CVS PhExam Flashcards
Jane way lesion - non tender red macular
osler nodes - painful red raised
splinter hemorrhages - red brown lines in nail bed
all signs seen in infective endocarditis
pressure applied to nail bed until it turns white
prolonged: dehydration, shock, PVS, hypothermia
capillary refill
JVP best assessed where
right internal jugular vein
atrium contracting tricuspid valve open
A wave on JVP
atrium relaxing then filling, tricuspid closed
x descent on JVP
atrium tense, full; tricuspid closed
v wave on JVP
atrium emptying, tricuspid open
y wave on JVP
resistance to RA emptying at or beyond TV
open tricuspid
causes - pulmonary HTN, tricuspid stenosis
elevated a wave
occurs when RA contracts against a closed TV during AV dissociation
cause - PAC; ventricular beats, complete AV block, ventricular tachycardia
closed tricuspid valve
cannon a wave
no atrial contraction
cause A fib
absent a wave
increased atrial filling during systole
cause - tricuspid regurgitation (lancisi sign)
elevated v wave
normal JVP
3-4 cm above sternal angle
8-9 cm from right atrium
increased JVP
1) RHF
2) pericardial dz
3) tricuspid stenosis
4) chronic pulmonary HTN
5) SVC obstruction
decreased JVP
hypovolemia
with px breathing normally, place right hand on RUQ of abdomen and press firmly upward under costal margin for 10-15 sec
+ sign: JVP rises and persists as long as abdominal pressure continues
RHF
hepatojugular reflex
+ sign: failure of the jugular venous column to collapse during inspiration
constrictive pericarditis
kussmaul sign
correlates well with pulse pressure
amplitude
speed of upstroke - brisk or high pitched, murmur like sound
smooth, rounded, midsystolic - contour
contour
high pitched, murmur like sound
bruit or thrill
small thready pulse amplitude
cardiogenic shock
bounding amplitude
AR
delayed upstroke contour
AS
pulsus alternans contour
beat to beat variability
bigeminal pulse contour
normal heart alternating with PVC
biferiens pulse contour
double systolic peak
carotid sinus
tortuous carotid artery
hypervascularity of hyperthyroidism
external compression from TOS
examples of bruits and thrills
rarely palpable soft, biphasic, undulating quality eliminated on light pressure height of pulsations changes on inspiration usually falls
JVP
palpable brisk, single pulse does not disappear on light tough no change with position change no effect on inspirations
carotid pulse
point of maximal impulses
5th ICS, LMCL
single outward pulse
double pulse (2 peaks)
hypertrophic cardiomyopathy
fast impulse with large amplitude, terminates quickly
increase volume work
MR and AR, exercise, hyper metabolic state
forceful and hyper dynamic amplitude
impulse is sustained throughout systole
increase pressure work
AS, LVH, systemic HTN
forceful and sustained amplitude
anemia
hyperthyroidism
high cardiac output
hyper metabolic state
closure of mitral and tricuspid mitral closes first transition from diastole to systole listen with diaphragm loudest at apex identify just before the carotid upstroke
S1 sound
short PR interval
mild mitral stenosis
hyperdynamic states
loud S1
Long PR interval severe mitral stenosis LBBB COPD obesity pericardial effusion
soft S1
AV dissociation
atrial fibrillation
large pericardial effusion
severe LV dysfunction
variable S1
closure of AV and PV AV closes first identify just after upstroke listen to it with diaphragm during expiration single during inspiration split loudest at base - 2 ICS
S2 sound
presence if splitting during expiration, wider during inspiration
RBBB, pulmonic stenosis, MR
wide split
splitting at both expiratory and inspiratory phases but dies not lengthen with inspiration
ASD, RV failure, pulmonary HTN
fixed splitting
reverse of normal physiology; splitting of S2 during expiration, singular during inspiration
pulmonary before aortic
LBBB, AS
paradoxical split
single S2
severe AS or AR
listen with the bell
ventricular gallop rhythm (Kentucky)
apex, left lateral decubitus position
early diastole: rapid ventricular filling
physiological: child, pregnant, athletes
pathological: abrupt deceleration (LVF, volume overload, decreased myocardial contraction)
S3
listen with bell atrial gallop (Tennessee) apex, left lateral decubitus position late diastole pathologic: stiff and non complaint ventricle
S4
heard at right 2 ICS
at early systole
causes: dilated aorta, AS
aortic ejection sound
heard left 2 ICS and 3 ICS
at early systole
cause: dilated pulmonary artery, pulmonic stenosis, pulmonary HTN
pulmonic ejection sound
heard at apex
at mid systole
cause: ballooning of part of MV into the atrium
MVP click
vibration felt through chest wall
thrills
murmur intensities
grade 1 - barely audible
grade 2 - soft but easily heard
grade 3 - loud
grade 4 - loud + palpable thrill
grade 5 - loud with minimal contact between stethoscope and chest + thrill
grade 6 - loud with no contact between stethoscope and chest + thrill
heard at erbs point - left 3 ICS
AR
scratchy, scraping sound left 3 ICS seen in pericarditis px leans forward, exhales and holds breath triphasic in 50% of px
pericardial friction rub
systemic HTN
dilated aortic root
loud A2
calcified aortic stenosis
soft or absent A2
pulmonary HTN
ASD
loud P2
pulmonic stenosis
COPD
aging
soft or absent P2
