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PCM 1 > CV exam, heart sounds - Johnston > Flashcards

CV exam, heart sounds - Johnston Flashcards

1
Q

proper sequence of physical exam in

assessment of cardiac function

A

IPPA: inspection,

palpation, percussion, auscultation

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2
Q

the proper approach to assessment of the

cardiovascular system

A

history, physical, ECG, imaging,

lab

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3
Q

shortness of breath

A

dyspnea

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4
Q

coughing up frothy, blood tinged secretions

A

hemoptysis

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5
Q

patient puts heart right on chest wall, called

A

levine sign

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6
Q

no specific s/s of CHF but potential are

A 
fatigue
dyspnea
chest pain
palpitations
syncope
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7
Q

familial clustering is
common in patients with certain heart
diseases; ie:

A

hypertrophic cardiomyopathy,
Marfan’s syndrome, prolonged QT
syndrome

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8
Q

seen in young athletes when push them too hard, they die an “electrical” death, ventriuclar ectopy, ventriuclar tachycardia/ fabriliation

A

hypertrophic cardiomyopathy

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9
Q

problem with CT, prone to aortic aneurysms, tall and lanky, congenital form of heart disease

A

Marfan’s syndrome

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10
Q

prolonged QT syndrome..

A

ones with long QT interval prone to developing suddne death from arrythmias
dependent on rate of heartbeat

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11
Q

if PMI displaced laterally or downward..

A

means bigger heart see if there’s hypertrophy/ cardiac enlargement

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12
Q

ideal conditions and patient positions for auscultaiton of heart

A

quiet room
gown patient
sitting, supine, left lateral decubitus, leaning forward, standing

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13
Q

considerations when inspecting/ looking at patient

A 
 Face – Acromegaly, Cushnoid, Down’s
syndrome, hyperthyroid, myxedema
 Jaundice – yellow
 Cyanosis – blue
 Pallor – pale, anemia, shock
 Nails – clubbing, hemorrhages
 Body habitus – tall, short
 Hydration – Blood pressure, weight
 Temperature
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14
Q

inspection of heart

A

Precordium
 Scars, pacemaker, skeletal abnormalities
 Apex – 5th ICS, left, 1 cm. Medial to MCL

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15
Q

palpable thrill reflective of loud heart murmur will be graded

A

4 or above

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16
Q

palpation of heart

A

 Apex beat; gently lifts palpating fingers

 Thrills – turbulent blood flow causing murmurs

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17
Q

percussion of heart

A

 Limited: cardiac border

18
Q

S1

A 
 MV closure 1st component
 TV closure 2nd component
 Beginning of systole
 Loudest at apex
[full sequence: MTAP]
19
Q

S2

A 
Aortic valve closure 1st component
Pulmonic valve closure 2nd component
 Loudest at the base
 End of systole Marks end of systole, beginning of diastole
[full sequence: MTAP]
20
Q

PMI

A

point of maximal intensity

21
Q

PMI in LVH

A

laterally displaced, downward to 6-7th ICS

22
Q

PMI in RVH

A

sustained systolic lift at lower left sternal area

23
Q

location of heart sounds

A 
 Aortic V. – 2nd ICS to the R of sternum
 Pul V – 2nd ICS L of sternum
 Tricuspid – 4th ICS at LSB
 Mitral – Apex of heart
5th Left ICS at mid -
clavicular line
24
Q

S2 splits during.. because of..

A

Splitting of S2
inspiration because of increased venous
return during inspiration and more time for
RV to deliver blood to the lung (delayed P2)

25
Q

murmur grading system

A
  1. Barely audible, faint
  2. Soft, but easily heard, quiet
  3. Loud, without a thrill
  4. Loud with a thrill
  5. Loud with minimal contact between
    stethoscope and chest
  6. Thrill
    Loud, can be heard without a stethoscope
26
Q

vibratory sensations caused by the heart and felt on the body surface

A

thrills

27
Q

starts with S1 and stops at S2 without a gap between murmur and heart sounds

A

pansystolic (holosystolic ) murmur

28
Q

begins after S1 and stops before S2, brief gaps between murmur and heart sounds, gap just before S2 heard more easily and confirmatory

A

midsystolic murmur

29
Q

starts in mid or late systole and persists up to S2

A

late systolic murmur

30
Q

diastolic murmurs

A

early
mid
late

31
Q

starts short time after S2, may fade away or merge into a late diastolic murmur

A

middiastolic murmur

32
Q 
Stretching of
myocytes prior to
contraction. It’s the
EDP at the beginning
of systole
A

preload

33
Q 
Load on heart during
ejection of blood from
ventricle. Vent.
pressure at end of syst
(ESP)
A

afterload

34
Q

INCREASED preload causes

A

INCREASED active force development up to a limit

35
Q

INCREASED afterload

A

DECREASED volume of blood ejected each beat

36
Q

Blood ejected from ventricle per beat= EDV-ESV

A

Stroke volume (SV)

37
Q

the preload in V

A

EDV

38
Q

the afterload in V

A

ESV

39
Q

Cardiac Output (CO)

A

volume of blood pumped by heart in a minute

CO = SV x HR

40
Q

Ejection Fraction (EF)

A

Measures contractility: (EF= SV/EDV)

41
Q

normal, reduced, and severely reduced EF

A

normal 50-60
mild reduced 40-49
mod reduced 30-39
severely reduced 15-29

42
Q

what is the Kussmauls sign and what does it indicate

A

Venous column (JVP) rises during
inspiration, rather than falls
Seen in R heart failure, constrictive
pericarditis or RV infarction

PCM 1 (17 decks)

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