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Pt Assess II Final > Chapter 11 - Heart > Flashcards

Chapter 11 - Heart Flashcards

1
Q

Major categories of heart disease

A
  1. Coronary
  2. HTN
  3. Rheumatic
  4. Bacterial endocarditis
  5. Congenital
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2
Q

Which type of heart disease is the MC?

A

Coronary

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3
Q

Why is bacterial endocarditis still a problem?

A

Despite abx, # of cases are increasing d/t IV street drug use

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4
Q

Circulation system consists of a ___ pressure delivery system and a ___ pressure return system

A 
High delivery (left)
Low return (right)
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5
Q

Most of the anterior cardiac surface is the ____ ventricle

A

Right

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6
Q

The RA forms a narrow border from the ___ to ___ ribs to the ___ of the sternum

A

3rd-5th Right

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7
Q

Where is the apex of the heart located?

A

5th ICS at midclavicular line

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8
Q

What is the apical impulse also known as?

A

Point of maximum impulse (PMI)

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9
Q

4 classic auscultatory areas and where they are

A
  1. Aortic = 2ICS-RSB (right sternal border)
  2. Pulmonic = 2ICS-LSB
  3. Tricuspid = LLSB
  4. Mitral = 5ICS-MCL (midclavicular line)
    Also Erb’s point (3rd ICS) - best for aortic/pulmonic
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10
Q

What are the only sounds that should be heard normally?

A

Closing of the valves (S1 and S2)

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11
Q

What does S1 indicate?

A

Closing of the AV valves (lub)

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12
Q

What does S2 indicate?

A

Closing of the semilunar valves (dub)

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13
Q

When can opening of the valves be heard?

A

Only when they are damaged

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14
Q

Define “opening snap” and when it occurs

A

Sound of an AV valve opening when it is stenotic

*Diastole

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15
Q

Define “ejection click” and when it occurs

A

Sound of a SL valve opening when it is stenotic

*Systole

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16
Q

How do the pulmonic and aortic valves open/close in relation to each other?

A

Pulmonic opens first, but closes last

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17
Q

When does isovolumetric contraction occur?

A

Between closure of AV valves and opening of the SL valves

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18
Q

Ejection is defined as:

A

Time between opening and closing of SL valves

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19
Q

Incisura/Dicrotic notch =

A

The point at which ejection is completed and the aortic and left ventricular curves separate

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20
Q

When does isovolumetric relaxation occur?

A

Between closure of SL valves and opening of AV valves

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21
Q

Define S3

A

Third heart sound - end of ventricular filling

*Mainly heard in children/young adults

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22
Q

What does an S3 in 30+ yos indicate?

A

Ventricular volume overload (could be from regurg/CHF)

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23
Q

Define S4

A

4th heart sound - atrial contraction/additional ventricular filling
*Normal in children/young adults

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24
Q

What does an S4 in 30+ yos indicate?

A

Noncompliant/stiff ventricle (from pressure overload/CAD)

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25
Q

What are gallop sounds?

A

S3 and S4

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26
Q

The ___ heart sound is loudest at the cardiac apex

A

S1

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27
Q

The ___ heart sound is loudest at the base

A

S2

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28
Q

Splitting of the first heart sound may be heard in the ___ area

A

Tricuspid

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29
Q

What is sinus arrhythmia?

A

Normal finding!

Reflex tachycardia during inspiration that compensates for decreased LV volume

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30
Q

Anacrotic pulse and what causes it?

A

Small, slow rising, delayed pulse with a notch or shoulder on the ascending limb
*Aortic stenosis

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31
Q

Pulse pressure =

A

Difference in systolic and diastolic pressures

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32
Q

Systolic blood pressure is ____ in the legs compared to the arms

A

Greater in the legs (Poiseuille’s law)

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33
Q

MC cause of R heart failure is:

A

Left heart failure

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34
Q

Components of jugular venous pulse:

A 
a wave
x descent
c wave
v wave
y descent
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35
Q

Define “a wave”

A
  • Part of jugular venous pulse

- Signifies right atrial contraction

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36
Q

Define “x descent”

A
  • Part of jugular venous pulse

- Atrial relaxation

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37
Q

Define “c wave”

A
  • Part of jugular venous pulse

- Tricuspid valve closure (RV contraction)

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38
Q

Define “v wave”

A
  • Part of jugular venous pulse

- Increase in RA pressure due to filling

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39
Q

Define “y descent”

A
  • Part of jugular venous pulse

- Drop in RA pressure due to opening of tricuspid valve

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40
Q

What does a normal jugular venous pulse wave show?

A

Only a and v waves

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41
Q

What is the true symptom of coronary heart disease?

A

Angina pectoris

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42
Q

How is angina caused?

A
  • Hypoxia of myocardium

- Imbalance between supply and demand

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43
Q

Why does PND occur?

A

Supine position increases intrathoracic blood volume and a weakened heart may be unable to handle this

44
Q

What symptom is often associated with PND?

A

Orthopnea (need more pillows to sleep, sitting up more)

45
Q

What is trepopnea?

A

Rare form of positional dyspnea

Dyspnea occurs while lying on R or L side

46
Q

Define syncope

A

Transient loss of consciousness from inadequate cerebral perfusion

47
Q

What is the MC type of fainting?

A

Vasovagal syncope

48
Q

Carotid sinus syncope

A

A/w a hypersensitive carotid sinus
MC in older adult population
Tight shirt collar or turning the neck causes it

49
Q

What is the MC heart-related cause of hemoptysis?

A

Mitral valve stenosis

50
Q

Differential cyanosis

A

Cyanosis only in lower extremities (Related to R-L shunt)

51
Q

How should the patient be positioned for PE of the heart?

A
  • Supine with examiner on the right side of the bed

- HOB may be elevated slightly

52
Q

Xanthoma

A
  • Stony-hard, slightly yellow masses
  • Found on extensor tendons and fingers
  • Pathognomonic for familial hypercholesterolemia
53
Q

Primary biliary cirrhosis

A
  • Rare progressive and often fatal liver disease
  • Mostly women
  • Pruritus is common symptom
  • Xanthomata develop in 15-20% pts
  • LDL can be as high as 1000-1500 mg/dL
  • Antimitochondrial antibody is present in 90%
54
Q

Eruptive xanthomata

A
  • Chest, butt, abdomen, back, face, arms
  • Seen in familial disturbances of fat metabolism (HLD types I-IV)
  • Happen as a result of high TG levels
55
Q

Erythema marginatum in a febrile pt is indicative of:

A

Acute rheumatic fever

Reddened areas that are disc shaped with raised edges

56
Q

Osler’s nodes

A
  • Painful lesions that occur in tufts of fingers and toes

- Pts with infective endocarditis

57
Q

Splinter hemorrhages

A
  • Small reddish brown lines in nail bed

- A/w infective endocarditis

58
Q

What is infective endocarditis a/w?

A

Osler’s nodes
Splinter hemorrhages
IV street drug use
Palatal petechiae

59
Q

Lichtstein’s sign

A

An oblique crease in ear lobe (often bilaterally)

Pts 50+ yo with significant CAD

60
Q

Xanthelasma

A

Yellowish plaques on the eyelids

*Less specific than the xanthoma

61
Q

Arcus seen in patients eyes less than 40 yo could indicate:

A

Hypercholesterolemia

62
Q

What is often seen in the eyes of Marfan’s syndrome patients with aortic regurg?

A

Displacement of lens

63
Q

What is commonly seen in the eyes of someone with infective endocarditis?

A

Conjunctival hemorrhage

64
Q

Hypertelorism and what is it often a/w?

A
  • Widely set eyes

- A/w congenital heart disease (esp. pulmonic and supravalvular aortic stenosis)

65
Q

Webbing is seen in what patients?

A

Turner’s syndrome

Noonan’s syndrome

66
Q

What heart problem may Turner’s syndrome patients have?

A

Coarctation of the aorta

67
Q

What heart problem may Noonan’s syndrome patients have?

A

Pulmonic stenosis

68
Q

Korotkoff sounds

A
  • Heard when assessing BP
  • Low-pitched sounds originating in the vessel
  • Related to turbulence produced by partially occluding an artery with the cuff
69
Q

BP should be recorded to the nearest ___ mm Hg

A

5 mm Hg

70
Q

Masked HTN

A

Normal BPs in a medical facility, but actually have much higher BPs throughout the day
*Opposite of white coat HTN and more serious

71
Q

How to test for supravalvular aortic stenosis?

A
  • Take BP in both arms

- BP will differ between arms

72
Q

How to test for coarctation of aorta?

A
  • Take BP in arms and then legs

- If legs BP is lower than suspect COA

73
Q

How to test for cardiac tamponade?

A
  • If low BP and rapid/feeble pulse, necessary to r/o

- Marked paradoxical pulse (exaggerated fall in systolic pressure during normal inspiration) could indicate tamponade

74
Q

Normal pulsus paradoxus

A

Approx 5 mm Hg fall in systolic BP during inspiration

75
Q

Waterhammer (Corrigan’s) pulse and what causes it?

A
  • Rapid and sudden systolic expansion

- Aortic regurge

76
Q

Bisferiens pulse and what causes it?

A
  • Double peaked pulse with a midsystolic dip

- Aortic regurge

77
Q

Alternans pulse and what causes it?

A
  • Alternating amplitude of pulse pressure

- Congestive heart failure

78
Q

How is the jugular venous pulse evaluated?

A

ONLY ON THE RIGHT SIDE!

Straighter vessel than on the left

79
Q

Hepatojugular reflex

A

Applying pressure over liver allows assessment of RV function
*Pts with R heart failure show further distension of neck veins

80
Q

Where is percussion of the heart performed?

A

3rd-5th ICS from left anterior axillary line to right

*Dullness = heart

81
Q

How to palpate PMI?

A
  • Patient sitting
  • Examiner on right side of bed
  • 5th ICS-MCL
82
Q

What is a RV rock and what does it suggest?

A
  • Sustained L parasternal impulse a/w lateral retraction

- Suggests large RV

83
Q

Heart auscultation with the bell of stethoscope allows you to hear which sounds?

A

LOW pitched sounds (press lightly)

-Gallop rhythms, murmur of AV stenosis

84
Q

Heart auscultation with the diaphragm of stethoscope allows you to hear which sounds?

A

HIGH pitched sounds (press firmly)

-Valve closure, systolic events, regurge murmurs

85
Q

Which areas should be listened for S3 and S4 sounds?

A
  • Apex
  • LLSB
  • With the BELL
86
Q

How should you auscultate for mitral stenosis murmur?

A
  • Patient turned onto L side

- Listen at apex with BELL (low pitch)

87
Q

How should you auscultate for aortic regurg?

A
  • Patient sits up and leans forward
  • Exhale and hold breath
  • Listen w/DIAPHRAGM 2nd and 3rd ICS on both sides
88
Q

Most murmurs or sounds originating in the R side of the heart are accentuated with ____

A

Inspiration

89
Q

Holosystolic/pansystolic murmurs

A

Occur throughtout systole

90
Q

Grading of murmur intensity

A 
I = lowest, often not heard by inexperienced listeners
II = low
III = medium w/o a thrill
IV = medium w/ a thrill
V = loudest; a/w a thrill
VI = loudest, audible w/o stethoscope, a/w thrill
91
Q

Pericardial rub components =

A 
1 systolic (during ejection)
2 diastolic (during rapid filling and atrial contraction)
92
Q

Pericardial rubs are best heard how?

A

With pt sitting while holding breath in expiration

93
Q

Quantification of pitting edema

A 
1+ = 2 mm in depth, disappears rapidly
2+ = 4 mm in depth, disappears 10-15 sec
3+ = 6 mm in depth, may last more than 1 minute
4+ = 8+ mm, may last 2-5 mins
94
Q

How should edema be evaluated in patients who are bedridden?

A

Dependent area will most likely be the sacrum not the shins

95
Q

Arc of coaptation

A
  • Angle through which the AV valve closes

- Wider arc = louder S1

96
Q

Longer PR interval = ____ S1

A

Softer

97
Q

Why is S1 softer than normal in very obese or COPD patients?

A

Heart is “further” away so S1 is softer

98
Q

The distance the heart is from the chest affects which heart sound?

A

S1

99
Q

Any condition that increases systolic pressure increases the intensity of which heart sound?

A

S2

100
Q

What causes wide splitting of S2?

A
  • Delayed RV systole

- Shortened LV systole

101
Q

What causes paradoxical splitting of S2?

A

Delayed LV emptying (delayed closure of aortic valve)

102
Q

Fixed splitting of S2 indicates?

A

Atrial septal defect

103
Q

Midsystolic clicks

A

NOT ejection clicks (early systole)

MC condition a/w midsystolic clicks = prolapse of mitral/tricuspid valves

104
Q

Blowing murmurs

A

Large gradients w/variable flow volumes

105
Q

Rumbling murmurs

A

Small gradients that depend on flow

106
Q

Harsh murmurs

A

Large gradients and high flow

107
Q

Ejection murmurs

A
  • Turbulence across a SL valve during systole
  • Diamond shaped and crescendo-decrescendo
  • Ejection click may precede the murmur

Pt Assess II Final (17 decks)

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