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Physical Diagnosis > Heart > Flashcards

Heart Flashcards

1
Q

classic symptoms of acute heart failure

A
  • chest pain or radiating to jaw, neck, arms or back
  • GI discomfort
  • exertional dyspnea
  • pain, pressure or discomfort aggravated or precipitated by physical or emotional stress, heavy meals or cold weather
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2
Q

classic symptoms of chronic right sided heart failure

A

fatigue, dyspnea, and ankle edema which may lead to jugular distension and ascites

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3
Q

classic symptoms of chronic left sided heart failure

A

fatigue, exertional dyspnea, orthopnea, chronic cough and pink frothy sputum

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4
Q

traditional physical exam procedures are performed in this order

A
  • inspection of precordium and veins
  • palpation of precordium and peripheral pulses
  • percussion of heart borders
  • auscultation of normal and abnormal heart sounds
  • BP
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5
Q

what are you looking for on the precordium, during inspection, in relation to heart size

A
  • edema, cyanosis, or clubbing of fingers
  • apical impulse
  • precordial heaves or lifts
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6
Q

where is the apical impulse found and how can it help determine heart size

A

left 5th ICS just medial to mid-clavicular line. If felt lateral to midclavicular line or precardial heaves or lifts are observed then indication of cardiac hypertrophy or displacement

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7
Q

during inspection, what are you looking for in the jugular veins

A
  • engorgement

- accentuated waves

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8
Q

prominent A and V jugular waves indicate what

A

problem with right heart; tricuspid stenosis or regurgitation

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9
Q

distention of the jugular veins usually indicates

A

problem with right heart; tricuspid stenosis or regurgitation

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10
Q

what other signs of right heart failure can be expected when distention of the jugular veins is present

A
  • pitting ankle edema

- failure of veins on back of hand to collapse

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11
Q

what is checked and looked for in the inspection portion of a cardiac exam

A
  • edema, cyanosis, or clubbing of fingers
  • apical impulse
  • jugular vein distention
  • accentuated waves in jugular veins
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12
Q

what is checked and looked for in the palpation portion of a cardiac exam

A
  • apical impulse
  • precordial thrills
  • palpation of peripheral pulses
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13
Q

the most accurate means of measuring heart size

A

P-A chest film from 72”

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14
Q

what is the purpose of percussion during a cardiac exam

A

determine heart size

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15
Q

auscultation site for aortic valve

A

right 2nd ICS next to sternum

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16
Q

auscultation site for pulmonic valve

A

left 2nd ICS next to sternum

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17
Q

auscultation site for tricuspid valve

A

left 4th ICS next to sternum

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18
Q

auscultation site for bicuspid/mitral valve

A

left 5th ICS just inside midclavicular line

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19
Q

the auscultation sites for the valves represents their anatomical location

A

FALSE; simply where they are best heard

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20
Q

what is the recommended procedure for auscultation of the valve sites

A
  • first listen for rate, rhythm, and amplitude
  • second added heart beats
  • third added heart sounds
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21
Q

the diaphragm allows you to hear subtle high pitched abnormalities

A

TRUE

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22
Q

the bell allows you to hear subtle low pitched abnormalities

A

TRUE

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23
Q

the diaphragm must be applied lightly and the bell may be applied firmly

A

TRUE

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24
Q

which valves closing creates the first heart sound/S1/LUBB

A

mitral and tricuspid

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25
Q

which valves closing creates the second heart sound/S2/dup

A

aortic and pulmonic

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26
Q

which heart sound marks the start of systole

A

LUBB

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27
Q

which heart sound marks the start of diastole

A

dup

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28
Q

which heart sound marks the end of diastole

A

LUBB

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29
Q

which heart sound marks the end of systole

A

dup

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30
Q

emptying of the heart

A

systole

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31
Q

filling of the heart

A

diastole

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32
Q

contraction of the heart

A

systole

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33
Q

which atrioventricular valve closes a fraction before the other

A

mitral closes before tricuspid

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34
Q

which heart sound is longer and of lower pitch

A

S1/LUBB

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35
Q

where is the S1/LUBB heard the loudest

A

mitral valve site (left 5th ICS medial to midclavicular line)

36
Q

what is one way to accentuate the sound of the mitral and tricuspid valves

A

have the patient in the left lateral recumbent position, bringing the apex closer to the chest wall

37
Q

which heart sound should be in sync with the apical impulse and the carotid pulse

A

S1/LUBB

38
Q

which semilunar valve closes a fraction before the other

A

aortic valves closes just before pulmonic

39
Q

which heart sound is shorter and of higher pitch

A

S2/dup

40
Q

where is the S2/dup heard the loudest

A

aortic valve site (right 2nd ICS next to sternum)

41
Q

what is one way to accentuate the sounds of the aortic and pulmonic valves

A

having patient sitting down leaning forward bringing base of heart closer to chest wall

42
Q

what are the added heart beats

A
  • splits
  • gallops
  • clicks
  • snaps
43
Q

when both components of the first heartbeat (mitral & tricuspid) are audible causing a double sound

A

S1 split

44
Q

where would an S1 split be heard the best

A

at tricuspid site (4th left ICS next to sternum) right after daistolic pulse

45
Q

an S1 split may be a normal finding in a person of what body type

A

thin

46
Q

what could an S1 split indicate when not a normal finding

A

delayed tricuspid closure; RBBB

47
Q

if the cause of an S1 split were RBBB what might you expect

A

might expect patient profile and associated signs and symptoms of chronic right-sided heart failure

48
Q

what is the best way to diagnose RBBB

A

EKG

49
Q

when both components of the second heartbeat (aortic & pulmonic) are audible causing a double sound

A

S2 split

50
Q

type of S2 split

A
  • physiologic
  • paradoxical
  • fixed
51
Q

when is a physiologic split heard

A

during inspiration

52
Q

physiologic S2 split

A

separation of S2 heart sound caused by late closure of pulmonic valve due to right heart’s inability to keep up with the left extra blood being pumped. all made possible by decrease in pressure in thoracic cavity due to the depression of the diaphragm during inspiration

53
Q

when the aortic valve is pathologically delayed, as in left bundle branch block (LBBB), during expiration

A

paradoxical S2 split

54
Q

when the aortic valve closes after the pulmonic during expiration due to LBBB

A

paradoxical S2 split

55
Q

If the pulmonic valve is delayed even more than usual, as in the case of a septal defect; where blood from the left heart is shunted to the right heart causing extra workload for the right heart, a split on both phases of respiration may occur

A

fixed S2 split

56
Q

what is the name of the S2 split present on inspiration and expiration

A

fixed S2 split

57
Q

blood striking a damaged and therefore stiffened ventricular wall in early diastole creating an audible vibration

A

ventricular gallop S3/third heartbeat

58
Q

where is a ventricular gallop best heard

A

apex of the heart with the bell

59
Q

an S3 gallop normally indicates acute or chronic heart failure but it may be functional in which patients

A

thin

60
Q

describe the cadence of an S3 gallop

A

same as a fixed S2 split

61
Q

synonyms for S4 gallop

A
  • atrial gallop
  • presystolic gallop
  • fourth heartbeat
62
Q

blood striking a damaged and therefore stiffened ventricular wall in late diastole creating an audible vibration

A

S4 gallop

63
Q

difference between S4 and S3 gallops

A

S3 early diastole and S4 late diastole

64
Q

describe the cadence of an S4 gallop

A

same as an S1 split

65
Q

an abrupt stopping of a damaged atrioventricular valve heard in early diastole

A

opening snap of the atrioventricular valves

66
Q

possible causes of atrioventricular valve opening snaps

A
  • thickening
  • deformity
  • calcification
  • often due to childhood strepthroat or rheumatic fever
67
Q

describe the cadence of atrioventricular valve opening snaps

A

same as an S2 split

68
Q

mid systolic beat created by thickening, deformity, or calcification of the semilunar valves

A

ejection clicks of the semilunar valves

69
Q

describe the cadence of an ejection click of the semilunar valves

A

same as an S1 split

70
Q

causation of splits

A

a paired valve is delayed

71
Q

causation of gallops

A

stiff ventricular wall vibration

72
Q

causation of clicks and snaps

A

calcified valve pops open

73
Q

abnormal heart sounds due to turbulent blood flow

A

murmurs

74
Q

what usually causes murmurs

A

primarily faulty valves but can be caused by septal defects

75
Q

grades of murmurs

A

1 - faint in a quiet room

76
Q

murmur refers to a short, late diastolic murmur

A

presystolic

77
Q

murmur refers to a short, early systolic murmur

A

protosystolic

78
Q

murmur extends from S1 to S2 (all of systole)

A

pansystolic. what is the difference between holosystolic and pansystolic?

79
Q

murmur extends from S1 to S2 (all of systole)

A

holosystolic. what is the difference between holosystolic and pansystolic?

80
Q

murmur is present throughout systole & into some of diastole

A

continuous

81
Q

what do murmurs involving right sided heart failure get louder. during inspiration or expiration

A

inspiration

82
Q

what kind of patients would an innocent murmur be found

A
  • children

- athletes

83
Q

A continuous, rough murmur in he 2nd ICS due to a patent ductus arteriosis, that should have closed after birth

A

machinery murmur

84
Q

A benign, functional midsystolic murmur heard in children

A

still’s murmur

85
Q

Late diastolic murmur associated with aortic insufficiency; the regurgitant blood is thought to vibrate the mitral valve causing the murmur

A

austin flint murmur

Physical Diagnosis (8 decks)

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