Chapter 9 Cardiology Flashcards
Left ventricular Hypertrophy will have what PMI?
PMI >2.5 cm
Jugular veins
reflect arterial pressure
Elevated JVP
98% specific for increased left ventricular end systolic and diastolic blood pressures
Carotid pulse- brisk
normal
Carotid pulse- delayed
suggests aortic stenosis
Carotid pulse- bounding
suggest cardiac insufficiency
Bruit mumur
Indication of turbulent flow (normally should not hear); could indicate atherosclerosis, CVD
PMI- tapping
normal
PMI- sustained
suggest LV hypertrophy (thickening of heart)
PMI- diffuse
suggests a dilated ventricle from CHF cardiomyopathy
Lateral displacement from cardiac enlargement
CHF, cardiomyopathy, ischemic heart disease
Palpation of heaves/lifts
abnormal ventricular movement
Palpations of thrills/turbulance
may accompany loud, harsh, or rumbling murmurs as in aortic stenoisis, ventricular septal defect, damage heart valve
MR. AS
Mitral Regurgitation (MR): Aortic stenosis (AS) found only in systole.
MS. AR
Mitral Stenosis (MS): Aortic regurgitation (AR); found only in diastole
Mid-systolic murmur
Begins after S1 and stops before S2. Brief gaps are audible between murmur and heart sounds. Typically arise from blood flow across the semilunar valves.
Holosystolic (pansystolic) murmur
Starts with S1 and stops at S2, without a gap between murmur and heart sounds. These murmurs often occur with regurgitant (backflow) across the atrioventricular valves.
Late diastolic (presystolic) murmur
Starts in late diastole and typically continues up to S1.
Early diastolic murmur
Starts after S2, with a discernible gap, and then usua fades into silence before the next S1. These murmurs accompany regurgant flow across incompetent semilunar valves.
Sustained, high amplitude apical impulse
Suggest left ventricular hypertrophy from pressure overload as in hypertension. If displaced laterally consider volume overload
Sustained, low amplitude apical impulse
May result from dilated cardiomyopathy
2nd Left ICS
A palpable S2 suggests increased pressure in the pulmonary artery such as pulmonary hypertension
2nd Right ICS
A pulsation here can suggust a dilated of aneurysmal aorta
Left lateral decubitus postion
This position brings out a left sided S3 & S4 and mitral murmurs, especially mitral stenosis
Lean forward, exhale completely, and stop breathing in expiration
This position brings our aortic mumurs (aortic regurgitation).
Mitral stenosis
Late diastolic crescendo, valve cannot open wide enough and leads to decrease blood flow to body; often occurs w/ Rheumatic fever
Aortic regurgitation
Early diastolic, Descrescendo; leaflets of aortic valve fail to close completely and blood regurgitates from aorta to left ventricle
Aortic stenosis
Midsystolic murmur, crescendo/decrescendo; typically arise from narrowed aortic valve
Mitral regurgitation
Holosystolic murmur; flat; often occurs with backflow across the atrioventricular valves
Mitral Regurgitation- example
Harsh 2/6 medium pitched holosystolic murmur best heart at apex
Aortic Regurgitation- examples
Soft blowing 3/6 decrescendo diastolic murmur heart at lower left sternal border
Coarctation of the Aorta
A pulse in the femoral area or feet will be weaker than pulse in the arms or cartotid. Sometimes pulse may not be felt at all.
Grading of murmurs-1
Very faint, heard only after listener has “tuned in”; may not be heard in all positions
Grading of murmurs-2
Quiet, but heart immediately after placing the stethoscope on the chest
Grading of murmurs-3
Moderately loud
Grading of murmurs-4
Verly loud, with thrill
Grading of murmurs- 5
Very loud with thrill. May be heard when the stethoscope is partly off the chest
Grading of murmurs-6
Very loud with thrill. May be heard when the stethoscope is entirely off the chest
Heart murmurs- Quality
Apply terms like harsh, musical, soft, blowing
Heart murmurs-Pitch
Apply terms like high, medium, or low pitched
S3
Period of rapid ventricular filling as blood flows in early diastole; children/young adults=rapid deceleration of the column of blood against ventricular wall; water faucet; pathological after the age of 40.
S4
Atrial contraction; Immediately preceeds S1; diastole
Cardic Output
SV (stroke volume) X HR (heart rate)
SV
The difference between end-diastolic volume and end-systolic volume; how much blood is pushed out of heart
Ejection fraction
Stroke volume divided by end-diastolic volume; % of how much blood pushed out vs. how much started with
Preload
work imposed on the heart before contraction begins filling
Afterload
the pressure or tension work of the heart (peripheral resistance)
Hypertension s/s
Often none, headache, Target organ damage (nocturia, visual changes, CV complications i.e. MI)
Atrial Fibrillation
Irregularly Irregular
Holosystolic plateau murmur heard at the left 5th intercostal space, midclavicular line.
Mitral Regurgitation
Crescendo-Decrescendo systolic murmur heard at the right second intercostal space, right sternal border
Aortic Stenosis
Crescendo diastolic murmur heard at the left 5th intercostal space, midclavicular line.
Mitral Stenosis
Decrescendo diastolic murmur heard at the right second intercostal space, right sternal border
Aortic Regurgitation
Midsystolic Click
Mitral Valve Prolapse
Between S1 and S2
Systole
Between S2 and S1
Diastole
Systole
Ventricles contract
Diastole
Ventricles relax
Harsh murmurs are typically:
Mitral
Soft, blowing murmurs are typically:
Aortic
Ventricular Septal Defect mimics:
Mitral Regurgitation
Opening Snap
Opening of a stenotic mitral valve
Squatting from a standing position
Increased Mitral and Aortic Regurgitation
Decreased Hypertrophic Cardiomyopathy murmur
Valsalva/Bearing Down
Increased Hypertrophic Cardiomyopathy murmur
S1 is the first heart sound and is produced by:
Closure of the mitral valve
S2 is the second heart sound and is produced by:
Closure of the aortic valve
What type of splitting is always pathological?
Expiratory
Sounds best heard with the diaphragm:
S1, S2, S4, and most murmurs
Sounds best heard with the bell:
S3 and the rumble of mitral stenosis
