Cardiovascular PD Flashcards
aortic stenosis
harsh systolic crescendo-decrescendo aortic area (R 2nd intercostal) radiates to carotid area
severe findings: late-peaking murmur, soft/lost S2, pulsus parvus et tardus (weak/small carotid upstroke)
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 diastolic heard best on expiration at apex L lateral decubitus
time to opening snap=associated w/ severity
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, some murmurs, friction rubs.
bell
Low Pitch.
SD3, S4, some 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 TO VENTRICLE - HF
S4 sound
Low pitched sound in late diastole.
Precedes S1.
Aorta contracting forcefully against a STIFF 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
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)
systolic murmurs
aortic stenosis mitral regurgitation pulmonic stenosis tricuspid regurgitation hypertrophic cardiomyopathy ventricular septal defect
diastolic murmurs
aortic regurg
mitral stenosis
pulmonic regurg
tricuspid stenosis
continuous
PDA
holosystolic
mitral regurg
tricuspid regurg
VSD
how to differentiate aortic stenosis and HCM
valsalva inc HCM, dec aortic stenosis
VSD
holosystolic (sim to MR)
holosystolic murmurs
mitral regurg
tricuspid regurgitation
VSD
young otherwise healthy female
MVP
Marfan’s
MVP
immigrant
pregnant
mitral stenosis
IV drug abuser
tricuspid regurg
Turner syndrome or aortic coarctation
bicuspid AV
early stenosis
aortic regurgitation
how to differentiate systolic click and opening snal
mitral valve disorders
- proCLICK
- stenoSNAP
PDA murmur
continuous, machine-like
small VSD murmur
loud, holosystolic
left lower sternal border
loud S2
pulmonary HTN
continuous murmur over back between scapula
coarctation of aorta
fixed split S2
ASD
inc blood In R heart –> delayed closure of pulmonary valve
ASD murmur
systolic murmur heard best over the left upper systolic border
poss RV heave
systolic ejection click
MR (bicuspid aortic valve)
electrical wave that repetitively goes around a physical structure in the atrium (e.g. tricuspid valve annulus)
atrial flutter
large “V-Waves” on a pulmonary artery wedge tracing
severe mitral regurgitation
inspiration
mechanism/effect on heart sounds
inc VR to RA
inc R heart sounds
hand grip (mechanism/effect on heart sounds)
inc afterload
inc of MR, AR, VSD
dec HCM, AS
later onset of MVP click/murmur
valsalva or standing up
mechanism/effect on heart sounds
dec preload
dec most murmurs (AS)
inc HCM
earlier onset of MCP click/murmur
squatting or raising legs
mechanism/effect on heart sounds
inc VR, inc preload, inc afterload
dec HCM
inc AS, MR, VSD
later onset of MVP click/murmur
