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Cardiology 2 > Phys Di 1 > Flashcards

Phys Di 1 Flashcards

1
Q

Possible cause angina

A

MI

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2
Q

Possible cause rapid onset of cough, pink/frothy sputum

A

PE

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3
Q

Possible cause dyspnea

A
  • Heart failure
  • atrial fibrillation
  • pulmonary edema
  • pleural effusion
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4
Q

Possible cause orthopnea

A

heart failure

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5
Q

Possible cause claudication

A

peripheral arterial disease

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6
Q

Possible cause syncope

A
  • Heart block

- bradycardia

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7
Q

Possible cause palpitations

A
  • dysrhythmia
  • atrial fib
  • SVT
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8
Q

Possible cause fatigue

A
  • bradycardia
  • heart blocks
  • atrial fib
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9
Q

Possible cause dizziness or lightheadedness

A

heart blocks

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10
Q

Possible cause pounding heart

A

SVT

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11
Q

Possible cause edema

A

heart failure

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12
Q

Questions to ask Past Medical History

A
  • cardiac surgery
  • hospitalizations for cardiac evaluation
  • rheumatic fever
  • HX of unexplained fever
  • HTN
  • DMII
  • thyroid dysfunction
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13
Q

Family history to focus on

A
  • DM
  • HTN
  • Stroke
  • cholesterol
  • Congenital heart defects
  • sudden death less than 50
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14
Q

Social history to focus on

A
  • Tobacco, drugs, alcohol
  • occupation
  • stress level
  • diet/exercise
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15
Q

Characteristics of CARDIAC chest pain

A
  • quality: dull, achy, pressure (need to burp but can’t), squeezing, fullness
  • substernal
  • radiation to jaw, shoulders, arms, etc.
  • aggravated by moving, relieved by rest
  • onset very specific “started at 2 pm”
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16
Q

characteristics of NON-CARDIAC chest pain

A
  • quality: sharp, stabbing, burning
  • reproducible with palpation
  • worse with breath or cough
  • aggravated by chest movement/stretching
  • more vague onset
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17
Q

Signs of ARTERIAL leg pain

A
  • starts during exercise
  • quickly relieved by rest
  • intensity increases with intensity/duration of exercise
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18
Q

signs of venous/musculoskeletal leg pain

A
  • more likely to start after exercise
  • relieved by rest bu sometimes only after hours or even days
  • pain more constant
  • greater variability than arterial pain in response to intensity and duration of exercise
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19
Q

What blood pressures do you measure in cardiovascular exam

A

BOTH upper extremities

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20
Q

What body parts to inspect

A
  • skin
  • neck pulsations
  • chest
  • extremities
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21
Q

inspection of skin

A
  • cyanosis
  • pallor
  • diaphoresis
  • dependent rubor
  • xanthomas
  • shiny leg skin
  • cap refill (nails), want <2 seconds
22
Q

inspection of chest

A

apical pulse

23
Q

inspection of neck

A
  • jugular vein pulsations

- measurement of jugular venous distention

24
Q

inspection of general appearance

A
  • distress
  • labored breathing, dyspnea
  • obesity
  • “syndromes” : marfans, etc. that would cause CV problems
25
Q

What to auscultate for in cardiovascular exam

A
  • heart sounds
  • murmurs
  • bruits in arteries
26
Q

what does measurement of jugular venous distention assess?

A

central venous pressure

27
Q

what to palpate for in cardiovascular exam

A
  • peripheral pulses

- extremities for edema

28
Q

Raynaud’s apperance

A

very white fingers

29
Q

Three characteristics of carotid artery pulse

A
  1. intensity: correlates with pulse pressure
  2. Contour: speed of upstroke, duration of summit, speed of downstroke
  3. Volume: normal, increased or decreased

*volume does not change with respiration

30
Q

Venous pulsations

A
  • can see external or internal jugular veins
  • bifid, “flicking” quality
  • sinks with inspiration, rises with expiration
  • change with bed position/elevation of head (unlike carotid which should NOT change)
  • not palpable, can obliterate with fingers
  • abnormal waveform are sign of pathology
31
Q

Carotid characteristics

A
  • palpable pulsations
  • pulsations not obliterated with pressure
  • pulse not affected by respiration
  • descents not prominent
  • pulse not affected by abdominal pressure
32
Q

jugular vein characteristics

A
  • no pulsations palpable
  • pulse is obliterated by pressure
  • pulse wave decreases with inspiration, increases with expiration
  • two pulsations per systole “flicking”
  • prominent descents
  • abdominal pressure makes pulsations more prominent
33
Q

5 portions of jugular venous pulse wave

A
  • A wave: atria contracts
  • X descent: first decent
  • C wave: closure tricuspid
  • V wave: volume increases
  • Y descent: smaller, final descent
34
Q

Jugular venous pulse wave

- two prominent portions of wave visible on neck exam

A
  • A wave: most prominent, back flow of blood into vein as right atrium contracts
  • V wave: increase in pressure as right atrium fills
35
Q

5 JVP wave abnormalities

A
  1. Large A wave
  2. cannon A wave
  3. steep X and Y descents
  4. Larve V wave
  5. Kussmaul’s sign
36
Q

Large “A” wave in JVP d/t what (3)

A
  • tricuspid stenosis
  • pulmonary HTN
  • pulmonary valve stenosis
37
Q

Cannon “A” wave in JVP d/t what (4)

A
  • atrial fib
  • heart block
  • v tach
  • VVI pacing (pacemaker)
38
Q

Steep X and Y descent in JVP d/t what (1)

A

constructive pericarditis

39
Q

Large “V” wave in JVP d/t what

A

tricuspid regurg

40
Q

Kussmaul’s sign in JVP d/t what

A

constructive pericarditis

41
Q

In cardiac tamponade, what is visible in jugular vein

A

JVD

NO kussmaul’s sign

42
Q

When is measurement of jugular venous distention helpful?

A

pericardial dz

43
Q

What does the height of JVD help estimate?

A

right atrial pressure

44
Q

What is elevated jugular venous pressure a cardinal finding in (2)

A
  1. cardiac tamponade

2. constructive pericarditis

45
Q

disorders that increase JVD

A
  • cardiac tamponade (#1)
  • pericardial effusion
  • constructive pericarditis
  • left side heart failure
  • lung disease
  • pulmonary HTN
46
Q

How to measure JVD

what is abnormal measurement

A
  1. stand on right side of pt
  2. recline pt to 45 degrees
  3. locate top of blood column (meniscus)
  4. measure distance from sternal angle to meniscus
  5. document as cm above sternal angle
    >3 cm is abnormal
47
Q

location of apical pulse

A

midclavicular line at left 5th IC space (helps if pt leans forward)

  • look for PMI: point of maximal impulse
  • assess for lift or heave
48
Q

Abnormal apical pulse findings (3)

A
  • absence even in left lateral decubitus position (pericardial fluid)
  • displacement lateral or downward (cardiomegaly)
  • lift occurs - ventricular hypertrophy present
49
Q

What should you do if you see an intense apical pulse

A

palpate for a thrill

50
Q

describe a lift (palpation of apical pulse)

A
  • strong precordial pulse, more vigorous than expected
  • can be seen or palpated

ex: lift along left sternal border = RV hypertrophy or severe MR

51
Q

Describe a thrill (palpation of apical pulse)

A

fine, palpable, rushing vibration

Cardiology 2 (13 decks)

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