PE Flashcards
Parasternal heave
- Precordial impulse visible/palpated on chest wall
- Systolic elevation of L costal cartilages
o From heart or great vessels => hypertrophy/enlargement of underlying ventricle
o W cardiac or respiratory diseases
Souffle
- Vascular/cardiac murmur w a blowing quality
o After S1
o Short to long: mid systolic to S2 or beyond
Causes souffle
o Postpartum/lactation: mammary souffle = rapid/incr flow through breast arteries
Systolic murmur
Can be abolished by pressure applied lateral to the breast
Precordial thrill
- Vibration at point of maximal intensity
o Loud murmur
o Location depend on associated lesion
Bruit
- Systolic noises
Causes of bruit
o Flow turbulence from partial obstruction of artery lumen or high flow
Heard over large arteries
o Peripheral arteriovenous shunts
Involved arteries may be dilated
May have venous pulsation
Thrill may be present
* Anything incr blood flow can incr bruit (fever, anemia, hyperT4)
Pulse deficit
- Irregular pulse rhythm => suggest arrhythmia.
o Pulse rate not equal HR
o Difference btw pulse and HR = pulse deficit
Cause of pulse deficit
Afib most common
Friction rub
Triphasic
* Systolic: ventricular contraction
* Diastolic: ventricular relaxation and expansion during diastole
* Atrial systolic: atrial contraction at end of diastole
Scratchy/squishy noise
Accentuate on inspiration => distorted pericardium pulled by inspiratory expansion
Pathology causing friction rub
o Infection, metastatic dz, acute myocardial infacrtion, post cardiac sx
- No correlation btwn qty of pericardial effusion
o Not associated w small amount of pericardial effusion
o Pericarditis: fibrin strands caused by inflammation connecting 2 layers
Acute: viral infection, collagen vascular dz, trauma, uremia, invasive tumors
Pericardium anatomy
o 2 layers: parietal (fibrous) and visceral (serous)
o Separated by small amount of fluid (ultrafiltrate plasma)
Pulse pressure
- Normal pulse:
o Smooth, rapid upstroke with smooth dome shape summit
o Slower downstroke
o Dicrotic notch after 300ms
hypokinetic pulse causes
Decreased pulse pressure
decr SV: CHF/hypovolemia
Most of the time: ↓ SV → ↑ arterial resistance + ↓ compliance to maintain BP
Pulse pressure ≠ sensitive to detect ↓SV
Weak pulse = severely ↓SV or acutely ↓SV
* Severe SAS
o ↓ peripheral vascular resistance
o ↑ arterial compliance
hyperkinetic pulse causes
increased pulse pressure
rapid ejection of ↑ volume of blood
o ↑ systolic BP → ↑ SV
o ↓ diastolic BP → shunts/regurgitation
Run off of blood during diastole
AI, PDA → bounding pulses
Arteriovenous fistula
Severe bradycardia
Thyrotoxicosis, anemia, fever
Pulsus paradoxus
- Expiration: ↑ pulse pressure
- Inspiration: ↓ pulse pressure
o Secondary to ↓systemic BP >10mmHg
o Weak pulses may disappear for several beats during inspiration - Exaggerated w cardiac tamponade
Pulsus Bisfierens
- Pulse with double impulse → bifid pulse
- HCM w obstructive component
- Severe AI w SAS
Pulsus alternans
Alternating strong and weak pulses
* Higher and lower amplitude pulse → alternating SV
o Extreme cases: lower pulse can become imperceptible
o Regular intervals/height alteration
o No change w respiration
* Sign of myocardial depression and LV failure
o DCM
Pulsus bigeminus
- Alternating pulse with arrhythmias
- Ventricular bigeminy most commonly
o Amplitude of VPC is lower
Waterhammer/bounding/Corrigan’s pulse
- Large and strong pulse with normal contours
- PDA, AV fistula
- Corrigan’s pulse → AI
Pulsus brevis
- Brisk pulse → shorter pulse w rapid rise in systole
- MR
Pulsus parvus & tardus
- Small/weak pulses
- Delayed systolic peak
- Moderate to severe SAS
Dicrotic pulse
- Twice peaked pulse
o Diastolic notch following S2
o Systolic notch - Impaired Lv performance → ↓CO, ↑SVR
