur that is
very loud
a grade 6 murmur is a murmur that is
loud with a thrill
A _________ murmur is one that begins softly and becomes louder
crescendo
A ___________ murmur begins loud, becomes softer, and then increases in loudness
decrescendo-crescendo
A low pitched murmur is best heard with the stethoscopes
bell
A medium pitched murmur is best heard with the stethoscopes
both bell and diaphragm
a high pitched murmur is best heard with the stethoscopes
diaphragm
Which of the following murmurs begin with the first heart sound and end in mid systole?
early systolic
all of the following are possible causes of early systolic murmurs except:
a. valvular aortic stenosis
b. small ventricular septal defect
c. large ventricular septal defect with pulmonary hypertension
d. severe acute mitral/tricuspid regurgitation
valvular aortic stenosis
which of the following murmurs begins after the semilunar valves open?
systolic ejection
all of the following are associated with a systolic ejection murmur except
ventricular septal defect
which of the following murmurs is present when there is flow between two chambers that have widely different pressures throughout systole
pansystolic
all of the following are considered associated with a pan systolic murmur except :
a. mitral/tricuspid regurg
b. ventricle septal defect
c. aorticopulmonary shunts
d. mitral valve prolapse
mitral valve prolapse
which of the following murmurs start well after ejection?
late systolic
all of the following are associated with a late systolic murmur except:
a. papillary muscle dysfunction
b. myocardial ischemia/infarction
c. valvular pulmonic stenosis
d. mitral valve prolapse
valvular pulmonic stenosis
which of the following murmurs begins immediately after the second heart sound?
early diastolic
which of the following is most likely to cause an early diastolic murmur?
a. aortic valve regurgitation
b. mitral valve prolapse
c. patent ductus arteriosus
d. ventricular septal defect
aortic valve regurgitation
which of the following murmurs is caused by forward flow across an AV valve?
mid-diastolic
all of the following are associated with a mid-diastolic or late diastolic murmur except
aortic regurgitation
which of the following murmurs may result from blood flow constantly moving from a high pressure to a low pressure area
continuous
all of the following are associated with a continuous murmur except:
a. patent ductus arteriosus
b. systemic arteriovenous fistula
c. severe mitral regurgitation
d. coronary artery from the pulmonary artery
severe mitral regurg
which effect will the strain phase of the Vasalva maneuver have on venous return?
a. increase
b. decrease
c. varies
d. cannot be predicted
decrease
all of the following murmurs will decrease in intensity during the strain phase of the Vasalva maneuver except:
a. valvular aortic stenosis
b. mitral stenosis
c. hypertrophic obstructive cardiomyopathy
d. tricuspid regurgitation
hypertrophic obstructive cardiomyopathy
what effect will the isometric handgrip have on mitral regurgitation
increase
what effect will the isometric handgrip have on valvular aortic stenosis
decrease
what effect will the inhalation of amyl nitrite have on a ventricular septal defect murmur
decrease
what effect will the inhalation of amyl nitrite have on left heart regurgitant murmurs?
decrease
what effect will the inhalation of amyl nitrite have on the murmur of hypertrophic obstructive cardiomyopathy
increase