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Comps - Mod 2 > PC 615 test 1 - Sheet1(1) > Flashcards

PC 615 test 1 - Sheet1(1) Flashcards

1
Q

Reasons to order an ECG

A

To provide support for a diagnosis. Questionable cardiovascular complaint, including chest pain, dyspnea, and dizziness, routine physical exams (to obtain a baseline), pre-op, and for individuals starting exercise programs. Quick and inexpensive, non-invasive.

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2
Q

Downfall of ECG

A

Can provide false positives and false negatives. Brief view of heart, not 100% specific, specific lead placement required, doesn’t specifically diagnose MI, many normal variations, difficult to interpret, and cannot replace thorough H&P.

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3
Q

Important information to gather along with the ECG

A

Complete history and complete physical exam

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4
Q

Information provided by the ECG

A

Rhythm disturbances, conduction abnormalities, electrolyte disturbances, medication/drug effects, chamber enlargement, ischemia, mass of cardiac muscle, and orientation of heart in the chest

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5
Q

What cardiac leads of an ECG do

A

Provide a view of the heart’s electrical activity between two points and each has a negative and positive pole.

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6
Q

Measurement of smallest boxes on ECG paper

A

1 mm

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7
Q

Measurement between heavy lines on ECG paper

A

5 small boxes

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8
Q

Time measurements of boxes on ECG

A

Large blocks = 3 seconds; 30 large blocks = 6 seconds

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9
Q

Wave forms on ECG

A

Represents the heart’s electrical activity that occurs in one cardiac cycle

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10
Q

P wave

A

First component of normal ECG and represents artial depolarization.

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11
Q

ECG indications of atrial hypertrophy - such as tricuspid valve stenosis or pulmonary hypertension

A

Peaked notched or inverted P waves

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12
Q

Indication of broad or bifid P waves

A

Anything that causes left atrium hypertrophy, such as mitral stenosis

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13
Q

ECG indications of retrograde conduction through AV junction

A

Inverted P wave

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14
Q

Indication if P wave does not precede the QRS

A

Heart block may be present

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15
Q

Indication of a prolonged PR interval

A

Conduction delay as with digoxin or heart block

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16
Q

QRS wave

A

Represents depolarization of the ventricles.

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17
Q

Indication of deep and wide Q wave

A

Possible MI and also buncle branch blocks

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18
Q

Pathological Q wave

A

Depth is greater than 33% of height of next R wave or if the Q wave is 0.04 seconds or more.

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19
Q

Indication of pathological Q wave

A

Dead non-conducting tissue

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20
Q

Indication of notched R wave

A

Possible bundle branch block

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21
Q

Indication of tall R wave

A

Left ventricular hypertrophy in V5 or V6

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22
Q

Indication of missing QRS

A

Possible AV block or ventricular standstill

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23
Q

What does the ST segment measure

A

The end of ventricular conduction and beginning of re-polarization

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24
Q

J joint

A

Located at the end of the QRS complex and the beginning of the ST segment

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25
Q

Indication of ST segment elevation

A

Small infarct, pericarditis, or ventricular aneurysm

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26
Q

Indication of ST segment depression

A

Partial thickness infarct or digitalis effect

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27
Q

T wave

A

Indicates ventricular repolarization

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28
Q

Indication of peaked T wave

A

Ventricular recovery and can be caused by hyperkalemia

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29
Q

Indication of bumpy T waves

A

May indicate a hidden P wave

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30
Q

Indication of tall or tented T waves

A

Possible MI or electrolyte imbalances such as hyperkalemia

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31
Q

Indication of MI looking at T wave deflection

A

Inversion in leads I, II, aVl, aVf, or V2 through V6

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32
Q

Indications of notched or pointed T waves

A

Possible pericarditis

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33
Q

When is T wave inversion normal

A

Common in blacks and with digoxin treatment.

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34
Q

Indication of T wave inversion in lateral leads

A

Left ventricular hypertrophy

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35
Q

Indication of sloping ST depression and T wave inversion

A

Indicates digoxin treatment

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36
Q

Indication of T wave flattening

A

Hypokalemia

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37
Q

What does the QT interval measure

A

The time needed for ventricular depolarization and repolarization.

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38
Q

Causes of prolonged QT intervals

A

Certain drugs and congenital cardiac anomalies

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39
Q

Causes of short QT intervals

A

Digoxin toxicity o electrolyte disturbances

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40
Q

Dangers of prolonged QT intervals

A

Can produce drug-induced ventricular tachycardia. This form of drug toxicity is called Torsades de Points.

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41
Q

What does the U wave measure

A

Re-polarization of the HIS Purkinje system. Not present on every ECG. Follows T wave and is usually upright.

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42
Q

Pathological U wave

A

Occurs if it follows a flat T wave

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43
Q

Indication of prominent U wave

A

May result from hypercalcemia, hypokalemia, or digoxin toxicity

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44
Q

S wave

A

Any deflection below the baseline following an R wave and is when the main muscle is depolarized

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45
Q

Indication of deep S wave in V1 or V2

A

Left ventricular hypertrophy

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46
Q

Is the rhythm regular or irregular?

A

Refers to the part of the heart that is controlling the activation sequence. For atrial rhythm, measure P-P interval. For ventricular rhythm, measure R-R intervals

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47
Q

System of examining a heart rhythm

A

Rate - rhythm - axis - description of QRS complexes - description of ST segments and T waves - look for hypertrophy - look for infarction

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48
Q

Are P waves present?

A

Do the P waves have normal configuration? Is ther a 1:1 ration between P waves and QRS complexes? Do all P waves have similiar shape and size? Is the PR interval constant?

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49
Q

Examining the QRS wave

A

Is the duration within normal limits? Are all the QRSs the same size and shape? Does a QRS come after each P wave?

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50
Q

Causes of abnormal cardiac rhythm

A

Flutter, fibrillation, heart block, escape rhythm

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51
Q

Axis

A

The direction of the movement of electrical depolarization as it spreads through the heart. Electrical impulses occur in 3 dimensions.

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52
Q

Normal axis measurement

A

30 to +90 degrees. Some books say 0 degrees to +90 degrees

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53
Q

Normal path of electrical currents of the heart

A

Normally from the right atrium through the left ventrical

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54
Q

Depolarization of the septum

A

Occurs left to right

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55
Q

Normal axis

A

0 to +90 degrees

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56
Q

Causes of right axis deviation

A

Normal variation, lateral wall MI, left posterior hemi-block, RBBB, emphysema, right ventricular hypertrophy, pulmonary hypertension, pulmonic stenosis. Mainly caused by pulmonary conditions and congenital disorders. Requires no treatment.

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57
Q

Axis deviation of infants and children

A

Normally have right axis deviation

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58
Q

Axis deviation of pregnant women

A

Normally have left axis deviation

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59
Q

Causes of left axis deviation

A

Caused by a conduction defect. Normal variation, inferior wall MI, left anterior hemi-block, Wolff Parkinson White syndrome, mechanical shifts (ascites, pregnancy, tumors), aortic stenosis, aging

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60
Q

Right atrium enlargement

A

Affects P wave and caused by COPD, tricuspid stenosis, tricuspid regurgitation, and PE. Caused by any severe lung disease.

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61
Q

Axis deviation in tall, thin individuals and short, fat individuals

A

Normal left deviation

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62
Q

ECG changes related to right atrium enlargement

A

Peaked P wave in lead II greater than 2.5 mm amplitude; V1 increasing in initial positive deflection

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63
Q

Left atrium enlargement

A

Causes delay in electric in left atrium, causing change in shape of P wave. Caused by mitral valve stenosis or insufficiency and left ventricular hypertrophy

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64
Q

ECG changes related to left atrium enlargement

A

P wave duration of 0.11 msec or longer; notching of P wave with peaks 1 mm apart, prominence of the terminal portion of P wave in V1

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65
Q

Right ventricular hypertrophy

A

Caused by right ventricular outflow obstruction, pulmonary disease, pulmonary HTN, pulmonary valve stenosis, tetratology of Fallot, and ventricular septal defect

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66
Q

ECG changes related to right ventricular hypertrophy

A

QRS complex: R wave getting progressively smaller from V1-V6, deep S wave in V5 or V6, slightly increased QRS duration, ST depression may occur, T wave inverted in V1 and V2, and may have right axis deviation

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67
Q

Causes of left ventricular hypertrophy

A

Mitral insufficiency, cardiac myopathy, aortic stenosis or insufficiency, HTN

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68
Q

ECG changes related to left ventricular hypertrophy

A

QRS prolonged with increased amplitude, increasing amplitude in R waes in I, aVl, V5, V6. S wave increasing in V1 and V2. Possible ST depression with T wave inversion. T wave may be inverted in V5 or V6. May have left axis deviation

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69
Q

Ischemia

A

Blood flow and O2 demands are out of sync, can be reversed. Indicated by ST depression on ECG

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70
Q

Injury

A

Ischemia prolonged and damage present. Indicated by ST depression on ECG

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71
Q

Infarction

A

Death of cells, damage irreversible. Indicated by ST segment elevation on ECG. Represents MI or pericarditis.

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72
Q

ECG changes of anterior MI

A

Q wave in V1 to V4 and ST elevation. V3 and V4

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73
Q

ECG changes of lateral MI

A

aVl and lead I, V5 and V6 with Q wave and ST elevation

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74
Q

ECG changes of inferior MI

A

Leads II and III, and aVF with Q wave and ST elevation

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75
Q

ECG changes of posterior MI

A

Oppositeo f anterior MI, with a larger R wave, and with ST wave depression

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76
Q

Diagnosing MI on ECG

A

Look for changes in 2 contiguous leads. Changes in more than 1 lead in a cluster or grouping is diagnostic. That means two leads are in diagnostic groupings.

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77
Q

ECG changes hours following cardiac blood flow obstruction

A

May see ST depression

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78
Q

ECG changes hours to days following cardiac blood flow obstruction

A

May have Q wave, may have ST elevation, may have T wave inversion

79
Q

ECG changes days to weeks following cardic blood flow obstruction

A

Q wave may be present, ST elevation decreasing, may have deepening T wave inversion

80
Q

ECG changes weeks to months following cardiac blood flow obstruction

A

May have Q wave, ST elevation may resolve, and T wave my return to positive deflection

81
Q

Depressed ST segments

A

In ischemia and with digoxin

82
Q

Supraventricular rhythms tracings on ECG

A

Have narrow QRS complexes. Only exception are right or left BBB that will produce wide QRS complexes

83
Q

Ventricular rhythm tracings on ECG

A

Have wide QRS complexes and a rate of 30 or less

84
Q

Acute causes of chest pain

A

MI, PE, pneumothorax and other pleuritic disease, pericarditis, aortic dissection

85
Q

Causes of intermittent chest pain

A

Angina, oseophageal pain, muscular pain, and nonspecific pain

86
Q

Diseases associated with left ventricular hypertrophy

A

Aortic stenosis or regurgitation or mitral regurgitation

87
Q

Diseases associated with right ventricular hypertrophy

A

Mitral stenosis, severe lung disease

88
Q

Most common sustained cardiac rhythm disturbance

A

A fib. More common in men and increasing in prevalence with age

89
Q

Mechanism for reentry

A

Involves the existence of two conduction pathways with different refractory periods

90
Q

Symptoms of tachyarrhythmias

A

Usually asymptomatic, but when symptoms do occur, it is related to ventricular rate, extent of underlying heart disease, ventricular function, and associated precipitating factors. Palpitations are most common symptom

91
Q

Adverse effects of tachyarrhythmias

A

Ventricular filling is compromised, causing hypotension, chest pain, heart failue, change in LOC, or even sudden cardiac death

92
Q

Physical exam of patient experiencing tachyarrhythmias

A

Color, respiratory effort, anxiety, hydration status, evidence of dehydration and hypovolemia, mental status, auscultation of heart and lungs, JVD

93
Q

ECG of sinus tachycardia

A

P wave for each QRS. Rhythm regular, P waves identical, QRS complexes are normal and narrow, rate is above 100

94
Q

Paroxysmal supraventricular tachycardia (PSVT)

A

Rate 140-240, regular rhythm, P waves may appear different, QRS more narrow, P waves may be buried in previous beats

95
Q

Atrial flutter

A

Rate between 250-350, Sawtooth appearance of P waves

96
Q

Atrial fibrillation

A

Normal P wave replaced by F wave producing wavy baseline, rate 350-650, irregularly irregular ventricular response. More common in men

97
Q

PVCs

A

Wide QRS complexes that interrupt the prevailing rhythm, P wave usually absent, beat often followed by a full compensatory pause

98
Q

Indications of S3 sound

A

Occurs in early diastole at time of maximum ventricular filling. May commonly be heard in young fit adults and during pregnancy. Best heard with bell. May warn of impending heart failure and is a significant finding.

99
Q

Drug of choice for treatment of PVCs

A

Beta blockers

100
Q

Symptomatic bradycardia

A

A documented bradyarrhythmia that is directly responsible for the development of frank syncope or near-syncope, transient dizziness, or lightheadedness and confusional states resulting from cerebral hypoperfusion attributable to a slow ventricular rate

101
Q

Characteristic symptoms of chronic stable angina

A

Symptoms occur with predictable frequency, severity, duration, and provocation, occur with exertion, relieved by rest and no more than one nitro tab, and generally last for 1-3 minutes

102
Q

Levine’s sign

A

Patients who present with a clenched fist over their sternal area as a result of chest pain

103
Q

Murmur

A

A relatively lengthy series of sounds produced by the turbulent flow of blood

104
Q

Causes of murmurs

A

High rates of flow through a normal or abnormal valve; forward flow through a constricted or irregular valve or into a dilated vessel; or backward flow through a regurgitant valve, septal defect, or patent ductus arteriosus

105
Q

Aortic stenosis

A

Harch, creschendo-decrescendo characteristic sound. Located right sternal border, but the click is loudest at apex. Valsalva maneuver decreases murmur. Patient presents with chest pain, syncope, exercise intolerance, and dyspnea. Left ventricular hypertrophy results

106
Q

Mitral regurgitation

A

Pansystolic blowing characteristic sound. Located apex, radiation to axilla. Left ventricular hypertrophy results. May be asymptomatic for years then present with complaints of fatigue and dyspnea on exertion

107
Q

Mitral valve prolapse

A

Mid to late systolic; occasionally honking; may have midsystolic click. Located lower left sternal border. ECG usually within normal limits. May be asymptomatic for years then present with chest discomfort, palpitation, mid dyspnea, fatigue, and anxiety. Most prevalent in women. Often seen in pectus excavatum and shallow AP diameter. Moves forward with position change to standing.

108
Q

Heart blocks

A

Interference with the conduction process

109
Q

First-degree heart block

A

Conduction delay along the bundle of His. PR interval is prolonged. May be a sign of CAD, acute rheumatic carditis, digoxin toxicity, or electrolyte disturbances. No specific actions

110
Q

Second-degree heart block

A

Some conduction failes to pass through the AV node or the bundle of His. Usually indicates a heart disease, often seen in MI.

111
Q

Mobitz type 2

A

There is an occassional atrial contraction without a subsequent ventricular contraction.

112
Q

Wenchkebach

A

There is progression lengthening of the PR interval until a QRS is eventually dropped

113
Q

2:1 or 3:1 conduction disorder

A

There are more atrial contraction or P waves than QRS complexes. May indicate a need for temporary or permanent pacing

114
Q

Third-degree heart block

A

Atrial contractions are normal, but there is no connection to the ventricular contractions. Indicates conducting tissue disease.

115
Q

Bundle branch blocks

A

Occurs with abnormal conduction with either BBB and causes a delay in ventricular depolarization resulting in wide QRS complex

116
Q

Right bundle branch block

A

Often common in healthy people. Indicated by RSR1 wave in V1. Can be caused by PE

117
Q

Left bundle branch block

A

Always indicates heart disease and prevents ECG interpretation. Lead V6 shows a letter “M”. May be asymptomatic, but may present with chest pain. May indicate MI.

118
Q

Indications of PE on ECG

A

Peaked P waves, right axis deviation (S waves in lead I), tall R wave in V1, RBBB, inverted T in V1, V2, or V3

119
Q

Lateral cardiac problems - ECG

A

Leads I, aVL, V5, and V6

120
Q

Inferior cardiac problems - ECG

A

Leads II, III, and aVF

121
Q

Septal cardiac problems - ECG

A

Leads V1 and V2, ST segment elevation

122
Q

Posterior cardiac problems - ECG

A

Leads V1 to V2, V3. ST segment depression, tall upright R waves

123
Q

Anterior cardiac problems - ECG

A

Leads V4 and V4

124
Q

Types of bradycardias

A

Sinus brady, SA exit block, AV nodal block, first-degree AV block, second-degree AV block, third-degree AV block, bundle branch blocks

125
Q

Types of narrow complex tachycardias

A

Sinus tach, atrial tach, a flutter, a fib, multifocal atrial tachycardias, paroysmal atrial tachycardia, AV nodal reentry tachycardia, AV reciprocating tachycardia, PACs, and PJC

126
Q

Types of wide complex tachycardias

A

V tach, V fib

127
Q

When is consultation most appropriate

A

Arrhythmia with hemodymanic decompensation - EMERGENCY!! Arrhythmias requiring non-pharmacologic agents - pacemaker, ablation, ICD implantation. New arrhythmias. Refractory to standard drug therapy - when pt on max doses. ECG changes. Co-mordibities - DM, HF, hyperlipidemia, PVD. Adventitious heart sounds, new murmurs, changes in heart sounds, arrhythmias

128
Q

System of assessing cardiac sounds

A

First heart sound - second heart sound - sounds in systole - sounds in diastole - systolic murmurs - diastolic murmurs - sound/murmurs in systole AND diastole

129
Q

Where to listen to diastolic murmurs

A

Best heard with patient sitting, leaning forward, and exhaling

130
Q

Where to listen to aortic insufficiency murmurs

A

Best heard at upper right sternal border

131
Q

When to use diaphragm of stethoscope

A

High frequency sounds of S1 and S2

132
Q

When to use bell of stethoscope

A

Low frequency or low pitch sounds such as diastolic murmurs of mitral stenosis - listen to S3 and S4

133
Q

S1

A

Closure of mitral and tricuspid valves

134
Q

S2

A

Closure of aortic and pulmonic valves

135
Q

Systolic murmurs

A

Pneumonic MRPASSMVP

136
Q

Pneumonic MRPASSMVP

A

Mitral regurgitation, physiologic, aortic stenosis, systolic murmurs, mitral valve prolapse

137
Q

Diastolic murmurs

A

Pneumonic MSARD

138
Q

Pneumonic MSARD

A

Mitral stenosis, aortic regurgitation, diastolic murmur

139
Q

Mitral stenosis

A

Always caused by rheumatic heart disease. May present with dyspnea and fatigue. Loud at S1. Low pitched diastolic rumble. Heard best at apex. Best heard in left lateral position. No radiation.

140
Q

Physiological (innocent) heart murmurs

A

Not due to any pathologic obstruction to flow

141
Q

Pathological heart murmur criteria

A

Murmurs that are due to an increased cardiac output are caused by excess flow across the outflow tract. May be caused by decreased mobility of aortic valves as a result of fibrosis and calcification. May be caused by atrial septal defect.

142
Q

Atrial septal defect

A

Pathologic ejection murmur that mimic the flow murmur acorss the pulmonic valve. Common in individuals with pectus excavatum

143
Q

Cardaic rubs

A

Rubbing together of inflamed membranes of the pericardium and often produces one systolic and two diastolic sounds. May occur in pericarditis or after an MI. Often mistaken for course crackles. Loudest at the left lower sternal border. Often transient and louder with inspiration or forced expiration with the patient leaning forward. Best heard with diaphragm and sounds high-pitched and scratchy, grating, or squeaking.

144
Q

Characteristics of sinus arrhythmia

A

P waves with each QRS,, intervals ar normal, rhythm regular, and rate above 60

145
Q

Common innocent murmurs in children and adults

A

Venous hum, pulmonary flow murmur, midsystolic murmur, innocent vibratory, mammary soufle, innocent pulmonary flow murmur

146
Q

Venous hum

A

Common in kids ages 12 months to 6 years. May be present in fit young adults, pregnancy, and anemia. Low continuous hum loudest above the right clavicle, but may be heard in aortic and pulmonary areas. By changing position of pt’s head or by pressing in the area of the major neck veins, the flow may be changed and these murmurs will change or disappear. Having the child look down or to the side while listening will often make these murmurs or sounds disappear.

147
Q

Common pathologic murmurs in children and adults

A

Aortic stenosis, pulmonary stenosis, pansystolic murmurs, diastolic murmurs

148
Q

Pulmonary stenosis

A

Heard upper left sternal edge over pulmonary area and is midsystolic. Loudest at times of high cardiac output, such as with febrile illness and pregnancy

149
Q

Still’s murmurs

A

Innocent murmur that is low-pitched heart at the lower left sternal area. They are musical or have a relatively pure tone in quality or may be squeaky. Most common between age 3 and adolescence

150
Q

Atrial septal defect

A

Hole in atrial septum and allows blood to flow from left to right atrium. During times of straining, blood is shunted right to left. Auscultation - normal S1, widely split S2. Loudest in the pulmonary area

151
Q

Patent ductus arteriosus (PDA)

A

Normal fetal structure that should close at birth. Can be mistaken for venous hum and best heard at upper left sternal edge, under the clavicle. Occurs throughout systole into diastole. This is a continuous high pitched murmur in the pulmonary area.

152
Q

Physiological split

A

Combined sound of aortic and pulmonary valves and S2 may sound like two separate and distinct sounds. Occurs during inspiration and best heard at left upper sternal border. Splitting heard at apex is almost always a sign of pulmonary hypertension.

153
Q

Normal Sinus Rhythm

A

Atrial and ventricular rhythms are regular. Rate 60-100. P wave - normal and upright in lead II, similar shape and size, one for every QRS. PR interval - 0.12-0.20. QRS complex- 0.06-0.10. T wave - Normal shape, upright and rounded in lead II. QT interval - 0.46-0.44. No ectopic or aberrant beats

154
Q

Sinus Brady

A

Rhythm - regular. Rate - less than 60. P wave - normal shape, upright in lead II, similar shape and size, one for every QRS. PR interval - 0.12-0.20. QRS complex - 0.06-0.10. T wave - normal shape, upright and rounded in lead II. QT interval - 0.36-0.44 or prolonged. No ectopic or aberrant beats.

155
Q

Sinus Tachycardia

A

Rhythm - regular. Rate - greater than 100. P wave - Normal shape and upright in lead II, similar shape and size, one for every QRS, may increase in amplitude, may superimpose on T as rate increases. PR interval - 0.12-0.20. QRS - 0.06-0.10. T wave - normal shape, upright and rounded in lead II. QT interval - 0.36-0.44, possibly shortened. No ectopic or aberrant beats.

156
Q

Paroxysmal atrial tachycardia (PAT)

A

Rhythm - regular. Rate - greater than 150. P wave - abnormal, may be hard to distinguish. PR interval - Usually within normal, but may be immeasurable. QRS - usually normal. T wave - usually distorted. QT - may be indistinguishable. Sudden onset, usually brought on by PAC

157
Q

Hyperkalemia on ECG

A

Flattened P waves, QRS widens, peaked T waves

158
Q

Hypokalemia on ECG

A

Flat T waves and U waves appear

159
Q

Hypercalcemia on ECG

A

QT interval shortens

160
Q

Hypocalcemia on ECG

A

QT interval prolonged

161
Q

Digitalis effect on ECG

A

Can cause AV block

162
Q

Effect of digitalis toxicity on ECG

A

Ventricular ectopy

163
Q

Effect of quinidine on ECG

A

Widening of P wave, widening of QRS, ST depression, prolonged QT, presence of U wave

164
Q

S3

A

An early diastolic sound usually caused by ventricular overload. Caused by left atrium pushing into an overfull ventricle during early diastolic filling. Can occur with heart failure. Best heard at apex 4th LICS MCL. Low pitch listen with bell. Can be normal in children and young adulte.

165
Q

S4

A

Late diastolic or pre-systolic sound. Usually caused by poor diastolic function - inability of heart to relax during diastole. Caused by blood entering a stiff left ventricle during atrial contraction with uncontrolled hypertension and myocardial ischemia. Best heard at apex 4th LICS MCL. Best heard with bell.

166
Q

Pathological or innocent and benign murmurs

A

Most innocent murmurs have these qualities - soft, relatively short systolic, medium pitch, vibratory, heard best at left lower sternal border, no radiation to apex, base, or back

167
Q

Pathological murmurs

A

RED FLAGS. Accompanied by failure to thrive in infants. Accompanied by cyanosis. Diastolic only. Grave III/VI. Increases with standing.

168
Q

Characteristics of physiological murmurs

A

Negative history. Less than grade 3. PMI is normal. Softens or disappears with standing

169
Q

Characteristics for pathological murmurs

A

Symptomatic history. Grade 3 or higher. S1 and S2 obliterated. PMI displaced. Position change does not affect murmur or murmur becomes louder with standing.

170
Q

Functional murmurs

A

Due to increased blood flow through the heart - anemia, fever, hyperthyroidism, pregnancy

171
Q

Continuous murmur

A

Begins in systole and continues into diastole. Includes - PDA, fistulas or local arterial obstructions, venous hum, mannary souffle

172
Q

Description of murmurs

A

Loudness (grade). Pitch (high, medium, or low). Pattern (crescendo, decrescendo, or crescendo-decrescendo). Quality (musical, blowing, harsh, or rumbling). Location of where best heard. Radiation. Posture (disappear or increased with change of position).

173
Q

Systolic ejection (midsystolic) murmur

A

Builds in intensity and decreases in intensity before the S2. Crescendo-decrescento. Occurs with left ventricular outflow obstruction

174
Q

Systolic regurgitant (holosystolic) murmur

A

Caused by flow from high pressure to low pressure (incompetent valves or VSD). Murmur begins as soon as pressure starts to increase and continues throughout systole. Lasts the entire S1, not S1 and S2

175
Q
A
176
Q

Aortic stenosis

A

Caused by rheumatic disease, congenital defect, or degeneration. If severe may produce chest pain, dyspnea, exertional angina, and syncope. Loud and harsh. Crescendo-descendo mid-systolic ejection murmur. Loudest at second right intercostal border. Radiates widely to side of neck, down left sternal border, or apex.

177
Q

Pulmonic sternosis

A

Caused by calcification of pulmonic valve. Systolic medium pitch. Crescendo-decrescendo. Best heard at second left intracostal space. Radiates to left and neck.

178
Q

Mitral regurgitation

A

Incompetent mitral valve. This allows blood to flow from a high pressure area back to a low pressure area. Holosystolic. Loud and blowing. Best heard at apex. Radiates well to left axilla.

179
Q

Tricuspid regurgitation

A

Caused by back flow of blood through incompetent tricuspid valve into RA. May have engorged pulsating neck veins and liver enlargement. Lift at sternum and thrill at left lower sternal border. Soft and blowing, holosystolic. Best heard at left lower sternal border. Increases with inspiration.

180
Q

Diastolic murmurs

A

Caused by regurgitation across either aortic or pulmonic valve or filling rumbles casued by flow across obstructed mitral or tricuspid valve. Loudest early diastole. Best heard with patient sitting, leaning forward, exhaling. Best heard with diaphram of stethoscope.

181
Q

Tricuspid stenosis

A

Casued by calcification of tricuspid valve obstructs flow into right ventricle. Diastolic rumble. Best heard at lower left sternal border. Louder with inspiration.

182
Q

Aortic regurgitation

A

Caused by an incompetent aortic valve allows blood to back flow into left ventricle during diastole. “Water hammer” pulses with wide pulse pressure. Begins with S2. Soft high pitched, blowing diastolic, de-crescendo. Best heard at 3rd left intercostal space. Best heard sitting up leaning forward. Radiates down.

183
Q

Pulmonic regurgitation

A

Caused by incompetent pulmonic valve allows backflow of blood into right ventricle. Same timing and characteristics of aortic regurgitation so hard to tell difference on physical exam.

184
Q

Considerations of newborn murmurs

A

Should be grade 1 or 2, systolic,, not accompanied by cyanosis or respiratory distress and disappear within 2-3 days

185
Q

Workup of pediatric murmur

A

Pregnancy - infection (Rubella 1st trimester, herpes), drugs, illness, genetic (Downs), prematurity

Birth - cyanosis, resuscitation

Growth and development - failure to thrive, gain weight, feeding problems

Dyspnea, anoxic spells, squatting when tired, eyelid edema

ECGs

186
Q

Venous hum

A

Caused by turbulent flow in jugular veins. No pathological significance. Continuous low pitched soft hum, heard throughout entire cycle and not affected by respiration. May be louder with standing.

187
Q

Mammary souffle

A

Occurs in near term pregnancy and when lactating. Caused by increased flow through internal mammary artery.

Continuous and best heard in systole.

188
Q

Split S2

A

Can hear closure of aortic and pulmonic valve. Normally heard on inspiration and goes away on expiration.

189
Q

Sinus arrhythmia

A

Rhythm change with inspiration - increases at peak of inspiration and slowing with expiration.
Normal in young adults and children

190
Q

Cardiac Rubs

A

Inflammation of pericordium. High pitched and scratchy. Best heard with diaphragm. Best heard in sitting position leaning forward with breath held during expiration.

Sounds like sand paper being rubbed together.

Often occurs post MI

191
Q

Name two innocent continuous murmurs

A

Venous hum

Mammary souffle

192
Q

Name two abnormal continuous heart sounds

A

PDA

Friction rub

193
Q

Name two heart sounds affected by respiration

A

Sinus arrhythmia

Split S2

Tricuspid regurgitation

Comps - Mod 2 (9 decks)

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