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Pt Assess II Final > CV Lecture > Flashcards

CV Lecture Flashcards

1
Q

What is the MC chief complaint for cardiac events?

A

Chest pain

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2
Q

What is the true symptom of CV disease?

A

Angina pectoris

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3
Q

What is angina pectoris?

A
  • Crushing, squeezing chest pain
  • Usually on exertion
  • True symptom of CVD
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4
Q

Define preload

A

End diastolic volume at the beginning of systole directly related to stretch (Starling’s law)

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5
Q

Define stroke volume

A

Volume of blood pumped from one ventricle of the heart with each beat

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6
Q

Define afterload

A

Amount of resistance that the L side of the heart has to overcome to eject blood (“squeeze”)

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7
Q

How can fever affect HR and respirations?

A

Increases both

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8
Q

How can hypothermia affect HR and respirations?

A

Decreases both

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9
Q

How do you directly measure blood pressure?

A

Insertion of intra-arterial catheter (A-line)

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10
Q

How do you indirectly measure BP?

A

BP cuff and stethoscope

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11
Q

What can happen to BP if cuff is too small?

A

Falsely elevated

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12
Q

What BP finding indicates supravalvular aortic stenosis?

A

Difference in BP of 20+ mmHg between arms

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13
Q

What BP finding indicates coarctation of aorta?

A
  • If BP is high in both arms, take BP in the legs

- If legs have lower BP, then could be coarctation of aorta

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14
Q

What does jugular venous pulse reflect?

A

RA pressure

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15
Q

What are the components of a jugular venous pulsation?

A

a wave
x descent
v wave
y descent

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16
Q

What is the “a” wave?

A
  • Part of JVP
  • Atrial contraction
  • Reflects slight rise in atrial pressure that accompanies contraction
  • Occurs before S1 and carotid pulse
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17
Q

What is the “x descent”?

A
  • Part of JVP
  • Atrial relaxation
  • Ventricles contract
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18
Q

What is the “v wave”?

A
  • Part of JVP
  • Venous filling
  • Atria begin to fill
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19
Q

What is the “y descent”?

A
  • Part of JVP
  • Atria empty
  • Blood flows into RV
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20
Q

What does the hepatojugular reflex assess?

A

RV function

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21
Q

Why does the hepatojugular reflex occur?

A

Inability of R side of heart to accommodate increased venous return

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22
Q

What is the normal response of hepatojugular reflex?

A

Jugular veins show a transient increase during first few cardiac cycles of compression followed by a fall to baseline

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23
Q

What are the different types of carotid upstroke?

A
  • Brisk (normal)
  • Delayed (possible AS)
  • Bounding (possible AR)
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24
Q

Use finger pads to palpate for ____ in the CV PE

A

Heaves or lifts

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25
Q

Use ball of hand to palpate for ____ in the CV PE

A

Thrills

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26
Q

What is a laterally displaced PMI suggestive of?

A

Cardiomegaly

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27
Q

The PMI can be described as:

A
  • Tapping (normal)
  • Sustained (suggests LV hypertrophy from HTN or AS)
  • Diffuse (suggests dilated ventricle from CHF or cardiomyopathy)
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28
Q

In the L lat decubitus position, a PMI 3+ cm is an indicator of:

A

LV enlargement

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29
Q

If the PMI is displaced to the right, this may indicate:

A

RV hypertrophy

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30
Q

How may the PMI present in a COPD patient?

A

Felt in the epigastrium

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31
Q

If the PMI is palpated in the normal position in a COPD patient, what can this indicate?

A

Cardiomegaly

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32
Q

Presence of a heave with a lateral retraction felt along the left parasternal border is suggestive of:

A

RV hypertrophy

33
Q

Name where all of the auscultation points are on the chest

A
  • Aortic: R 2nd ICS
  • Pulmonic: L 2nd ICS
  • Erb’s point: L 3rd ICS
  • Tricuspid: L 4th ICS
  • Mitral: L 5th ICS mid-clavicular line
34
Q

Apex in L lateral decubitus position with the bell will detect:

A

Mitral stenosis murmur (low pitched diastolic)

35
Q

Diaphragm of stethoscope on the chest is best used to listen for:

A

High pitched sounds like S1, S2, S4 and most murmurs

36
Q

Bell of stethoscope on the chest is best used to listen for:

A

Low pitched sounds like S3 and rumble of mitral stenosis

37
Q

Which heart sounds are accentuated by inspiration?

A

S3 and S4 originating in R side of heart

38
Q

Why are most murmurs or sounds originating in R side of heart accentuated by inspiration?

A

Because of increased return of blood that occurs and increased RV output

39
Q

S1 is muffled or decreased in patients with:

A
  • Pleural and pericardial effusions
  • COPD
  • PTX
  • Obesity
40
Q

Normally, the tricuspid valve closes a split second ____ the mitral valve

A

After

aka splitting of S1

41
Q

When can splitting of S1 occur?

A
  • PVCs of LV origin
  • RBBB
  • LV pacing
  • ASD
  • Severe TS
42
Q

What is reverse splitting of S1?

A

When tricuspid valve closes BEFORE mitral

-Occurs with LBBB, RV pacing, severe MS, left atrial myxoma

43
Q

When is the intensity of A2 increased?

A
  • Pulm HTN
  • Coarctation of aorta
  • Aortic aneurysm in thin ppl
  • Tetralogy of Fallot
  • Transposition of great vessels
44
Q

When is the intensity of A2 decreased?

A
  • Aortic dissection
  • Aortic stenosis
  • Decreased systemic arterial pressure
45
Q

When is the intensity of P2 increased?

A
  • PA HTN

- ASD

46
Q

Normally, the aortic valve closes ____ the pulmonary valve

A

Before

S2 split

47
Q

What is reverse splitting of S2?

A

Aortic valve closes AFTER pulmonic valve

aka paradoxical split

48
Q

When does an S3 occur?

A

Rapidly rushing flow of blood from atria is suddenly decelerated by the ventricle when it reaches its elastic limit

49
Q

In a normal ventricle, when does S3 occur?

A

Hyperdynamic states

Volume loaded conditions

50
Q

In a ventricle with decreased compliance, when does an S3 occur?

A

With a normal amount of blood entering during diastole

51
Q

Is S3 always normal or always abnormal?

A
  • It can be pathological

- Can also be a normal variant in 40 yo or younger

52
Q

What does an S3 present with heart failure indicate?

A

Poor prognosis

53
Q

Conditions associated with pathological S3:

A
  • Ischemic heart disease
  • MR or TR
  • Systemic and pulm HTN
  • Acute AR
  • Volume overload (renal failure)
54
Q

Describe S4

A

Late diastolic sound heard just before S1 that corresponds to late ventricular filling through active atrial contraction

55
Q

Conditions a/w S4:

A
  • LVH from systemic HTN
  • RVH from pulm HTN or stenosis
  • IHD from acute MI or angina
  • Ventricular aneurysm
56
Q

How do S1 and S2 differ from S3 and S4?

A
  • S1 and S2 are high pitched and best audible with diaphragm

- S3 and S4 are low pitched and best heard with bell

57
Q

What is an opening snap?

A
  • High pitched diastolic sound
  • Produced by rapid opening of mitral valve in MS or tricuspid in TS
  • Closer to A2 means more severe stenosis
58
Q

What is a systolic ejection click?

A
  • High pitched, early part of ventricular systole
  • Can be valvular or vascular
  • Intensity decreases with increased valve calcification
59
Q

What is a non-ejection systolic click?

A
  • High pitched systolic sound that follows S1

- A/w mitral or tricuspid valve prolapse

60
Q

What 3 factors can contribute to development of heart murmurs?

A
  1. High flow rate through normal or abnormal orifices
  2. Forward flow through a constricted or irregular orifice OR into a dilated vessel or chamber
  3. Backward or regurgitant flow through an incompetent valve
61
Q

How do we identify or describe heart murmurs?

A
  • Timing (systole or diastole)
  • Location
  • Radiation
  • Duration
  • Intensity (graded)
  • Pitch
  • Quality (harsh, blowing, etc.)
  • Relationship to respiration
  • Relationship to position
62
Q

How are murmurs described by shape?

A
  • Crescendo (rises in intensity from S1 to S2)
  • Decrescendo (decreases in intensity after S2)
  • Crescendo-decrescendo (rises and then falls between S1 and S2)
  • Plateau
63
Q

Describe the murmur of AS:

A
  • Mid to late systolic
  • Crescendo-decrescendo
  • Medium pitch
  • Ejection click
  • S4
  • Narrow pulse pressure
  • Parvus tardus pulse
  • Radiates to carotid
64
Q

Describe the murmur of MR:

A
  • Early systole
  • Radiates to axilla
  • High pitched
  • Blowing
  • S3
65
Q

How is PMI affected with MR?

A

Laterally displaced and diffuse

66
Q

Describe the murmur of PS:

A

Similar to AS just in pulmonic area

67
Q

Describe the murmur of TR:

A

Similar to MR just in tricuspid area

68
Q

What does a ventral septal defect (VSD) sound like and where is it best heard?

A
  • Holosystolic
  • High pitch
  • Harsh
  • Radiates to R of sternum
  • Best heard in tricuspid area
69
Q

How does a venous hum sound and where is it best heard?

A
  • Continuous
  • High pitch
  • Roaring/humming
  • Radiates to R side of neck
  • Heard best above clavicle
70
Q

What does an innocent murmur sound like?

A
  • Widespread (systolic)
  • Diamond shaped
  • Medium pitch
  • Twanging/vibratory
  • Minimal radiation
71
Q

What are the systolic murmurs?

A
  • AS/PS
  • MR/TR
  • VSD
  • Venous hum
  • Innocent murmur
72
Q

What are the diastolic murmurs?

A
  • AR/PR

- MS/TS

73
Q

Describe murmur of MS:

A
  • Decrescendo
  • Low pitch
  • Rumbling
  • Opening snap
  • Mid diastole
  • NO radiation
74
Q

Describe murmur of AR:

A
  • Early diastole
  • Decrescendo
  • NO radiation
  • High pitch
  • Blowing
  • S3
  • Wide pulse pressure
  • Laterally displaced PMI
75
Q

What is an Austin Flint murmur?

A

Apical diastolic murmur a/w AR - mimicking MS

76
Q

How do continuous murmurs develop?

A

Results from a communication between high pressure arterial and low pressure venous chamber or vessel

77
Q

What is the best example of a continuous murmur?

A

Patent Ductus Arteriosus (PDA)

78
Q

Describe Patent Ductus Arteriosus (PDA)

A
  • Abnormal communication b/w aorta and PA
  • Occurs end of systole into diastole
  • Blowing
  • High pitched
  • Most pronounced at S2

Pt Assess II Final (17 decks)

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