Part 1 Flashcards
What is the typical patient profile for people who are heart patients?
overweight middle aged or older sedentary with little regular exercise smoker or exposed to smoke high strong compulsive or hostile personality poor stress coping skills history of bad cholesterol high BP, diabetes previous heart or vessle problems
what are some classic presentations of acute heart failure?
substernal chest pain
pressure radiating to the jaw, neck, arms, back, gastrointestinal discomfort
exertional dyspnea
pain, pressure and discomfort aggravated by physical or emotional stress, heavy meals or cold weather
general observations of acute heart failure
pale
perspiring
apprehensive
what are classic presentations of chronic right sided heart failure?
fatigue dyspnea ankle edema jugular distention ascites
What are the classic presentations of chronic left sided heart failure?
fatigue exertional dyspnea cough orthopnea pink frothy sputum
most common cause of right sided heart failure
high blood pressure
what is a common atrial gallop in MI?
S4
what is the number 1 cause of acute heart failure?
coronary artery disease
what is the traditional cardiac physical assessment procedures in classic sequence?
inspection of precordium
palpation of precordium and peripheral pulses
percussion of the heart borders
auscultation of normal and abnormal heart sounds
what do you look for when inspection?
pitting edema of the ankles
cyanosis
clubbing of fingers
apical impulse
engorgement and accentuated waves of the jugular veins
veins of the back of the hand don’t collapse when brought to heart level
what do you do during palpation?
estimate heart size and placement, should only be felt in 5th left ICS, medial to midclavicular line
feel for precordial thrills
palpation of peripheral pulses are a logical extension of the cardiac exam
what do you do during percussion?
percuss left and right heart borders moving lateral medial in iCS 5-2
what are the traditional auscultation sites?
aortic- R2ICS
pulmonic- L2ICS
tricuspid- L3ICS
mitral- L5ICS just inside midclavicular line
what are audible characteristics of heart sounds?
quality pitch intensity duration timing location respiratory variation pattern position
describe the first heartbeat
S1/Lubb sound
mitral and tricuspid close
relatively longer and lower pitched than dup
loudest at mitral valve site
having patient in the left lateral recumbent position
lubb should be in sync with the apical and carotid impulse
describe the second heartbeat
aortic and pulmonic close
shorter and higher than lubb
loudest at the aortic site
having patient sitting up and leaning forward
what are the 4 types of unexpected heartbeats?
splits, gallops, clicks and snaps
split S1
mitral and tricuspid valves aren’t closing together
heard best at tricuspid site following diastolic pause
may represent delayed tricuspid closure or RBBB
physiologic S2 split
takes longer for the right heart to propel the extra blood to the lungs, which causes the pulmonic valve to close delayed
apparent in children and some adults
paradoxical S2 split
aortic valve is pathologically delayed (LBBB)
on inspiration and expiration
fixed S2 split
pulmonic valve delayed even more than usual (septal defect)
blood from left heart is shunted to the right heart, making it harder on the right heart
ventricular gallop (third heartbeat)
early diastole
subtle, low pitched, early diastolic sound, heart best at apex with bell
implies acute or chronic heart failure in those over 40
may be functional in children, teens, young adults, late-stage pregnancy
atrial gallop (presysteolic gallop, or 4th heartbeat)
late diastole
implies acute or chronic heart failure in people 40 years old
also in functional, well conditioned athletes
how is an added early diastolic beat produced? (opening snaps of the mitral and tricuspid valves)
strep throat and scarlet fever
cadence is like a fixed S2 split
ejection clicks of the aortic and pulmonic valve
like split S1
higher pitched than atrial gallop
murmur
abnormal heart sounds due to turbulent blood flow, usually due to faulty valves or septal defects
what are the characteristics of murmurs?
quality- often a blowing or rumbling sound
usually due to valve problems
sometimes by septal defects or increased velocity or viscosity of blood
better heard with diaphragm
intensity can be faint, or loud
grade I murmur
faint in a quiet room
grade II murmur
quiet, but clearly audible
grade III murmur
moderately loud (same intensity as S1 and S2)
grade IV murmur
loud with a thrill
grade V murmur
loud with a thrill with only the edge of the stethoscope touching the patient
grade VI murmur
loud with a thrill with the stethoscope not touching the chest
presystolic murmur
short, late diastolic murmur
protosystolic murmur
short, early systolic murmur
pansystolic murmur
extends through all of systole
holosystolic murmur
extends through all of systole
continuous murmur
present through all of systole and some of diastole
where is a murmur heard best if it is because of the aortic valve?
2nd right ICS
where is a murmur heard best if it is because of the pulmonic valve?
2nd left ICS
where is a murmur heard best if it is because of the tricuspid valve?
4th left ICS
where is a murmur heard best if it is because of a mitral valve?
5th left ICS, midclavicular line
when are right sided heart valve murmurs heard best?
during inspiration
what is the pattern a murmur can take on?
crescendo or decrescendo
are all murmurs bad?
no, they can occur in children and young athletes
if the murmur is heard between S1 and S2…
it is systolic in timing
if the murmur is heard between S2 and S1..
it is diastolic in timing
machinery murmur
a continuous, rough murmur in the 2nd ICS due to a patent ductus arteriosis, that should have closed after birth
Still’s murmur
a benign, functional midsystolic murmur heard in children
Austin Flint murmur
late diastolic murmur associated with aortic insufficiency; the regurgitant blood is through to vibrate the mitral valve causing a murmur
pneumonic to remember the murmurs
he Died in her ARMS & PRTS
pericardial friction rub
inflammation of the pericardial sac with or without fluid can result in a high pitched, grating, scratching noise heard during systole and diastole
best heard with patient leaning forward in deep expiration
cardiovascular red flags
angina or intermittent claudation racing heart or palpitations persistent dyspena, fatigue or cough light headed or fainting spells ankle edema
