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Semiology second semester > Lecture 4 cv > Flashcards

Lecture 4 cv Flashcards

1
Q

CARDIOVASCULAR PHYSICAL EXAMINATION

A
  • INSPECTION
  • PALPATION
  • PERCUSSION
  • AUSCULTATION
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2
Q

INSPECTION

A

GENERAL INSPECTION

INSPECTION OF THE ANTERIOR THORAX.

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3
Q

GENERAL INSPECTION

A
  1. HEIGHT , WEIGHT => NUTRITIONAL STATUS
  2. FACIES
  3. CONSTITUTIONAL TYPE
  4. PSYCHIC STATUS
  5. SPEAKING
  6. DECUBITUS
  7. OTRHOSTATISM AND WALKING
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4
Q

INSPECTION
EXAMINATION OF SKIN, MUCOSAE AND
SUBCUTANEOUS TISSUE.

A
  • CYANOSIS
  • PALOR
  • TELEANGIECTASIS
  • JAUNDICE
  • NAILS
  • ERITEMA
  • FINGERS
  • CARDIOVASCULAR
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5
Q

INSPECTION
INSPECTION OF THE ANTERIOR THORACIC
REGION

A 
- INSPECTION OF THE ANTERIOR VERVICAL
REGION.
- INSPECTION OF THE PRECORDIAL REGION
- INSPECTION OF THE RIGHT THORACIC REGION
AND OF THE INFERIOR STERNAL REGION.
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6
Q

INSPECTION

PERIODS

A
  • STATIC

- DYNAMIC

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7
Q

INSPECTION OF THE ANTERIOR CERVICAL REGION

A
  1. CAROTID PULSATION (ARTERIAL DANCE)
  • JUGULAR PULSATION
  • JUGULAR TURGOR
  1. AORTIC PULSATION
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8
Q

INSPECTION OF THE PRECORDIAL REGION

A
  • VISIBLE APICAL IMPULSE
  • LEFT VENTRICULAR ANURYSM
  • AORTIC ANEURYSM
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9
Q

INSPECTION OF THE RIGHT HEMITHORAX AND STERNAL REGION

A
  • AORTIC ANEURYSM
  • LIVER PULSATIONS
  • RIGHT VENTRICULAR IMPULSE
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10
Q

PALPATION

A
  1. ANTERIOR CERVICAL REGION
  2. STERNAL NOTCH
  3. APICAL IMPULSE
  4. MEZOCARDIAC REGION
  5. AUSCULTATION AREAS
  6. IRRADIATION AREAS
  7. EPIGASTRIC REGION
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11
Q

PALPATION

APICAL IMPULSE

A
  • LOCATION
  • SURFACE
  • AMPLITUDE
  • UNICITY
  • RITHMICITY
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12
Q

PALPATION

AREAS- FOCI

A
  1. CARDIAC SOUNDS EQUIVALENTS
  2. THRILLS –palpable vibrations from murmurs or
    bruits- grade 4/6 or louder.
  3. PERICARDIAL RUB.
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13
Q

PERCUSSION

2 MOMENTS

A
  • SUPERFICIAL
  • DEEP.
    LOCATION OF THE CARDIAC DULLNESS -> RELATIVE
    ABSOLUTE
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14
Q

PERCUSSION

A

RV -> RIGHT EDGE OF THE STERNUM III – VI IC.
-> DOWNWARDS INCREASED DULLNESS
LV -> POSTERIOR PERCUSSION

AO -> RIGHT EDGE. SP II – III IC.

PA -> SP III IC. LEFT.

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15
Q

CARDIAC AUSCULTATION

A

DIRECT CORRELATION BETWEEN
HEMODYNAMIC PHENOMENA – ACOUSTIC
PHENOMENA = ACURACY OF THE CONCLUSION

PRACTICABLE IN ANY CONDITIONS
C. A. => DIRECT (IMEDIATE)
INDIRECT (MEDIATE)

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16
Q

BIAURICULAR STHETOSCOPE

A
  • AURICULAR PIECE: COMFORTABLE
  • TUBES: 25 – 30cm, lumen ≥ 3mm
  • CHEST PIECE: FLAT RESPONSE CURVE FOR: 50 – 1200 Hz
 TECHNIQUE
-  QUIET ROOM
 WE LISTEN FOR
    1. LOW FREQUENCIES
    2. HIGH FREQUENCIES
-  COMFORTABLE POSITION
-  PACIENT IN DORSAL DECUBITUS
-  SPECIFIC MANOEUVRES
-  ORTHOSTATISM
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17
Q

AUSCOULTAION FOCI(AREAS)

A

LOOK AT THE PRESENTATION

18
Q

– – TUM – TA – – TUM – TA – –

A

SOUND I

FREQUENCY — VARIABLE

RHYTHMICITY — VARIABLE

INTENSITY — INTENSE

PITCH — LOWER

DURATION — LONGER

DELIMITATION — LESS CLEAR

AUDIBILITY — MITRAL AREA

19
Q

SOUND II

A

FRECUENCY — VARIABLE

RHYTHMICITY — VARIABLE

INTENSITY — LESS INTENSE

PITCH — HIGHER

DURATION — SHORTER

LIMITS — CLEAR

AUDIBILITY — BASE OF THE HEART.

20
Q

HEART SOUNDS

A

TAKE A LOOK AT SLIDE 22

21
Q

CONCOMITANT

A

DIMINUATION

ENHANCEMENT

22
Q

SEPPARATE

A

DIMINUATION
ENHANCEMENT
VARIABLE
SPLITTING

23
Q

CHANGES IN HEART SOUNDS

DIMINUATION

A

EMPHYSEMA
OBESITY
EXTREME TACHY

24
Q

CHANGES IN HEART SOUNDS

ENHANCEMENT

A
  • “FETAL RHYTHM”
  • CARDIOGENIC SHOCK
  • RHEUMATIC FEVER (initial)
25
Q

CHANGES IN HEART SOUNDS

_______ —–>

A
  • CHILDREN
  • HYPERKINETIC status.
  • hypertension
  • —->
  • RHEUMATIC FEVER(late)
26
Q

CHANGES IN SOUND I

SOUND I INTENSITY IS DETERMINED BY:

A
  1. POSITION OF THE CUSPS.
  2. VALVULAR INTRINSIC MOBILITY.
  3. LV CONTRACTION VELOCITY
  4. MITRAL VALVE COMPLETE CLOSURE.
  5. OTHER BIOLOGICAL AND PHYSICAL CHARACTERISTICS OF THE VALVES.
27
Q

ENHANCEMENT OF SOUND I

EHANCEMENT

A
  • NONCALCIFIED MITRAL STENOSIS.

- SCLEROUS VALVES.

28
Q

SOUND I DIMINUATION

A

TAKE A LOOK AT SLIDE 27 ,28

29
Q

Changes in sound I
VARIABLE S I
——>
SPLITTING OF S I

A
  • ATRIAL FIBRILLATION
  • —–>
  • AV DISSOCIATION.

1 .MITRAL component

  1. – TRICUSPID component

PHYSIOLOGIC
PATHOLOGIC
− RBBB,LBBB
− idioventricular rythm

30
Q

Intensity changes for Sound II

A 
S II formed of
- ­ II A
- II P
ENHANCEMENT
 - PHYSIOLOGIC – pulmonary area (↑ in inspiration)
 - PATHOLOGIC

AORTIC AREA (CLANGOR)

  • hypertension
  • AORTIC ATHEROMA

PULMONARY AREA (pulmonary hypertension)

  • MITRAL STENOSIS
  • COR PULMONARE (±)
  • Primary pulmonary hypertension
  • Congenital heart disease
  • Interatrial septal defect.
31
Q

CHANGES IN INTENSITY-SOUND II

DIMINUATION

A

AORTIC area

  • hypotension
  • SHOCK
  • AORTIC REGURGITATION
  • AORTIC STENOSIS, CALCIFIED

Pulmonary area
- PULMONARY VALVULAR STENOSIS

32
Q

CHANGES IN INTENSITY-SOUND II

SPLITTING

A

SPLITTING
> PHYSIOLOGICAL - ONLY in the pulmonary area in INSPIRATION.
> PATHOLOGIC
LARGE SPLITTING
- RBBB.
- PULMONARY VALVULAR STENOSIS
- MITRAL REGURGITATION

   FIXED SPLITTING (NO change in inspiration)
                  -  ATRIAL SEPTAL DEFECT
   REVERSED SPLITTING
                   - LBBB
                   - AORTIC STENOSIS
33
Q

THREE STROKE CARDIAC RHYTHM

A
  1. PHYSIOLOGIC - S III physiologic
  2. PATHOLOGIC
  3. SPLITTING of SI
  4. SPLITTING of SII
  5. CLICKS
    • PROTOSYSTOLIC
      –>AORTIC
      PULMONAR
    • MEZOTELESYSTOLIC
    • IZODIASTOLIC
    • MITRAL VALVE OPENING.
  6. GALOPURI
34
Q

CLICKS

PPROTOSYSTOLIC CLICK

A

PPROTOSYSTOLIC CLICK

  • Short, snaped , ejectional click
  • Large psudosplitting of SI = SI + click

AORTIC

  • it can be listened in the mitral area.
  • no obvious respiratory variation
  • Noncalcified AS – aortic sclerosis.
  • AR sometimes.
PULMONARY
pulmonary area
disappearance in inspiration.
- LARGE PS
- PAH
- MS
35
Q

CLICKS

MESOTELESYSTOLIC CLICK

A 
MESOTELESYSTOLIC CLICK
- LARGE INTENSITY
- SHORT
- SNAPED 
             in PRIMARY VALVULAR MITRAL PROLAPSE
  • VIBRANT
  • SUPERFICIAL
  • Also called – triolet sound.
36
Q

CLICKS

ISODIASTOLIC CLICK

A

ISODIASTOLIC CLICK

  • LARGE INTENSITY
  • SHORT
  • HIGH PITCH
  • IT HAPPENS “UNDER THE EAR”
  • MAXIMAL INTENSITY –LOWER STERNUM in CONSTRICTIVE PERICARDITIS.
37
Q

CLICKS

MITRAL OPENING CLICK (TRICUSP)

A

MITRAL OPENING CLICK (TRICUSP)

  • LARGE INTENSITY
  • SHORT
  • IT IS PERCEIVED AT A DEFINITE DISTANCE FROM SII.
  • BETTER HEARD AT THE APEX AND LOWER STERNUM
  • CHARACTERISTIC FOR MS WITH NONCLCIFIED VALVES.
  • IN MS, MITRAL DISEASE , MR (RARE)
38
Q

GALLOPS

A
  • PATHOLOGICAL SOUNDS
  • ONLY IN DIASTOLE
  • LOW PITCH
  • LOW INTENSITY
  • DULL ARMONICS.
39
Q

GALLOPS
LEFT
RIGHT

A
  • PRESYSTOLIC
  • PROTODIASTOLIC
  • SUMMATION
40
Q

GALLOPS

PRESYSTOLIC = S IV PATHOLOGIC

A

PRESYSTOLIC = S IV PATHOLOGIC

  • CONNECTED TO THE ATRIAL SYSTOLE
  • SIGN OF DIASTOLIC LV DYSFUNCTION-elevated filling pressure.
  • CAUSES:
    1. HYPERTENSION
    2. LEFT VENTRICULAR HYPETROPHY
    3. CAD
    4. AMI
    5. HYPERTROPHIC CARDIOMYOPATHY concentric
    6. Severe Aortic Stenosis
    7. Third degree AV block.
41
Q

GALLOPS

PROTODIASTOLIC = S III pathologic

A 
PROTODIASTOLIC = S III pathologic
> Ventricular gallop
> SVERE LEFT VENTRICULAR DYSFUNCTION.
> PROGNOSIS ( 4 – 5 YEARS)
> CAUSES:
         - CAD
         - HYPERTENSION
         - DILATED CARDIOMYOPATHIES
         - EXCENTRIC HYPERTROPHIC
         - CARDIOMYOPATHY.
42
Q

GALLOPS

MESODIASTOLIC = SUMMATION

A

MESODIASTOLIC = SUMMATION

  • SUM OF THE S3 AND S4.
  • TACHYCARDIA
  • GRADE I AV BLOCK.

RIGHT.

  • LOWER EXTREMITY OF THE STERNUM
  • ENHANCED IN POSTINSPIRATORY APNEEA.

Semiology second semester (13 decks)

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