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Cardiac- Cecil > Chapter 4- Evaluation of the patient with cardiovascular disease > Flashcards

Chapter 4- Evaluation of the patient with cardiovascular disease Flashcards

1
Q

What are the cardiovascular causes of chest pain?

A

Angina
Myocardial infarction
Pericardiitis
Aortic dissection

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2
Q

What is the location of angina?

A

Location- Retrosternal region; radiates to or occasionally isolated to neck, jaws, shoulders, arms (usually left) or epigastrum

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3
Q

What is the quality of angina?

A

Quality- Pressure squeezing, tightness, heaviness, burning, indigestion

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4
Q

What is the duration of angina?

A

Duration <2-10 mins

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5
Q

What are the aggravating or alleviating factors of angina?

A

Aggravating or alleviating factor- precipitated by exertion, cold weather, or emotional stress; relieved by rest or nitroglycerin; variant (prinzmetal) angina may be unrelated to exertion, often early in the morning

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6
Q

What are the associated sx and signs with angina?

A

Associated symptoms or signs- dyspnea; S3, S4, or murmur of papillary dysfunction during pain

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7
Q

What is the location of myocardial infarction?

A

Same as angina

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8
Q

What is the quality of myocardial infarction?

A

Same as angina although more severe

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9
Q

What is the duration of myocardial infarction?

A

Variable; usually longer than 30 mins

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10
Q

What are the aggravating or alleviating factors of myocardial infarction?

A

Unrelieved by rest of nitroglycerin

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11
Q

What are the associated sx and signs of myocardial infarction?

A

Dyspnea, nausea, vomiting, weakness, diaphoresis

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12
Q

What is the location of pericarditis?

A

Left of the sternum; may radiate to neck or left shoulder, often more localized than pain of myocardial ischemia

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13
Q

What is the quality of pericarditis?

A

Sharb, stabbing, knifelike

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14
Q

What is the duration of pericarditis?

A

Last many hours to days; may wax and wane

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15
Q

What are the aggravating or alleviating factors of pericarditis?

A

Aggravated by deep breathing, rotating chest, or supine position; relieved by sitting up and leaning forward

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16
Q

What are the associated sx and signs of pericarditis?

A

Pericardial friction rub

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17
Q

What is the location of aortic dissection?

A

Anterior chest; may radiate to back, interscapular region

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18
Q

What is the quality of aortic dissection?

A

Excruciating, tearing, knifelike

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19
Q

What is the duration of aortic dissection?

A

Sudden onset, unrelenting

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20
Q

What are he aggravating or alleviating factors of aortic dissection?

A

Usually occurs in setting of hypertension or predisposition, such as marfans syndrome

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21
Q

What are the associated sx or signs of aortic dissection?

A

Murmur of aortic insufficiency; pulse of blood pressure asymmetry; neurological deficeit

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22
Q

What are the noncardiac causes of chest pain?

A 
PE (chest pain is often not present)
Pulmonary HTN
Pneumonia w/ pleurisy
Spontaneous pneumothorax
Musculoskeletal disorders
Herpes zoster
Esophageal reflux
Peptic ulcer
Gallbladder disease
Anxiety states
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23
Q

What is the location of pulmonary embolism?

A

Substernal or over region of pulmonary infarction

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24
Q

What is the quality of pulmonary embolism?

A

Pleuritic (with pulmonary infarction) or angina-like

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25
Q

What is the duration of pulmonary embolism?

A

Sudden onset (minutes to hours)

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26
Q

What are the aggravating or alleviating factors of pulmonary embolism?

A

Aggravated by deep breathing

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27
Q

What are the associated sx and signs of pulmonary embolism?

A

Dyspnea, tachypnea, tachycardia; hypotension, signs of acute right ventricular heart failure, and pulmonary HTN with large emboli; pleural rub; hemoptysis with pulmonary infarction

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28
Q

What is the location of pulmonary hypertension?

A

Substernal

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29
Q

What is the quality of pulmonary hypertension?

A

Pressure oppressive

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30
Q

What is the duration of pulmonary hypertension?

A

-

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31
Q

What are the aggravating or alleviating factors of pulmonary hypertension?

A

Aggravated by effort

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32
Q

What are the associated sx or signs of pulmonary hypertension?

A

Pain usually associated with dyspnea, signs of pulmonary HTN

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33
Q

What is the location of pneumonia with pleurisy?

A

Located over involved area

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34
Q

What is the quality of pneumonia with pleurisy?

A

Pleurtic

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35
Q

What is the duration of pneumonia with pleurisy?

A

-

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36
Q

What are the aggravating or alleviating factors of pneumonia with pleurisy?

A

Aggravated by breathing

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37
Q

What are the associated sx and signs of pneumonia with pleurisy?

A

Dyspnea, cough, fever, bronchial breath sounds, rhonchi egophony, dullness to percussion, occasional pleural rub

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38
Q

What is the location of spontaneous pneumothorax?

A

Unilateral

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39
Q

What is the quality of spontaneous pneumothorax?

A

Sharp, well localized

40
Q

What is the duration of spontaneous pneumothorax?

A

Sudden onset; last many hours

41
Q

What are the aggravating or alleviating factors of spontaneous pneumothorax?

A

Aggravated by breathing

42
Q

What are the associated sx and signs of spontaneous pneumothorax?

A

Dyspnea; hyeperressonace, and decreased breath and voice sounds over involved lungs

43
Q

What is the location of musculoskeletal disorders?

A

Variable

44
Q

What is the quality of musculoskeletal disorders?

A

Aching, well localized

45
Q

What is the duration of musculoskeletal disorders?

A

Variable

46
Q

What are the aggravating or alleviating factors of musculoskeletal disorders?

A

Aggravated by movement; hx of exertion or injury

47
Q

What are associated sx and signs of musculoskeletal disorders?

A

Tender to palpation of with light pressure

48
Q

What is the location of herpes zoster?

A

Dermatomal distribution

49
Q

What is the quality of herpes zoster?

A

Sharp, burning

50
Q

What is the duration of herpes zoster?

A

Prolonged

51
Q

What are the aggravating or alleviating factors of herpes zoster?

A

None

52
Q

What are the associated sx and signs of herpes zoster?

A

Vesicular rash appears in area of discomfort

53
Q

What is the location of esophageal reflux?

A

Substernal or epigastric; may radiate to neck

54
Q

What is the quality of esophageal reflux?

A

Burning, visceral discomfort

55
Q

What is the duration of esophageal reflux?

A

10-60 minutes

56
Q

What is the aggravating or alleviating factors of esophageal reflux?

A

Aggravated by large meal, recumbency; relief with antacid

57
Q

What are the associated sx and signs of esophageal reflux?

A

Water brash

58
Q

What is the location of peptic ulcer?

A

Epigastric

Substernal

59
Q

What is the quality of peptic ulcer?

A

Visceral, burning, aching

60
Q

What is the duration of peptic ulcer?

A

Prolonged

61
Q

What are the aggravating or alleviating factors of peptic ulcer?

A

Relief with food, antacid

62
Q

What is the location of gallbladder disease?

A

Right upper quadrant; epigastric

63
Q

What is the quality of gallbladder disease?

A

Visceral

64
Q

What is the duration of gallbladder disease?

A

Prolonged

65
Q

What are the aggravating or alleviating factors of gallbladder disease?

A

Spontaneous or following meals

66
Q

What are the associated sx or signs of gallbladder disease?

A

Right upper quadrant tenderness may be present

67
Q

What is the location of anxiety states?

A

Often localized over precordium

68
Q

What is the quality of anxiety states?

A

Variable location often moves from place to place

69
Q

What is the duration of anxiety states?

A

Varies; often fleeting

70
Q

What are the aggravating or alleviating factors of anxiety states?

A

Situational

71
Q

What are the associated sx and signs of anxiety states?

A

Sighing respiration; often chest wall tenderness

72
Q

What is the class I classification of functional status?

A

Uncompromised

Ordinary activity does not cause symptoms, Sx occur only with strenuous or prolonged activity

73
Q

What is the class II classification of functional status?

A

Slightly compromised

Ordinary physical activity results in symptoms; no sx at rest

74
Q

What is the class III classification of functional status?

A

Moderately compromised

Less than ordinary activity results in sx; no sx at rest

75
Q

What is the class IV classification of functional status?

A

Severely compromised

Any activity results in sx, sx may be present at rest

76
Q

What are the effects of respiration on physiology and ausculatory events?

A

Increase venous return with inspiration

Increase heart murmurs and gallops with inspiration; splitting of S2

77
Q

What are the effects of valsalva (initial high BP, phase I, followed by lower BP, phase II) on physiology and ausculatory events?

A

Decreased BP, venous return, and LV size (phase II)

Increased HCM, decreased AS, MR, and MVP click earlier in systole; murmur prolongs

78
Q

What are the effects of standing on physiology and ausculatory events?

A

Increased venous return and LV size

Increased HCM, decreased AS, MR, and MVP click earlier in systole; murmur prolongs

79
Q

What are the effects of squatting on physiology and ausculatory events?

A

Increased venous return, systemic vascular resistance, LV size
Increased AS, MR, AI, decreased HCM, and MVP click delayed; murmur shortens

80
Q

What are the effects of isometric exercise (eg handgrip) on physiology and ausculatory events?

A

Increased arterial pressure and CO

Increased gallops, MR, AI, MS, and decreased AS, HCM

81
Q

What are the effects of post PVC or prolonged R-R interval on physiology and ausculatory events?

A

Increased ventricular filling and contractility

Increased AS, little change in MR

82
Q

What are the effects of amyl nitrate on physiology and ausculatory events?

A

Decreased arterial pressure, LV size, and increased CO

Increased HCM, AS, MS, decreased AI, MR, austin flint murmur, and MVP click earlier in systole; murmor prolongs

83
Q

What are the effects of phenylephrine on physiology and ausculatory events?

A

Increase arterial pressure, CO, and decreased LV size

Increased MR, AI, decreased AS, HCM, and MVP click delayed; murmur shortens

84
Q

What are the loud intensity heart sounds?

A

S1- short PR interval, mitral stenosis with pliable valve
A2- systemic hypertension, aortic dilation, coarctation of aorta
P2- pulmonary HTN, and thin chest wall

85
Q

What are the soft intensity heart sounds?

A

S1- Long PR interval, mitral regurgitation, poor left ventricular function, mitral stenosis with rigid valve, and thick chest wall
A2- calcific aortic stenosis, aortic regurgitation
P2- valvular or subvalvular pulmonic stenosis

86
Q

What are the varying intensifying heart sounds?

A

S1- artial fibrillation and heart block

87
Q

What conditions have a single S2?

A

Pulmonic stenosis
Systemic HTN
Coronary artery disease
Any condition that can lead to paradoxical splitting of S2

88
Q

What conditions have a widely split S2 with normal respiratory variation?

A 
Right bundle block branch
Left ventricular pacing
Pulmonic stenosis
Pulmonary embolism
Idiopathic dilation of the pulmonary artery
Mitral regurgitation
Ventricular septal defect
89
Q

What conditions have a fixed split S2?

A

Artial septal defect

Severe right ventricular dysfunction

90
Q

What conditions have paradoxically split S2?

A 
Left bundle branch block
Right ventricular pacing
Angina, MI
Aortic stenosis
Hypertrophic cardiomyopathy
Aortic regurgitation
91
Q

What grade of murmur is a barely audible murmur?

A

Grade 1

92
Q

What grade of murmur is a murmur of median intensity?

A

Grade 2

93
Q

What grade of murmur is a loud murmur with no thrill?

A

Grade 3

94
Q

What grade of murmur is a loud murmur with a thrill?

A

Grade 4

95
Q

What grade of murmur is a very loud murmur; stethoscope must be on the chest to hear it; may be heard posteriorly?

A

Grade 5

96
Q

What grade of murmur is a murmur audible with stethoscope off the chest?

A

Grade 6

Cardiac- Cecil (4 decks)

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