CVS Flashcards
1
Q
Harsh murmur
A
- Mitral regur
- Aortic stenosis
- Pulmonic stenosis
- VSD
- Hypertrophic cardiomyopathy
- PDA
2
Q
Blowing murmur
A
- Tricuspid regurg
- Aortic regurg
3
Q
Rumbling murmur
A
- mitral stenosis
4
Q
Musical murmur
A
- aortic stenosis when heard over apex
5
Q
Midsystolic murmur
A
- flow thru semilunar valves
- Ex. hypertrophic cardiomyopathy
- Assoc w anachrotic pulse (Aortic stenosis)
6
Q
Pansystolic murmur
A
- backflow thru AV valves
7
Q
Late systolic murmur
A
- MVP
8
Q
Early Diastolic murmur
A
- backflow thru semilunar valves
- Ex. Aortic regurg
- Assoc w Waterhammer pulse (rapid & collapsing pulse) & Bisfriens pulse
9
Q
Mid diastolic murmur
A
- obstruction of flow thru semilunar valves
10
Q
Late diastolic murmur
A
- Mitral stenosis
11
Q
Left heart failure
A
- Causes: systemic hypertension, ischemic heart disease, valvular disorders (mitral and aortic stenosis and regurgitation), cardiomyopathy
- Presentation: breathlessness, orthopnea, paroxysmal nocturnal dyspnea
- Findings: tachypnea, tachycardia, S3 gallop rhythm, bibasilar inspiratory lung crepitations. When severe: Cyanosis, pink frothy sputum, extensive crepitations
12
Q
Right heart failure
A
- Causes: secondary to left heart failure, chronic obstructive pulmonary disease, atrial septal defect
- Presentation: due to fluid retention, breathlessness and swelling of legs which may extend to ascites
- Findings; elevated JVP, large liver, ascites, cardiac cachexia (skeletal muscle loss) peripheral edema
13
Q
Cardiac Tamponade
A
Findings: cold extremities, tachycardia, pulsus paradoxus (decrease pulse amplitude or fall in systolic blood pressure greater than 10 mm Hg) with inspiration, low blood pressure, markedly raised JVP, positive Kussmaul sign (JVP elevated further in inspiration), muffled heart sounds, clear lung fields.
14
Q
Aortic stenosis
A
- Causes: congenital, congenital bicuspid vale with premature calcification, calcific calcification in a normal aortic valve, rheumatic aortic stenosis
- Presentation: breathlessness, chest pain dizziness or syncope, all on exertion
- Findings: slow rising pulse, thrusting or heaving apex beat (LVH), harsh loud ejection systolic murmur, heard best left mid parasternal, right second interspace or apex
- A2 maybe soft or absent
- crescendo-decrescendo murmur
15
Q
Aortic Incompetence
A
- Causes: dilated aortic root (hypertension, Marfan‟s, ascending aortic aneurysm), abnormal aortic valve (rheumatic heart disease, endocarditis)
- Presentation: exertional breathlessness
- Findings; collapsing pulse, wide pulse pressure (>90 mm Hg) (Corrigan‟s sign, de Musset‟s sign, Quinke‟s sign, pistol shot femorals, Duroziez‟s murmur), early diastolic decrescendo murmur along the left sternal border or right sternal border
16
Q
Mitral stenosis
A
- Causes: rheumatic heart disease, SLE
- Presentation: gradual onset of progressive breathlessness
- Findings: malar flush, elevated JVP, peripheral edema, atrial fibrillation, left parasternal heave heave, tapping apex beat, low pitched, rumbling mid-diastolic murmur, opening snap
17
Q
Mitral regurg
A
- Causes: intrinsic valve disease (valve or valve related mechanism), secondary to stretched valve ring due to left ventricular dilation
- Presentation: breathlessness, effort intolerance, fatigue
- Findings: displaced diffuse apex beat, loud pan-systolic murmur at apex, radiates up along left sternal border, or left axilla, S1 soft, S3 sometimes, atrial fibrillation
18
Q
Mitral valve prolpase
A
late systolic murmur
19
Q
Common causes of mitral incompetence
A
- Mitral valve prolapse
- Infective endocaditis
- Rheumatic heart disease
- Ruptured papillary muscle or chordae
- Papillary muscle dysfunction
- Left ventricular dilation from any cause- dilated mitral valve
20
Q
Hypertrophic cardiomyopathy
A
- Cause: genetic, resulting in asymmetric hypertrophy of left ventricular myocardium especially the septum
- Presentation: exertional breathlessness, chest pain, dizziness, sudden death due to ventricular arrhythmia
- Findings: double apex beat, bisferiens pulse, S4, crescendo decrescendo murmur at base which becomes more prominent with valsalva or standing and less loud with squatting.
21
Q
Sx of arterial insufficiency
A
- Pain – initially on activity and relieved by rest (intermittent claudication) due to muscle hypoxia
- Rest pain – progression of disease
- Paresthesia and numbness
- Cool or cold extremity
- Skin color changes – pallor (hypoxia),black means gangrene, red severe insufficiency
- Ulcers
22
Q
Signs of arterial insufficiency
A
- Pallor
- Decrease skin temperature
- Loss of hair distally
- Loss of muscle mass
- Decrease to absent pulses
- Distal ulceration (tips of digit) • Peripheral neuropathy
- Gangrene
24
Q
Buerger’s test
A
- Raise both legs to 60 degrees, shoes off
- Patient wiggle feet and toes
- Hold for 60 seconds
- Have patient sit up and swing legs over the side of the bed
- Observe for return of color (10 seconds) and venous filling (15 seconds)
25
Q
Signs of venous insufficiency (stasis dermatitis)
A
- Edema – dorsum of foot, posterior to medial
- malleolus, lower anterior leg
- Stasis dermatitis
- Ulcers – usually in the area of the medial
- malleolus
- Varicose veins
- Increase warmth due to associated cellulitis
- Cords – thrombosed superficial vein
33
Q
Fundoscopy changes
A
Hypertension
- A-V nicking
- Exudates ,hemorrhages
- Papilledema (malignant hypertension)
Endocarditis
- Roth spots
