Cardiovascular PD Flashcards
aortic stenosis
harsh systolic crescendo-decrescendo aortic area (R 2nd intercostal) radiates to carotid area
aortic regurgitation
blowing diastolic decrescendo Erb's point heard best leaning forward
mitral regurgitation
harsh systolic holosystolic (plateau) heard at apex (mitral) radiates to left axilla
mitral stenosis
loud S1 w opening snap rumbling mid diastolic heard best on expiration at apex L lateral decubitus
pericardial friction rub
High frequency scratching noise.
Mainly in L precordial area.
Exacerbated by inspiration, leaning forward, left lateral decubitus position.
Inflammation of pericardium causes friction in walls which generates noise
pulse amplitude scale
0: no palpable pulse
1+: diminished (weak, thready)
2+: normal, brisk, expected
3+: bounding, hyperdynamic
dicrotic notch forms from
aortic valve closing
a wave
increase in R atrial pressure produced by R atrial contraction
less robust (unless pathologic)
c wave
start of systole.
Tricuspid closes and bulges into atrium.
x descent
decrease in R atrial pressure.
Caused by R atrial relaxation
v wave
Increase in R atrial pressure.
Due to filling with blood from IVC during ventricular systole (tricuspid closed)
y descent
Decrease in R atrial pressure due to opening of tricuspid valve at end of ventricular systole
diaphragm
High Pitched.
S1, S2, regurgitant murmurs, friction rubs.
bell
Low Pitch.
SD3, S4, AV stenosis murmurs
S1 sound
start of ventricular contraction.
Closure of AV valves (T, M)
S2 sound
End of ventricular contraction.
Closure of semilunar valves (aortic, pulmonic)
S3 sound
Low pitched sound in early diastole.
Follows S2.
RAPID FILLING OF DILATED VENTRICLE causing AV apparatus to tense and vibrate.
May be normal in young adults.
VOLUME OVERLOAD
- regurgitant valvular lesion
- CHF
S4 sound
Low pitched sound in late diastole.
Precedes S1.
Aorta contracting forcefully against a NONCOMPLIANT, STIFF VENTRICLE
may be due to PRESSURE OVERLOAD on a ventricle
intensity scale of cardiac murmurs
1: very faint, may not be heard in all positions
2: quiet but recognizable
3: moderately loud
4: loud murmur with palpable thrill
5: loud with palpable thrill, heard w only rim of stethoscope on chest
6: very loud, heard with stethoscope off chest
hepatojugular reflex
For volume overload.
Pressure on RUQ –> blood flows up jugular vein
resonant percussion sound
Air.
Ex: over lung
dull percussion sound
solid
ex: over heart
how can you enhance a murmur?
have patient do valsalva maneuver
Symptoms of cardiac disease (ask these questions to anyone complaining of chest pain)
Palpitations. Dyspneas (SOB: resting or exertional). Syncope. Fatigue. Dependent edema. Cyanosis.
Korotkoff Sounds
I: 2 consectutive beats (systolic BP) II: soft, longer sounds III: loud, crisp sounds IV: begins to muffle V: sounds disappear (diastolic BP)
distension of external jugular vein
HF
obstruction of SVC
enlarged supraclavicular nodes
increased intrathoracic pressure
positive hepatojugular reflux
elevated JVP for 10 or more seconds (after pushing on RUQ of abdomen to temporarily increase venous return to the R side of the heart)
sternal angle is always ___ above RA
sternal angle is always 5 cm above RA
estimating CVP
add 5 to jugular venous pressure (cm H2O)
normal CVP
7-8 cm H2O
normal BP
100-120/60-80
Point of maximal impulse
Felt at 5th intercostal space along midclavicular line (apex of heart)
(movement of L ventricle against the chest wall)
easiest felt in lateral decubitus position
size: less than 2.5cm
brisk and tapping amplitude
felt immediately after S1, should NOT continue to S2
physiological splitting of S2
closing of aortic valve usually precedes closing of pulmonic valve
with inspiration, gap is widened
Ejection Click
early systole due to the opening of a defective semilunar valve
Midsystolic Click
Heard during mid-systole, commonly due to prolapse of a mitral or tricuspid valve
mitral opening snap of mitral stenosis
occurs after A2
tricuspid opening snap of tricuspid stenosis
occurs after P2
