CV Lecture Flashcards
1
Q
What is the MC chief complaint for cardiac events?
A
Chest pain
2
Q
What is the true symptom of CV disease?
A
Angina pectoris
3
Q
What is angina pectoris?
A
- Crushing, squeezing chest pain
- Usually on exertion
- True symptom of CVD
4
Q
Define preload
A
End diastolic volume at the beginning of systole directly related to stretch (Starling’s law)
5
Q
Define stroke volume
A
Volume of blood pumped from one ventricle of the heart with each beat
6
Q
Define afterload
A
Amount of resistance that the L side of the heart has to overcome to eject blood (“squeeze”)
7
Q
How can fever affect HR and respirations?
A
Increases both
8
Q
How can hypothermia affect HR and respirations?
A
Decreases both
9
Q
How do you directly measure blood pressure?
A
Insertion of intra-arterial catheter (A-line)
10
Q
How do you indirectly measure BP?
A
BP cuff and stethoscope
11
Q
What can happen to BP if cuff is too small?
A
Falsely elevated
12
Q
What BP finding indicates supravalvular aortic stenosis?
A
Difference in BP of 20+ mmHg between arms
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
14
Q
What does jugular venous pulse reflect?
A
RA pressure
15
Q
What are the components of a jugular venous pulsation?
A
a wave
x descent
v wave
y descent
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
17
Q
What is the “x descent”?
A
- Part of JVP
- Atrial relaxation
- Ventricles contract
18
Q
What is the “v wave”?
A
- Part of JVP
- Venous filling
- Atria begin to fill
19
Q
What is the “y descent”?
A
- Part of JVP
- Atria empty
- Blood flows into RV
20
Q
What does the hepatojugular reflex assess?
A
RV function
21
Q
Why does the hepatojugular reflex occur?
A
Inability of R side of heart to accommodate increased venous return
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
23
Q
What are the different types of carotid upstroke?
A
- Brisk (normal)
- Delayed (possible AS)
- Bounding (possible AR)
24
Q
Use finger pads to palpate for ____ in the CV PE
A
Heaves or lifts
25
Use ball of hand to palpate for ____ in the CV PE
Thrills
26
What is a laterally displaced PMI suggestive of?
Cardiomegaly
27
The PMI can be described as:
- Tapping (normal)
- Sustained (suggests LV hypertrophy from HTN or AS)
- Diffuse (suggests dilated ventricle from CHF or cardiomyopathy)
28
In the L lat decubitus position, a PMI 3+ cm is an indicator of:
LV enlargement
29
If the PMI is displaced to the right, this may indicate:
RV hypertrophy
30
How may the PMI present in a COPD patient?
Felt in the epigastrium
31
If the PMI is palpated in the normal position in a COPD patient, what can this indicate?
Cardiomegaly
32
Presence of a heave with a lateral retraction felt along the left parasternal border is suggestive of:
RV hypertrophy
33
Name where all of the auscultation points are on the chest
- 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
Apex in L lateral decubitus position with the bell will detect:
Mitral stenosis murmur (low pitched diastolic)
35
Diaphragm of stethoscope on the chest is best used to listen for:
High pitched sounds like S1, S2, S4 and most murmurs
36
Bell of stethoscope on the chest is best used to listen for:
Low pitched sounds like S3 and rumble of mitral stenosis
37
Which heart sounds are accentuated by inspiration?
S3 and S4 originating in R side of heart
38
Why are most murmurs or sounds originating in R side of heart accentuated by inspiration?
Because of increased return of blood that occurs and increased RV output
39
S1 is muffled or decreased in patients with:
- Pleural and pericardial effusions
- COPD
- PTX
- Obesity
40
Normally, the tricuspid valve closes a split second ____ the mitral valve
After
| aka splitting of S1
41
When can splitting of S1 occur?
- PVCs of LV origin
- RBBB
- LV pacing
- ASD
- Severe TS
42
What is reverse splitting of S1?
When tricuspid valve closes BEFORE mitral
| -Occurs with LBBB, RV pacing, severe MS, left atrial myxoma
43
When is the intensity of A2 increased?
- Pulm HTN
- Coarctation of aorta
- Aortic aneurysm in thin ppl
- Tetralogy of Fallot
- Transposition of great vessels
44
When is the intensity of A2 decreased?
- Aortic dissection
- Aortic stenosis
- Decreased systemic arterial pressure
45
When is the intensity of P2 increased?
- PA HTN
| - ASD
46
Normally, the aortic valve closes ____ the pulmonary valve
Before
| S2 split
47
What is reverse splitting of S2?
Aortic valve closes AFTER pulmonic valve
| aka paradoxical split
48
When does an S3 occur?
Rapidly rushing flow of blood from atria is suddenly decelerated by the ventricle when it reaches its elastic limit
49
In a normal ventricle, when does S3 occur?
Hyperdynamic states
| Volume loaded conditions
50
In a ventricle with decreased compliance, when does an S3 occur?
With a normal amount of blood entering during diastole
51
Is S3 always normal or always abnormal?
- It can be pathological
| - Can also be a normal variant in 40 yo or younger
52
What does an S3 present with heart failure indicate?
Poor prognosis
53
Conditions associated with pathological S3:
- Ischemic heart disease
- MR or TR
- Systemic and pulm HTN
- Acute AR
- Volume overload (renal failure)
54
Describe S4
Late diastolic sound heard just before S1 that corresponds to late ventricular filling through active atrial contraction
55
Conditions a/w S4:
- LVH from systemic HTN
- RVH from pulm HTN or stenosis
- IHD from acute MI or angina
- Ventricular aneurysm
56
How do S1 and S2 differ from S3 and S4?
- S1 and S2 are high pitched and best audible with diaphragm
| - S3 and S4 are low pitched and best heard with bell
57
What is an opening snap?
- 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
What is a systolic ejection click?
- High pitched, early part of ventricular systole
- Can be valvular or vascular
- Intensity decreases with increased valve calcification
59
What is a non-ejection systolic click?
- High pitched systolic sound that follows S1
| - A/w mitral or tricuspid valve prolapse
60
What 3 factors can contribute to development of heart murmurs?
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
How do we identify or describe heart murmurs?
- Timing (systole or diastole)
- Location
- Radiation
- Duration
- Intensity (graded)
- Pitch
- Quality (harsh, blowing, etc.)
- Relationship to respiration
- Relationship to position
62
How are murmurs described by shape?
- 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
Describe the murmur of AS:
- Mid to late systolic
- Crescendo-decrescendo
- Medium pitch
- Ejection click
- S4
- Narrow pulse pressure
- Parvus tardus pulse
- Radiates to carotid
64
Describe the murmur of MR:
- Early systole
- Radiates to axilla
- High pitched
- Blowing
- S3
65
How is PMI affected with MR?
Laterally displaced and diffuse
66
Describe the murmur of PS:
Similar to AS just in pulmonic area
67
Describe the murmur of TR:
Similar to MR just in tricuspid area
68
What does a ventral septal defect (VSD) sound like and where is it best heard?
- Holosystolic
- High pitch
- Harsh
- Radiates to R of sternum
- Best heard in tricuspid area
69
How does a venous hum sound and where is it best heard?
- Continuous
- High pitch
- Roaring/humming
- Radiates to R side of neck
- Heard best above clavicle
70
What does an innocent murmur sound like?
- Widespread (systolic)
- Diamond shaped
- Medium pitch
- Twanging/vibratory
- Minimal radiation
71
What are the systolic murmurs?
- AS/PS
- MR/TR
- VSD
- Venous hum
- Innocent murmur
72
What are the diastolic murmurs?
- AR/PR
| - MS/TS
73
Describe murmur of MS:
- Decrescendo
- Low pitch
- Rumbling
- Opening snap
- Mid diastole
- NO radiation
74
Describe murmur of AR:
- Early diastole
- Decrescendo
- NO radiation
- High pitch
- Blowing
- S3
- Wide pulse pressure
- Laterally displaced PMI
75
What is an Austin Flint murmur?
Apical diastolic murmur a/w AR - mimicking MS
76
How do continuous murmurs develop?
Results from a communication between high pressure arterial and low pressure venous chamber or vessel
77
What is the best example of a continuous murmur?
Patent Ductus Arteriosus (PDA)
78
Describe Patent Ductus Arteriosus (PDA)
- Abnormal communication b/w aorta and PA
- Occurs end of systole into diastole
- Blowing
- High pitched
- Most pronounced at S2
