History and Physical Flashcards
Common symptoms cardiac in origin
1) dyspnea with exertion
2) irregular heart beat
3) faintness/dizziness
4) swell in feet/hands
5) wake from sleep SOB
6) difficulty sleep when lie flat
7) leg pain with activity
8) stroke
9) chest pain/pressure
10) Passing out
11) cyanosis
True symptom of coronary artery disease
angina pectoris
what causes angina pectoris
supply demand mismatch in the coronary arteries –> hypoxia in the myocardium –> pain
Levine’s sign
pt points directly to sternum for pain
Associated symptoms with chest pain
1) N/V
2) diaphoresis
3) lightheadedness/syncope
4) palpitations
Murmurs
a
SYNCOPE
transient loss of consciousness from cerebral hypoperfusion
define orthostatic hypotension
exercising without hydration
pressure changes when you stand up
Approach of physical exam
1) exam from pt’s right side
2) develop pattern
3) Ask questions at each step
Estimating jugular venous pressure
1) examine from right side with head turned slightly left
Blood pressure
systolic blood pressure =
systolic blood pressure = first Korotkoff sound
diastolic blood pressure = loss Korotkoff osund
define orthostatic hypotension
1) patient lie down 5 min, check BP and pulse
2) repeat
20 mm Hg DROP in systolic BP WITH STANDING
Palpating carotid arteries
1) use 1-2 fingers btwn larynx and anterior bridge of sternocleidomastoid @ level of cricoid
palpating brachial pulse
1) right brachial artery pulse palpate in ANTECUBITAL FOSSA
pt can be stand, sit, or supine
point of maximal impulse
1) hand under nipple
feel where LV is beating and hitting hand
can feel sluggish with LBBB
can feel widened with dilated cardiomyopathy
coarctation of aorta
1) if BP high in arm and lower in legs above malleolus
ex: Turner’s
if BP different in two arms what could this be
(1) aortic dissection
(2) stenosis
palpating right ventricle in epigastrium
if RV is dysfunctional feel hand slide up due to RV heave
if patient pulse irregular
if patient pulse separated by pause
atrial fibrillation
PAC or PVC
palpating dorsalis pedis artery and tibial pulses
important
where is pain most commonly assoc with myocardial infarction
pain in chest radiating to left arm
less likely locations of pain with MI
1) right side
2) jaw
3) epigstrium
4) back
Angina vs. non angina
location
angina = retrosternal, diffuse
Not angina = left inframammmary, localized
angina vs non angina
radiation
angina = left arm, jaw back
non angina = right arm
angina vs non-angina
description
angina = “aching” dull, pressing, squeezing, vise-like
non angina = sharp, shooting, cutting
angina vs non angina
intensity
angina = mild to severe
non angina = excruciating
angina vs non angina
duration
angina = minutes
non angina = sec, hour, day
angina vs non angina
precip by
angina = effort, emotion, eating, cold
non angina = respiration, posture, motion
angina vs non angina
relieved by
angina = rest, nitro
non angina = nonspecific
