History and Physical Flashcards
Percent of patients that come in for heart pain, but have had no ischemic event.
20%
Most common distribution of pain for MI?
Sternal region radiating towards and down the medial portion of the left arm. (can also be right sided, epigastric, middle back between scapulas and left jaw)
Description of an MI (from a patient)
1) Elephant sitting on the chest
2) Burning Sensation
3) Choking feeling in throat
4) Like a toothache
Things to ask patients
1) Symptoms of risk factors for heart disease
2) History of Risk Factors for heart disease
3) Family History of Heart disease\risk factors
4) Social\Personal Risk Factors (smoking, weight loss…)
Techniques of a Cardio Exam
1) Fixed Routine
2) Ask questions about each part of the exam
3) Always examine from the patient’s right
Systolic Ejection Murmur Location, Description and Examples?
2nd intercostal space (right= aortic, left= pulmonic). Crescendo-decrescendo between S1 and S2. Examples include aortic and pulmonic stenosis. Can lead to SAD (syncope, angina and dyspnea).
Pansystolic Murmur Location, Description and Examples?
Apex to Axilla enhanced by maneuvers that increase TPR (mitral) and Left lower sternal border to right lower sternal border enhanced by maneuvers that increase RA return (tricuspid). Holosystolic, high-pitched “blowing” murmur that occurs between S1 and S2. Mitral and tricuspid regurgitation.
Mitral Regurgitation Causes
Ischemic heart disease, MVP, LV dilation, rheumatic fever and infective endocarditis
Tricuspid Regurgitation Causes
RV Dilation, rheumatic fever and infective endocarditis
Late Systolic Murmur Location, Description and Examples?
Apex to axilla. Late systolic crescendo murmur with midsystolic click. Increased sound with maneuvers that increase venous return. Caused by mitral valve prolapse.
Causes of Mitral Valve Prolapse
Rheumatic fever, chordae rupture or myxomatous degeneration.
Early Diastolic Murmur Location, Description and Examples?
Along left side (aortic) and upper left side (pulmonic) of the sternum. Increased amplitude with hand grip test. High- pitched “blowing” early diastolic decrescendo murmur. Caused by Aortic or pulmonic regurgitation.
Causes of Aortic Regurgitation?
Aortic root dilation, bicuspid aortic valve, endocarditis or rheumatic fever.
Mid-to-late Diastolic Murmur Location, Description and Examples?
Apex of the heart. Enhanced by maneuvers that increase LA return (expiration). Sound follows opening snap (OS). It is a delayed rumbling late diastolic murmur. A decreased time between S2 and OS correlates with increased severity. Can be secondary to rheumatic fever.
