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
what effect will the inhalation of amyl nitrite have on mitral valve prolapse
increase
what is used to evaluate the cardiovascular response to exercise?
exercise stress test
What does this EKG strip represent
Normal sinus rhythm
What does this EKG represent?
Sinus bradycardia
EKG strip
Sinus tachycardia
EKG strip
Sinus pause
EKG strip
Premature atrial contraction
EKG strip
Atrial flutter
EKG strip
Atrial fibrillation
EKG Strip
Premature Ventricular Contractions
EKG Strip
Ventricular Tachycardia
EKG strip
Ventricular fibrillation
EKG strip
First degree AV block
EKG Strip
2nd Degree AV block
EKG strip
2nd degree AV block
2 types
- in mobitz 1, PR interval gets longer and longer until beat is blocked
- in mobitz 2, some beats are conducted while others are not
EKG strip
3rd degree AV block
- p waves and QRS complexes occur independent of each other (atrial impulses don’t activate the ventricles)
EKG strip
Artificial pacemaker
All of these are indications for an exercise stress test…
- chest pain
- arrhythmias
- assessment of cardiovascular function
The following would NOT be an example
valvular aortic stenosis
Which of the following is the most reliable indicator of myocardial ischemia during an exercise stress test examination?
- ST segment depression
- hypotension
- decrease in R wave voltage
- arrhythmias
ST segment depression
which of the following is a positive inotrope and positive chronotrope?
- dipyridamole
- persantine
- adenosine
- dobutamine
dobutamine
all of the following may induce myocardial ischemia via dilatation of the coronary arteries except:
- dipyridamole
- persantine
- adenosine
- dobutamine
dobutamine
which of the following examinations is an invasive procedure used to visualize cardiac chambers. and the coronary arterial system:
-echocardiography
-electrocardiography
-electrocephalogram
-cardiac catheterization
cardiac catheterization
Identify
MR
Identify
Mitral stenosis
Identify
AS
Identify
AR
all of the following may be assessed during a cardiac catheterization except :
-intracardiac pressures
-oxygen saturations
-ventricular function
-pericardial thickness
pericardial thickness
all of the following may be assessed during a. right heart. catheterization. except:
-vena cava
-pulmonary veins
-right atrium
-pulmonary artery
pulmonary veins
all of the following pressures may be measured during a right heart catheterization except
- right atrium
- right ventricle
- main pulmonary artery
- mean aortic
mean aortic
the most common method of determining cardiac output during a right heart cardiac catheterization procedure is the
thermodilution
during a right heart catheterization, oxygen saturations may be obtained in each of the following except
- vena cava
- pulmonary veins
- right atrium
- right ventricle
pulmonary veins
the cardiac catheterization procedure that allows calculation of pressures on either side of the aortic valve is the
left heart catheterization
all of the following pressures may be measured during a left heart catheterization except
pulmonary artery wedge
the left heart cardiac catheterization procedure that allows for the evaluation of mitral regurgitation is
ventriculogram
the cardiac catheterization procedure. that allows for the evaluation. of the coronary arterial system is
arteriogram
significant coronary artery disease is considered present when the coronary artery diameter is reduced by at least
70%
which of the following cardiac catheterization procedures is used to determine the percent stenosis of a coronary a artery
arteriogram
which percent stenosis is considered significant coronary artery dz?
70%
which of the following coronary arteries provides blood flow to the. anterior interventricular septum and the anterior wall of the left ventricle?
left anterior descending
which of the following coronary arteries provides blood flow to the anterolateral and lateral walls of the left ventricle?
left. circumflex
which of the following coronary arteries provides blood flow to the right ventricle?
right coronary
which of the following coronary arteries provides blood flow to the inferior walls of the ventricles and the inferior interventricular septum in a right dominant system?
posterior descending
in a left dominant coronary artery system, which of the following coronary arteries provides the posterior descending coronary artery?
left circumflex
the formula used to determine valve area in the cardiac catheterization is
Gorlin
The formula used to determine mitral valve area in the cardiac Cath lab is MVA (cm2) =
CO/DFP/38 x square root of MPG
The formula used to determine the aortic. valve area. in the cardiac cath lab is
CO/SFP/44.5 x square root of MPG
the most COMMON invasive method of determining cardiac output is
thermodilation
Which invasive method to determine cardiac output measures the concentration of dye that has been injected into the right heart and measured at a distal arterial site
indicator dilution
which of the following invasive methods used to determine cardiac output is considered THE MOST ACCURATE
Fick
Which. of the following invasive techniques determine cardiac output by injecting dye into. the left ventricle and measuring ventricular volumes?
angiography
which of. the following procedures during a cardiac. catheterization allows. for. the. detection of. an intracardiac shunt?
oximetry
the following oxygen saturations have been recorded:
SVC: 72%
IVC: 78%
RA: 87%
RV: 87%
Main pulmonary artery: 87%
the diagnosis is
atrial septal defect
the following oxygen saturations have been recorded:
SVC: 72%
IVC: 78%
RA: 75%
RV: 85%
main pulmonary artery: 85%
diagnosis is?
VSD
the following oxygen saturations have been recorded:
SVC: 72%
IVC: 78%
RA: 75%
RV: 75%
Main pulmonary artery: 89%
diagnosis is?
patent ductus arteriosus
the forward flow across a normal valve is determined to be 60 cc. The total volume across a regurgitant valve is 120 cc. The regurgitant volume is
60 cc
The regurgitant fraction for question number 5 is
50%
The cardiac catheterization examination that injects a radioplaque dye into cardiac chambers great vessels and is recorded on cine film is a
angiography
Which of the following cardiac catheterization exams allows for the evaluation of ventricular function parameters (ie ejection fraction, stroke volume, cardiac output, cardiac index), regional wall motion abnormalities and atrioventricular regurgitation?
angiography
Which. of. the following cardiac catheterization exams allows for the evaluation of aortic regurgitation?
aortography
which of. the following cardiac catheterization exams allows for the. evaluation of pulmonary artery stenosis and pulmonary thrombosis?
angiography
the difference in pressures between two cardiac chambers is called a pressure
gradient
the cardiac cath lab may express a pressure gradient all of the following ways except:
- peak to peak
- peak to mean
- peak instantaneous
- mean
-peak to mean
the pressure gradient measurement that expresses the difference between the peak systolic pressure of a ventricle and a great artery is the
peak to peak
the pressure gradient that expresses an average pressure gradient between two chambers is
mean
the pressure gradient that expresses the maximum gradient between two chambers is
peak instantaneous.
which of the following cardiac Doppler measurements would correlate best with the. cardiac catheterization gradient measurement?
mean
A. patient with valvular aortic stenosis has a peak instantaneous gradient of 100 mm Hg. The cardiac cath peak to peak gradient is 60 mm Hg. The reason fro the difference in the gradient is:
the Doppler peak instantaneous gradient will always be greater than the catheterization peak to peak
The pressure waveform below demonstrates
Mitral stenosis
The pressure waveform below is demonstrating
Tricuspid stenosis
The pressure waveform below represents
Mitral regurgitation
The pressure waveform below represents
Tricuspid regurgitation
The pressure waveform below is demonstrating
Aortic stenosis
The pressure waveform below is demonstrating
Pulmonic stenosis
The pressure waveform below demonstrates
Aortic regurgitation
The pressure waveform below demonstrates
Pulmonic regurgitation
which of the following chest x-rays projections is useful in evaluating the heart?
- posterior-anterior
- lateral
- anterior oblique
- right lateral
posterior-anterior
cardiomegaly on chest x-rays is associated with all of the following except:
-pericardial. effusion
-ventricular hypertrophy/dilatation
-acute myocardial infarction
-dilated cardiomyopathy
acute myocardial infarction
all of the following are types of increased pulmonary vascularity as seen on chest x-ray except:
-pulmonary artery hypertension
-shunt vascularity
-pulmonary venous hypertensio
-pulmonary embolism
pulmonary embolism
the chest x-ray findings for coronary artery disease is/are:
-left atrial enlargement
-right ventricular enlargement
-figure 3 sign
-nonspecific
nonspecific
A left ventricular bulge on chest x-ray may indicate the presence of a left ventricular
aneurysm
all of the following chambers may appear enlarged on a chest x-ray of a patient with mitral valve stenosis except:
-left atrium
-left ventricle
-right ventricle
-right atrium
left ventricle
Which of the following cardiac chambers would most likely appear enlarged on chest x-ray in a patient with mitral regurgitation?
-left atrium, right atrium,
-left ventricle, right ventricle
-left atrium, left ventricle
-right atrium, right ventricle
left atrium, left ventricle
The most likely chest x-ray finding in a patient with significant chronic aortic regurgitation is enlargement of the
left ventricle
The chest x-ray finding of left ventricular enlargement due to concentric left ventricular hypertrophy, blunting of the cardiac apex and post stenotic dilatation of the ascending aorta most likely indicates
valvular aortic stenosis
All of the following are possible chest x-ray findings for atrial septal. defect except
-right ventricular enlargement
-main pulmonary artery enlargement
-figure 3 sign
-increased pulmonary vascularity
figure 3 sign
all of the following are possible chest. x ray findings for patent ductus arteriosus except:
-increased pulmonary vascularity
-left atrial enlargement
-left ventricular enlargement
-rib notching
rib notching
right ventricular enlargement due to right ventricular hypertrophy and post stenotic. dilatation of the main pulmonary artery on chest X-ray is most likely associated with
valvular pulmonic stenosis
all of the following chest x-ray findings are associated with coarctation of. the aorta except:
-left ventricular enlargement
-right ventricular enlargement
-figure three sign
-rib notching
right ventricular enlargement
which of the following is associated with. an increase of the cardiac silhouette as seen on chest x-ray
pericardial effusion
all of the following may be diagnosed by chest x-ray except :
-aortic dilatation/aortic. dissection
-pleural effusion
-myocardial ischemia
-calcified pericardium
myocardial ischemia
which of the following nuclear cardiology isotopes would be best to use to rule out a decrease in myocardial perfusion?
-Thallium-201
-technetium-99
-pyrophosphate
-Albunex
thallium-201
which of the following nuclear cardiology isotopes would be best to use to evaluate ejection fraction?
-Thallium-201
-technetium-99
-Cardiolyte
-Albunex
technetium-99
which of the following nuclear cardiology isotopes would be best to use to image infarcted myocardium?
-Thallium-201
-technetium-99
-Cardiolyte
-pyrophosphate
pyrophosphate
which of the following noninvasive examinations is also called cold spot scanning?
-myocardial perfusion
-infarct avid imaging
-radionuclide angiography
-MUGA
myocardial perfusion
Which of the f following nuclear studies is also referred to as hot spot scanning?
-myocardial perfusion
-infarct avid imaging
-radionuclide angiography
-MUGA
infarct avid imaging
EKG
Sinus arrhythmia
