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CV and PV system Flashcards

1
Q

What do you monitor when measuring peripheral pulses?

A

How they feel. If you can feel them, are they symmetric?

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2
Q

Heave

A

amplitude is elevated upon palpation

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3
Q

Thrill

A

Feels like a vibration and is from a valve problem

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4
Q

What does the left lateral decubitus accentuate?

A

Mitral murmurs

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5
Q

What does valsalva accentuate?

A

Aortic murmurs and pericarditis

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6
Q

what is a bruit

A

Noise from turbulence within an artery outside the heart itself

  • Typically lower pitch and softer
  • Usually best heard with the bell
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7
Q

grading murmurs

A

1/6: very faint
2/6: quiet, but can easily be heard if in quiet room
3/6: moderately loud

4/6: loud, with palpable thrill
5/6: very loud, thrill, can be heard with stethoscope partially off chest
6/6: very loud, thrill, can be heard with stethoscope OFF the chest

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8
Q

Turbulence

A

Any arterial area where bruit or murmur is heard, there is turbulence.

Indicates a vulnerable area for atherosclerosis lesions and potential for clots to form

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9
Q

Valvular problems that may cause murmurs or bruits

A
  • Papillary muscle tear or rupture
  • Chordae tendonae rupture
  • Congenital malformation fibrosis annulus or leaflet
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10
Q

Common causes of murmurs or bruits

A

Benign- Still’s

patent ductus
septal defects- ASD, VSD
artery stenosis

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11
Q

Less common causes of murmurs or bruits

A
  • Tetraology of Fallot
  • Abdominal Aneurysm
  • Hyperthyroid state
  • Obstructive Hypertrophic cardiomyopathy
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12
Q

S1

A

Mitra and tricupsid closures. Signals onset of systole

Closely timed with the carotid pulse

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13
Q

S2

A

Aortic and pulmonic closures. Signals onset of diastole

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14
Q

Causes of S1

A

May be normal variant ( if heard at LSB) or abnormal from RBB or PVC

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15
Q

Right bundle branch block

A

There is a delay or absence of conduction along the RBBB after it branches from the bundle of His. This delays conduction through the ventricle on that side creating separate timing for left and right ventricular contraction which then changes the valve timing.

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16
Q

Split S2

A

May be normal, increasing with inspiration, decreasing with expiration (2-3rd ICS)

Abnormal in pulmonic stenosis or RBBB (no respiratory variation)

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17
Q

S3

A

Early diastole, closely follows S2
- Best at apex in left lateral decubitus

Occurs at the transition of rapid to slow ventricular filling, ventricular wall is inadequate to accommodate the inflow of blood.

LV myocardial damage causing systolic dysfunction from dilated cardiomyopathy. Due to sudden limitation of normal ventricular relaxation during filling stage in diastole.

Often present in mitral regurgitation

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18
Q

S4

A

Just before S1, very late diastole just after atrial contraction

Best heard in left lateral decubitus

Caused by vibration of LV from the atrial kick trying to pump the last of the blood in but instead hitting less compliant ventricular wall.. Due to thickening of ventricular walls form a higher work load, and some stiffening.

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19
Q

Ejection click

A

A sound occuring at the moment of maximal pressure with sudden tensing of a valve root.

If annulus isn’t tight, it will move a little bit due to the pressure

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20
Q

Aortic ejection click

A

Early systolic- at onset of left ventricular ejection, aortic root suddenly stretched

Due to dilated aorta

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21
Q

Aortic stenosis

A

Systolic crescendo-decrescendo
- Transmits sound to carotid arteries

Pathology: rheumatic disease, congenital bicupsid valve, calcification of valve

Symptoms: Dyspnea on exertion, angina, and syncope . S4

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22
Q

Aortic regurgitation

A
  • Early diastolic, high pitch blowing decrescendo murmur from initial high pressure back flow through a more narrow orifice
  • Dilates the left ventricle (S3) and can cause high pulse pressure and brisk carotid pulse
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23
Q

Pathology of aortic regurgitation

A

Rheumatic disease
Congenital bicupsid valve
Endocarditis

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24
Q

Pulmonic valve ejection click and pathology

A
  • Sudden root tensioning. Very early systole

Pathology: HTN, aneurysm dilating the root
Pulmonary valve stenosis or regurg can alter stress on root of valve causing click

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25
Systolic crescendo-decresendo murmur
Pulmonary stenosis Symptoms: exertional dyspnea, chest pain, syncope. Can dilate RV and cause S4
26
Graham Steell Murmur
Pulmonary regurg Identical to aortic regurg, but not as loud. Pathology: anything that causes pulmonary HTN
27
Tricupside stenosis
Diastolic low pitch rumble
28
Tricupside regurgitation
Early to holosystolic at left sternal border Will not radiate to left axilla Inspiration increases RV filling, accentuating the murmur Pathology: Ebstein congenital anomaly is a very thin valve structure predisposing to failure. Severe failure can enlarge right atrium increasing risk for arrhythima.
29
Mitral valve opening snap
Occurs in diastole When stenotic mitral leaflets are tethered athte orofice but still mobile, as left ventricular emptying lowers intraventricular pressure below the left atrium, they snap into the LV space momentarily before atrial blood flows in
30
Mitral valve stenosis
diastolic murmur, can be with opening snap can result in pulmonary htn, JVD, and RV hypertrophy
31
What causes mitral snap and stenosis?
Rheumatic heart disease
32
Mitral valve proplapse
Click and murmur ``` leaflet prolapse = click mitral regurge = murmur ```
33
High pitch, short murmur
Mitral insufficiency
34
Valsalva
Lowers atrial volume. Standing has same affects
35
What is mitral valve prolapse associated with?
Unexplained association with anxiety or panic attacks, and palpitations are not an uncommon complaint. Very uncommonly associated with CHF and sudden death
36
Holosystolic murmur
mitral valve regurg can radiate to the left axilla
37
Symptoms of hypertrophic obstructive cardiomyopathy
- Exercise induced dyspnea - Angina - Syncope Responsible for sudden cardiac death in young athletes
38
When is murmur intensified in hypertrophic obstructive cardiomyopathy?
By standing from a squat of valsalva maneuver
39
Study of choice for hypertrophic obstructive cardiomyopathy?
Resting echocardiography
40
What is important to look for in sports physicals
hypertrophic obstructive cardiomyopathy- even without hearing initial murmur due to sudden death potential with exertion
41
What is the only systolic ejection murmur that increases in intensity during valsalva?
hypertrophic obstructive cardiomyopathy LV volume falls, stroke volume falls, walls collapse in, narrows the exit passageway --> intensified murmur
42
What is accentuated by squatting
Increases the murmur of mitral regurg and lessens hypertrophic obstructive cardiomyopathy murmur Squatting momentarily increases volume from more venous return and increases arterial blood pressure (afterload)
43
What is accentuated by standing
Mitral valve prolapse Standing momentarily decreases volume and therefore right ventricular filling. Not so much volume in LA to prevent back flow
44
Patent ductus arteriosis
Results from a remaining fistula between aorta and pulmonary artery. Causes a continuous murmur through all of systole and most of diastole. Machine like
45
Pathology of pericarditis
Fluid in the sac - Infection of pericardium, MI, metastasis to pericardium, post cardiac surgery - Often associated with recent respiratory viral infection
46
Pericardial knock
Diastolic knock heard widely over precordium in constrictive pericarditis. Blood coming in to fill RV, LV chambers finds smaller chambers, stops abruptly and vibrates the walls
47
Third spacing
The body’s effort to lower work load on the heart by pushing fluid out of the artery and vein, the first and second space, and into whatever other space will take it. We see and hear this the most in the lower legs and lung.
48
Atherosclerosis
Occurs in the endothelium, the vessel wall itself. | Is the cause of vascular issues that result in stenosis, plaque, and aneurysm
49
Intermittent claudication
A (not fully) occlusive arterial disease of the limbs - Symptoms characterized by pain, tension, and weakness of a limb when walking which intensifies with continued walking, resolving only when activity stops - Most commonly seen in the legs b/l Also seen in compression of the cauda equina
50
Symptoms of intermittent claudication
Symptoms occur distal to the site of stenosis or occlusion- | Activity induced pain, positional pain, rest pain, poorly healing wounds
51
Physical exam of intermittent claudication
Poor pedal pulses, ulcerations, palor, cool, shiny and hairless skin, bruit may be heard
52
Predisposing factors of intermittent claudication
Diabetes Smoking HTN hyperlipidemia
53
How to calculate ankle-brachial index (ABI)
ankle pressure/arm pressure
54
Interpretation of ABI
> 1.3: noncompressible 0.91-1.30: normal 0.41-0.91: mild to moderate peripheral arterial disease 0-0.40 severe peripheral arterial disease ABI
55
Treatment of intermittent claudication
- Meticulous foot care - Smoking cessation - Lower lipids - Walk, but not through pain - Cilostazol, pentoxifylline - Revascularization procedures
56
What is the gold standard for targeting surgical intervention in intermittent claudication?
Contrast angiography
57
True aneurysm
Involves all 3 layers of vessel wall and can dissect
58
Aneurysm
Dilation of a segment of a blood vessel. Due to weakening of the wall from atherosclerosis, HTN, vasculitis, and infection. Painful only when expanding or leaking
59
Pseduoaneurysm
Dilation or hematoma that may or may not involve layers of the vessel wall which is contained and does not dissect
60
Thoracic aneurysm
Involves ascending arch and distal aorta - Pain from sudden dilation, compression of adjacent organs or dissection - Ascending aneurysm can cause aortic regurg by distorting the ring - Descending aneurysms are frequently silent, discovered incidentally on CXR
61
Abdominal aortic aneurysm
- 75% are distal to renal arteries | - Uncommon
62
Aneurysm treatment
Elective graft - Mortality > 50% if rupture occurs | - Use beta blockers to reduce shear stress unless hypotensive already
63
Raynaud
Paroxysmal constriction/dilation of small arteries/arterioles - Constriction producing palor, followed by dilation and initial filling of deoxygenated blood in capillaries producing cyanotic color. - Disease not associated with other problems - Phenomenon associated with scleroderma - 80% are women
64
Raynaud treatment
- Avoid or stop smoking - Avoid cold temps - Avoid beta blockers: block vasodilation receptors leaving vasospastic receptors in sympathetic system unchecked - Mange stressors - CCBs
65
vasculitis
inflammation and damage to vessels, often the lumen, causing stenosis and ischemia to the involved tissue
66
polyarteritis nodosa
multisystem necrotizing vasculitis of primarily medium arteries Inflammation thickens vessel wall causing stenosis, ischemia, and possibly infarct to distal tissues Characterized by: fatigue, weakness, fever, wt loss, headache, abdominal or other tissue pain

PCM III (13 decks)

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