CV and PV Pitcher Flashcards
What do you note on characterization of peripheral pulses
how they feel and if you can feel them
how symmetric they are
What is a thrill and what does it feel like
valve problem, feels like a virbation
what position accentuates sounds best
supine, 30 degrees
leaning forward accentuates what pathology
aortic murmurs and pericarditis
left lateral decubitus accentuates what pathology
mitral murmurs
what causes a bruit
tubulance in artery outside heart itself
use bell
what is grading for murmurs
1 very faint
2 quiet, easily heard in quiet rrom
3 moderately loud
4 loud palpable thrill
5 very loud thrill and with stethoscope barely off chest
6 very loud, thrill, stethoscope off the chest
What can cause a split S1
normal variant or abnormal from RBBB or PVC
if S1 and S2 are both split what could it be
RBBB and PVC
what is a wide or fixed S2 and what could cause it
no respiratory variation
delayed pulmonic closure from stenosis or RBBB
What can cause S3
occurs at transition of rapid to slow ventricular filling
LV myocardial damage, CHF, MI (dilated CM)
sudden limitation of normal ventricular relaxation during filling stage in diastole
What are ways of early detection of dilated myocardium
BNP, pro-BNP doppler echo
Where is S4 best heard
apex in L lateral decubitus
what is going on in heart that causes S4
vibration of LV from atriak kick
What can cause S4 pathologically
thickening of ventircular walls from a higher work load, and some stiffening
HTN, aortic valve stenosis, pulmonic valve stenosis, hypertrophic CM
What is an ejection click
sound occurring at moment of maximal P with sudden tensing of a valve root
when do you hear an aortic ejection click
early systolic
at onset of L ventricular ejection, aortic root suddenly stretched
what can cause an aortic ejection click
dilated aneurysm of aortic root, coarctation of aorta, HTN
aortic valve stenosis and aortic regurg
(anything that over works root of aortic valve)
what is character of aortic stenosis murmur
systolic crescendo-decrescendo pattern, medium pitch, harsh
transmits sound to carotid aa
What are Sx of aortic stenosis
dyspnea on exertion, angina, syncope
What pathologies can lead to aortic stenosis
rheumatic disease, congenital bicuspid valve, calcification of valve
What is an Austin Flint murmur
early diasolit high pitch blowing decresendo murmur from high pressure back flow through narrow orifice. aortic regurg
what pathologies are behind aortic regurg
rheumatic disease, congenital bicuspid valve, endocarditis (strep, Staph, haemophilus)
what is a pulmonic ejection click
sudden root tensioning, very early systole
what can cause pulmonic ejection click
pulmonary HTN, aneurysm dilating the root
pulmonary valve stenosis or regurg can alter stress on the root of the valve
What is sound of pulmonic stenosis
systolic crescendo decrescendo murmur
most asymptomatic
what are Sx of pulmonic stenosis
exertional dyspnea, chest pain, syncope
What extra heart sound is heard with pulmonic stenosis
S4
What is a graham steell murmur
pulmonary regurg
soft diastolic decrescendo
what can cause pulmonary regurg
pulmonary HTN: mitral stenosis, LV failure, obstructive sleep apnea, emphysema, idiopathic pulmonary HTN
what is sound of tricuspid stenosis
diastolid low pitch rumble best hera with bell
openeing snap over tricuspid area
accentuated by inspiration
What can cause tricuspid stenosis
rheumatic valvular disease, congenital heart disease, carcinoid tumor
impeding R ventricular filling increases central venous P
What is sound of tricuspid regurg
early holosytolic at LSB
diaphragm
high pitch blowing
accentuated with inspiration
what can cause tircuspid regurg
ebstein congenital anomaly, thin valve predisposing to failure
What is sound of mitral valve stenosis
opening snap in diastole
what valve in heart is most often affected by Rheumatic heart disease
mitral
What is sound of mitral valve prolapse
click and murmur
louder with valsalva and standing
What is mitral valve prolapse assoc with
anxiety or panic attacks
dyspnea, non-anginal chest pain, palpitations, syncope
What is sound of mitral valve regurg
holosystolic (pansystolic) murmur
loud high pitch, best at apex, can radiate to left axilla
What are Sx of HOCM
exercise induced dyspnea, angina, syncope
Where is a systolic ejection murmur heard best in HOCM
LSB and apex
what is lab test fo choice for HOCM
restin echo
What type of murmur do you hear with PDA
pansystolic and most of diastole
may have thrill
often machine like in quality and can radiate to back
majority innocent murmurs are from what
benign pulmonary branch stenosis
bruit in thyroid, what do you suspect
graves, increased blood flow
What can cause pericarditis
infectino of pericardium, MI, metastasis to pericardium, post cardiac surgery
assoc with recent respiratory viral infection
What is best test to Dx pericarditis
echo
What is sound from constrictive pericarditis
pericardial knock, heard widely over precordium
What are the 3 phases of pericardial rub
atrial systole, ventricular systole, ventricular diastole
triphasic
Wha tis TTE and TEE
transthoracic endoscopy
transesophageal endoscopy
what are risk factors for murmurs
smoking, HLD, HTN
What medications are used for murmurs
Bblockers
ACEI
ARB
peripheral vasodialtors
what are surgeries for murmurs
valve replacement or repair,
stent
endarterectomy
What are Sx of intermittent claudication
pain, tension and weakness of a limb when walking which intesifies with continued walking, resolving only when activity stops
What are risk facotrs for intermitten claudication
aortic stenosis
anemia
polycythemia
atherosclerosis
What do you find on PE with intermitten claudication
poor pedal pulses, ulcerations, palor, cool, shiny and hairless skin, bruit may be heard
How do we Dx intermittent claudication
History and PE
segmental BP
ABI <0.9
contrast agiography
What is tx for intermittent claudication
meticulous foot care, smoking cessation
lower lipids, walk
cilostazole (pletal), phentoxifylline
revascularization procedures
the lower the ABI index gets tells you what about severity of PAD
lower = worse PAD
What are risk factors for carotid artery stenosis
older male
HTN, DM
smoking, HLD, heart disease
What do you use to Dx carotid a stenosis
bruit, dopper ultrasound
MRA and angiogrpahy if dopler and ultrasound are +
Tx for carotid a stenosis
endarterectomy if >69% occluded elective endarterectomy >50% stenosis stents risk factor management aspirin prophylaxis
What is a pseudoaneurysm
dilation or hematoma that may or may not involve layers of vessel wall which is contained and does not dissect
When do aneurysms become painful
expanding or leaky
What type valve defect can aortic ascending aneurysm cause
aoritc regurg
Where are 75% AAA located
distal to renal aa
What is Dx tool for AAA
if bruit with bell then US or CT angiography
Contrast CT if not emergent
What is Tx for aneurysm
elective graft
betablockers to reduce shear stress unless hypotensive already
What is raynaud phenomenon assoc with
scleroderma, lupus, peripheral neuritis, polyarteritis
What other problems is raynaud disease assoc with
none
What is Tx raynaud
avoid or stop smoking avoid cold temperatures aboid Bblockers manage stressors CCB
What are large vessel vasculitis
takayasu aortitis: aorta and major branches “pulseless disease”
what are the medium vessel vasculitis
polyarteritis nodosa
wegeners granulomatosis
what are the small vessel vasculitis
HSP: palpable purpura abdomen and legs, children more than adults
assoc with IC
Sx polyarteris nodosa
fatigue, weakness, fever, wt loss, HA, abdominal pain
elevated WBC neutrophils
how do you confirm Dx polyarteritis nodosa
biopsy
Tx for polyarteritis nodosa
steroids and immune modulating agents
