Examination of the Cardiac Patient Lecture Powerpoint Flashcards
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Cardiac disease is a ____ illness that requires an entire ____
systemic, general physical examination
Cardinal symptoms when obtaining history of heart disease (5)
- Chest pain or discomfort
- dyspnea
- syncope
- palpitations
- edema (worse in morning or evening?)
Most common congenital abnormality of heart, what does this predispose patients to?
Bicuspid aortic valve, aortic aneurysm
General appearance characteristics on cardiac exam (3)
- malnourishment
- cachexia (wasting)
- obesity
HEENT fundoscopic characteristics on cardiac exam (7)
- retinal hemorrhages
- papiledema
- cotton wool spots
- exopthalmos (hyperthyroidism)
- arcus senilis (ring around iris)
- xanthomas
- distended neck veins
Chest and lung characteristics on cardiac exam (4)
- pectus excavatum
- pectus carinatum
- pre-sacral edema (more accurate measure)
- wheezes/rales/rhonchi
JVD elevations indicate…
….right sided heart pressure elevation (increased CVP), indicative of potential right sided heart failure
If the PMI is displaced to the left think of these 2 conditions, if the right think of this condition
- Long standing systemic hypertension or aortic valve stenosis,
- COPD
Why does physiologic splitting of S2 occur?
-The pressure from inflation of the lungs and depression of the diaphragm causes external pressure on vena cava to decrease resulting in it widening and sucking in more blood to the right heart delaying closure of the pulmonic valve after the aortic valve (a2 before p2)
Cause of paradoxically splitting of S2
Left bundle branch block
S4 gallops are always ___, while S3 is only sometimes and S3 is associated with this condition
Pathologic, S3 often associated with chronic heart failure
5 steps in assessing a murmur
- Determine where it is heard best
- explain what type it sounds like
- perform valsalva: have patient clench to decrease venous return to better isolate the sound (less blood moves in and out of heart)
- perform handgrip: increase pressure (afterload) which will increase aortic pressure (less blood going out so more blood remains in heart to regurgitate
- leg lift/squatting to increase venous return to right side of heart (more blood comes in and out of heart)
Hypertrophic obstructive cardiomyopathy and pathonomonic sign
Genetic disorder with autosomal dominance that can cause sudden cardiac death in youthful athletes most often with potential to later in life result in atrial fib and other arrhythmias
-valsalva causing increased sound
Acute pericarditis pain is worsened upon ___ and ____
inspiration, laying in recumbant position
Parvus et tartus pulse
Delayed and weak pulse
Parvus et tardus at the carotid pulse is pathonomonic for this condition
Aortic stenosis
Corrigan’s pulse
Rapid upstroke and collapse of the carotid artery pulse
Corrigan’s pulse pathonomonic for this condition
Aortic insufficiency
Quinke’s sign
Pulsation of capillary bed in nails during capillary refill indicative of aortic insufficiency
Duroziez’s sign
Systolic and diastolic murmurs heard over femoral artery when gradually compressed with the stethoscope indicative of aortic insufficiency
Arachnodactyly
Hyperlaxity of the joints often seen in marfan syndrome
Persistant splitting of S2 at rest is representative of…
….a right bundle branch block
S3 cause
Rapid ventricular filling creating an early diastolic sound of blood sloshing into the ventricle (large and floppy)
S4 cause
Atria pushing blood into stiff ventricle creating a late diastolic sound of blood rubbing the wall as a bolus is pushed in (stiff noncompliant ventricle)
Louder S2 than S1 indicates…
…Pulmonary disease
Having afib once puts at risk for….
…having it recurrence
Valsalva should ___ aortic stenosis, ___ HOCM, ___mitral and tricuspid regurg
Decrease, increase, decrease
Handgrip should ___ aortic stenosis, ___ HOCM, and ___ mitral regurg
Decrease, decrease, increase
Leg lift/squatting should ___ aortic stenosis, ____ HOCM, ___mitral regurg and tricuspid regurg
Increase, decrease, increase
