HEART Flashcards
- Classical exertional pain, pressure or discomfort in the chest, shoulders, back, neck or arm (Angina Pectorsi)
- Acute Coronary Syndrome – including myocardial infarction (MI), non-ST elevation MI (non-STEMI) and ST elevation MI (STEMI)
- No CAD on angiogram – microvascular disease, especially in females
- Tearing or ripping chest pain radiating to the back or neck occurs with acute aortic dissection
chest pain
- Unpleasant awareness of the heart beat
- If there are signs or symptoms of irregular heart action, obtain ECG
- May be atrial fibrillation (irregularly irregular)
- Clues in history:
o transient skips, flip flops (premature contraction)
o rapid beat with sudden onset/offset (paroxysmal supraventricular tachycardia)
o rapid regular rate < 120 (sinus tachycardia)
Palpitations
- Common patient concern
- Dyspnea: uncomfortable awareness of breathing that is inappropriate to level of exertion
o Pulmonary embolism, spontaneous
pneumothorax, anxiety - Orthopnea: occurs when patient is supine and improves when patient sits up
- PND: episodes of sudden dyspnea and orthopnea that awaken patient from sleep: prompts patient to get up, stand up or go to window
for air
o Associated with wheezing or coughing
o PND occurs in left ventricular heart failure and mitral stenosis
Shortness of Breath
Accumulation of fluid in the extravascular interstitial fluid
- Causes: L/R ventricular dysfunction, pulmonary HTN or COPD
- Nutritional: hypoalbuminia
- Positional
- Dependent edema appears in lowest body parts
- Anasarca: severe generalized edema up to sacrum and abdomen
Swelling (Edema)
- Transient loss of consciousness followed by recovery
- Most common cause is neurocardiogenic (neutrally mediated vasodepressor syncope or vasovagal syncope)
- Cardiac origin from arrhythmias
Fainting
what is this heart condition:
Turbulent blood flow
Must time to cardiac cycle and note where best heard
types
murmurs
systolic and diastolic
name this type of systolic murmur:
functional or nonfunctional?
o Due to:
▪ Blood flow across the semilunar (aortic and pulmonic) valves
o Begins after S1 and stop before S2
▪ Gap in sound just before S2
o Short murmurs that decrease in intensity with maneuvers that reduce left ventricular volume
▪ standing, sitting up, and straining during Valsalva maneuver
o Often heard in healthy patients and not pathological
o Listen for aortic stenosis and innocent flow murmurs
midsystolic murmur
functional
name this type of systolic murmur:
functional or nonfunctional?
o Due to:
▪ Regurgitate flow across AV valves
o Begins with S1 and Stops with S2 (no gaps)
o May be mitral regurgitation
pansystolic murmur
holosystolic
this type of systolic murmur?
starts at mid/late systole and persists to S2
Late systolic
what type of murmur is this? systolic or diastolic? how is broken up?
represent valvular heart disease
diastolic
early, mid and late diastolic types
what type of diastolic murmur is this?
• Due to:
o Regurgitate flow across incompetent semilunar valves (aortic regurgitation)
• Starts immediately after S2 (without discernable gap) and fades into silence before next S1
Early diastolic
what type of diastolic murmur is this?
• Due to:
o Turbulent flow across AV valves (also happens in presystolic murmurs)
▪ Presystolic murmur of mitral stenosis in normal sinus rhythm
• Starts a short time after S2 and fades away before S1 or merges with late diastolic murmur
Mid-diastolic
what type of diastolic murmur is this?
• Starts late in diastole and continues until S1
Late Diastolic
name this murmur?
▪ Congenital patent ductus arteriosus and AV fistulas, common in dialysis patients,
produce continuous murmurs that are nonvalvular in origin
▪ Venous hums and pericardial friction rubs also have systolic and diastolic components
Continuous Murmurs
name this continuous murmur?
• First rises and then falls in intensity
Crescendo-decrescendo murmur
