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Clinical Medicine > L15: The Cardiovascular System > Flashcards

L15: The Cardiovascular System Flashcards

1
Q

Auscultation points for heart valves

A

1.) Aortic valve: right 2nd interspace*
2.) Pulmonic valve: left 2nd interspace* or Erb’s point = third left IC space*
3.) Tricuspid valve: left 4th interspace*
4.) Mitral valve: apex near mid-clavicular line in 5th IC space
*at sternal borders
Mnemonic = All physicians take money

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2
Q

Pericardium. Which layer is sensitive to pain? Insensitive?

A
  • Visceral (epicardium): insensitive to pain

- Parietal: sensitive to pain (innervated by phrenic nerve) – finger tip pain

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3
Q

Name and explain the 4 heart sounds

A
  1. ) S1 = produced by vibrations/turbulence created when mitral and tricuspid valves close and disrupt laminar flow of blood
  2. ) S2 = disruption of blood flow when aortic and pulmonic valves close
  3. ) S3 = blood flows passively from atria to ventricle
  4. ) S4 = turbulent blood flow in a ventricle as atrium contracts to eject any remaining blood during late diastole. Occurs when diminished ventricular compliance increases the resistance to ventricular filling
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4
Q

S3 mnemonic

A
  • KEN….tucky (beat….two beats)
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5
Q

S4 mnemonic

A
  • teNNE…ssee (two beats….one beat)
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6
Q

When is S3 normal? When is S3 pathologic?

A
  • In young people or physically fit, presence of S3 is common (physiological S3 heart sound). In elders or persons with cardiac disease, S3 is usually pathologic (pathological S3 heart sound).
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7
Q

What is a split S2 heart sound?

A
  • S2 is disruption of blood flow when aortic and pulmonic valves close
  • Split S2 = delay in closure of pulmonic valve and subsequently loss of synchronicity with aortic valve closure. This is normal and typically occurs during inspiration as the pulmonary artery can tolerate more volume of blood before pressure above the pulmonic valve increases. Also more blood fills right ventricles leading to slightly longer ejection time from that ventricle. These factors cause a delay in pulmonic valve closure.
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8
Q

What creates heart sounds?

A
  • Acceleration and deceleration of blood flow and accompanying turbulence
  • Not created by valve movement, unless valve is calcified, damaged or defective
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9
Q

Prior to detailed questioning of a chest pain pt, what is key?

A
  • Assessing for stability
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10
Q

List a few cardiac related chief complaints

A
  • Chest pain (pressure, crushing, band-like, jaw-pain, with exertion)
  • Palpitations (dysrhythmias)
  • SOB
  • Ankle swelling (edema)
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11
Q

Of THE CHADS, how many can present as chest pain?

A
  • 7 of them. CVA is excluded typically
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12
Q

Risk factors for cardiac related chief complaints

A
  • Cigarette use, poor diet (according to AHA diet is highest risk – starving = alcoholic, bulimics, anorexics), physical inactivity, obesity, HTN, dyslipidemias, diabetes, CAD, stroke, family history (less than 55 and 65 yo in first degree males and females respectively), scarlett fever, mitral prolapse, alcohol, illegal drug use, caffeine intake, stimulant use, salt?, THE CHADS, physiologic stress
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13
Q

During physical exam for a cardiac related chief complaint, what are you looking for in the “look” part of the examination?

A
  • Shape/body habitus (pear or apple-shaped obesity)
  • Scars (previous cardiac surgeries)
  • Pacemaker
  • JVD
  • Cyanosis
  • Xanthomas (indicative of dyslipidemia)
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14
Q

Where and how is PMI felt?

A
  • PMI = point of maximal impact, where apex of heart is felt most strongly
  • Place tips of fingers on left 5th interspace at mid-clavicular line and have pt lean forward while exhaling full
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15
Q

In what direction are sounds transmitted that make auscultation of heart possible?

A
  • In direction of blood flow, auscultating over areas where turbulence occurs after blood flows through a valve
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16
Q

How long to auscultate for heart sounds in each location?

A
  • about 4 beats (3 seconds)
17
Q

What part of the diaphragm does one use when auscultating the heart? What are the purposes of either side?

A
  1. ) Diaphragm = higher pitched sounds (S1, S2) – press firmly against chest wall
  2. ) Bell = lower pitched sounds (S3, S4, murmur, auscultation of arteries for bruits) – loosely againsts chest pain (not dimpling skin)
18
Q

Grading of murmurs

A
  1. ) Grade 1 = very faint, heard only after listener has “tuned in”, may not be heard in all positions
  2. ) Grade 2 = quiet, but heard immediately
  3. ) Grade 3 = moderately loud
  4. ) Grade 4 = loud with palpable thrill
  5. ) Grade 5 = very loud, with thrill, heard when stethoscope is tipped but touching body
  6. ) Grade 6 = very loud, with thrill, heard with stethoscope off the body
19
Q

In what position should pt be placed to augment low pitched filling sounds?

A
  • left lateral recumbent position
20
Q

6 criterion for naming murmurs

A
  1. ) Grade
  2. ) Where in cycle
  3. ) Sound shape
  4. ) Sound quality
  5. ) Heard loudest
  6. ) Radiation
21
Q

Is any murmur pathologic?

A
  • Any murmur heard in diastole is pathologic
22
Q

What are ejection clicks/sounds? Two types?

A
  • Turbulence produced when flow is abnormal across a semilunar valve
  • Aortic ejection sound heard in early systole is high pitched and radiates up into carotids and is not affected by respiration
  • Pulmonic ejection sound heard in early systole is less intense than aortic ejection sounds, intensifies on expiration and decreases on inspiration
23
Q

What is an opening snap?

A
  • Diastolic event that is the sound of the opening of a pathologically deformed mitral valve, common in mitral valve stenosis
  • High pitched, sharp snap or click sound not affected by respiration and easily confused with S2
24
Q

What is a pericardial friction rub sound?

A
  • Intense, grating sound that may be heard loud enough to mimic a murmur. Best heard at apex, may be heard in both systole and diastole
25
Q

Describe sound associated with mitral valve prolapse

A
  • Commonly associated with a midsystolic click over mitral area and soft mid to late systolic murmur. At times referred to as click murmur syndrome
26
Q

Why is cardiac-related pain referred to the left neck and shoulder?

A
  • Phrenic nerve innervates the parietal pericardium and it’s dermatome is C3,4,5, which overlies the neck, jaw and shoulder. Left-sided heart attack will cause left-sided phrenic nerve activation and therefore referred pain to the left C3,4,5 dermatomes
27
Q

Differentiate between a heave and a thrill

A
  • Heave = hand being lifted off chest with each heartbeat

- Thrill = palpable vibration (like cat’s purr)

28
Q

Abnormal results of palpating PMI

A
  1. ) Apical impulse
    - Displacement lateral of PMI suggests left ventricular hypertrophy
    - Increased amplitude may result from hyperthyroidism, severe anemia, pressure overload of left ventricle (aortic stenosis), volume overload of left ventricle (mitral regurg)
  2. ) PMI located somewhere other than apical impulse may result from enlarged right ventricle, dilated pulmonary artery or aneurysm of aorta
  3. ) Heaves may indicated right ventricular hypertrophy if felt at left sternal border, but when felt at apex may indicate left ventricular hypertrophy
  4. ) Thrills indicate turbulent flow, most frequently caused by aortic stenosis
29
Q

Angina

A
  • severe, often constricting pain caused by reduced arterial blood flow to myocardium, which reduces oxygen supplied to myocardial cells, causes injury and ischemia and sharp precordial pain directly related to ischemia, usually called angina pectoris
30
Q

Bruit

A
  • harsh or musical intermittent auscultatory sound especially an abnormal one
31
Q

Bacterial endocarditis

A
  • bacterial infection of the endothelial layer of the heart and valves
32
Q

Cardiac tamponade

A
  • excessive fluid accumulation between the pericardium and the heart
33
Q

CHF

A
  • failure of heart to pump effectively resulting in congestion within the pulmonary and systemic circulation of the heart
34
Q

Cor pulmonale

A
  • enlargement of the right ventricle secondary to chronic lung disease

Clinical Medicine (11 decks)

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