Lecture 4.2 cardiac pt 1 (8% of final) Flashcards
1) What makes up most of the ant. surface of the heart?
2) Where does this structure lead to?
3) Where does that second structure go?
1) Right ventricle (RV)
2) Pulmonary artery at the sternal notch
3) Courses pt. left.
Aorta courses along what boarder?
Right upper sternal
Where do murmurs heard in the right 2nd interspace originate?
Aortic valve
Where do murmurs heard in the left 2nd and 3rd interspaces (and at higher and lower levels) originate?
Pulmonic valve
Where do murmurs heard at or near the lower left sternal border originate?
Tricuspid valve
Where do murmurs heard at or around the cardiac apex originate?
Mitral valve
Trace the path of blood through the heart (12 steps)
1) SVC
2) Right atrium
3) Tricuspid valve
4) Right ventricle
5) Pulmonary SL valve
6) Pulmonary artery to lungs
7) Lungs
8) Pulmonary veins
9) Left atrium
10) Bicuspid/ mitral valve
11) Left ventricle
12) Aortic SL valve
What is synonymous with “systole vs diastole”
Constriction vs. rest
1) What is happening during systole?
2) What is happening during diastole?
1) Systole: blood flows from pulmonary and aortic SL valves
2) Diastole: blood flows through tricuspid and bicuspid (mitral) valves
During what stage is the pulse palpable?
In the middle of systolic, after S1
1) What is closing during the S1 sound?
2) What is closing during the S2 sound?
1) S1: mitral and tricuspid
2) S2: aortic and pulmonary
1) What is stenosis?
2) What is regurgitation?
1) Valve is disfigured, slightly closed even when supposed to be open, causing turbulent flow of blood through it, causing a murmur
2) Valve is open when supposed to be closed
1) When will aortic/ pulmonic stenosis be heard? Why?
2) What does it relate to? What kind of sound?
1) During systole/ S1, because it’s closed when it should be open
2) Carotids; cresendo-decrescendo
What is aortic stenosis characterized by?
Crescendo-decrescendo sound (rises in intensity, then falls)
When does mitral/ tricuspid stenosis occur?
During diastole, S2
When is mitral/ tricuspid regurgitation heard?
Heard throughout
1) When would aortic/ pulmonary regurgitation occur?
2) Where would you hear it?
1) Diastole; blood leaks back into ventricle when valve should be closed
2) Left upper sternal boarder
1) What is a VSD?
2) Where does this occur?
3) Where is blood moving? What will happen?
4) What kind of murmur does this cause?
1) Ventricular septal defect
2) L 3-5th interspaces
3) To the right ventricle from the left; goes back to the lungs
4) Plateau murmur
1) What is PDA?
2) What usually happens?
3) What kind of sound does this cause?
1) Patent ductus arteriosus; aorta and pulmonary artery are linked
2) Usually closes, if it doesn’t it will remain patent
3) Continuous machine-like murmur after both S1 and S2
1) Where is hypertrophic cardiomyopathy?
2) When is it decreased?
3) What kind of murmur?
4) What can it cause?
1) L 3-5th interspaces
2) Decreased with squat
3) Systolic murmur (that goes away with squatting)
4) Spontaneous cardiac arrest
1) What does an innocent/ physiologic murmur sound like?
2) Where is it?
3) When does it occur?
1) Soft: grade 1-2
2) Left sternal murmur
3) Always in systole
List the 6 grades of murmurs. What are most murmurs?
1) Very faint, heard only after listener has “tuned in”; may not be heard in all positions
2) Quiet, but heard immediately after placing stethoscope on the chest
3) Moderately loud
4) Loud, with palpable thrill
5) Very loud, with thrill. May be heard with stethoscope partially off chest.
6) Very loud, with thrill. May be heard with stethoscope entirely off chest.
-Most are 2 or 3
1) What do S4 gallops sound like?
2) What do S3 gallops sound like?
3) What is splitting?
1) “Tenne-ssee” (pre S1)
2) Kentucky (post S2)
3) S2 can split, aortic valve and pulmonic valve don’t close at the same time, causing two sounds. Hard to hear.
1) What is friction rubbing indicative of?
2) What is a mid-systolic click indicative of? What does it sound like and when do you hear it?
1) Pericarditis; “scratching the surface”
2) Mitral valve prolapse with regurgitation; “lub, pucker, dub”; late systolic murmur
1) Define cardiac output
2) What would it depend on?
1) How much your heart pumps in a minute
2) How much it pumps per beat, and how often it beats
1) Define preload
2) When does it go up?
1) How much blood you’ve got in the RV before it loads
2) When your venous system dumps a bunch of blood into your heart
1) Define afterload
2) When does it go up? (2)
1) The amount of resistance your heart’s LV has to overcome as it squeezes blood out
2) When you have a bunch of blood in your system or when your arterial system is all “clamping down”
1) Explain jugular venous pressure
2) What is it important in?
1) Atrial contraction produces the “a” wave (“A” for atrial contraction)
-Then, filling of the atria from vena cava produces second “V” wave (V for vena cava)
2) Assessing for heart failure
Define pulse pressure
The difference between your systolic and diastolic blood pressures
What is Pulsus Alternans?
Regular pulse, but it alternates between strong and weak beats
1) What is a paradoxical pulse?
2) When is this diagnosis earned?
3) What is it seen in?
1) Decrease in amplitude on inspiration
2) If sys. BP goes down by 10-12 mmHG
3) Pericardial tamponade
What are the four grades of pulses?
0+: absent, unable to palpate
1+: diminished, weaker
2+: brisk, normal
3+: bounding
List the red flags for heart issues (5)
1) Chest pain
2) Palpitations
3) SOB: dyspnea, orthopnea, paroxysmal nocturnal dyspnea
4) Swelling
5) Fainting
Give 3 examples of types of SOB
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
1) What could chest pain always be?
2) What could it also be?
1) MI
2) Aortic dissection, along with the pulmonary complaints of last lecture
1) What 4 symptoms correspond with infarction?
2) What type of symptoms are indicative of MI?
3) What questions should you ask the pt? Why?
1) Diaphoresis, SOB, presyncope, and nausea
2) Worse with activity and relieved with rest i
3) Make sure you suss out the pt’s family, social, and medical history: Smoking, diabetes, HTN, dyslipidemia, obesity and early MI in family are all risk factors
List risk factors for MI
Smoking, diabetes, HTN, dyslipidemia, obesity and early MI in family
List the key components of dissection (first 3 most important)
1) Tearing pain
2) Rapid onset
3) Sharp pain
4) Radiation to the back or neck
5) Diaphoresis
6) Neurological deficit
Physical exam findings in dissection include what?
Marked difference in upper extremity blood pressure
1) What are palpitations?
2) What words can be used to describe them?
3) Give 3 potential causes
1) Unpleasant awareness of the heartbeat
2) “Skipping, racing, fluttering, pounding, stopping”
3) Anxiety, hyperthyroid, atrial fibrillation
Besides the general complaint of dyspnea, what two things point towards HF?
Orthopnea and paroxysmal nocturnal dyspnea
1) What kind of weight gain points toward fluid overload? What may this indicate?
2) What should you do next? Give examples
1) Rapid weight gain with confirmed pretibial edema; may indicate heart failure
2) Add to your history and ask the questions that help you to cluster symptoms around this diagnosis
(like orthopnea, paroxysmal nocturnal dyspnea)
Syncope has many causes, but among them are what two things?
Arrhythmia and sudden cardiac failure
1) How do you investigate if syncope has a cardiac origin?
2) What do you need to know to investigate this complaint correctly?
3) Give examples
1) Sussing out the remainder of the history is key
2) Everything about the circumstance of their fainting spell
3) Do they remember it, did anyone see it, did the pt. shake, did they hit their head when they fell, did their vision change, did they feel the fainting coming on, had they just changed position, was their any accompanying chest pain, are they still having any symptoms: dizziness, SOB, difficulty moving, presyncope, confusion, ongoing pain – if so, where???
