Phys Di 1 Flashcards
1
Q
Possible cause angina
A
MI
2
Q
Possible cause rapid onset of cough, pink/frothy sputum
A
PE
3
Q
Possible cause dyspnea
A
- Heart failure
- atrial fibrillation
- pulmonary edema
- pleural effusion
4
Q
Possible cause orthopnea
A
heart failure
5
Q
Possible cause claudication
A
peripheral arterial disease
6
Q
Possible cause syncope
A
- Heart block
- bradycardia
7
Q
Possible cause palpitations
A
- dysrhythmia
- atrial fib
- SVT
8
Q
Possible cause fatigue
A
- bradycardia
- heart blocks
- atrial fib
9
Q
Possible cause dizziness or lightheadedness
A
heart blocks
10
Q
Possible cause pounding heart
A
SVT
11
Q
Possible cause edema
A
heart failure
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
13
Q
Family history to focus on
A
- DM
- HTN
- Stroke
- cholesterol
- Congenital heart defects
- sudden death less than 50
14
Q
Social history to focus on
A
- Tobacco, drugs, alcohol
- occupation
- stress level
- diet/exercise
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”
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
17
Q
Signs of ARTERIAL leg pain
A
- starts during exercise
- quickly relieved by rest
- intensity increases with intensity/duration of exercise
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
19
Q
What blood pressures do you measure in cardiovascular exam
A
BOTH upper extremities
20
Q
What body parts to inspect
A
- skin
- neck pulsations
- chest
- extremities
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
What to auscultate for in cardiovascular exam
- heart sounds
- murmurs
- bruits in arteries
26
what does measurement of jugular venous distention assess?
central venous pressure
27
what to palpate for in cardiovascular exam
- peripheral pulses
| - extremities for edema
28
Raynaud's apperance
very white fingers
29
Three characteristics of carotid artery pulse
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
Venous pulsations
- 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
Carotid characteristics
- palpable pulsations
- pulsations not obliterated with pressure
- pulse not affected by respiration
- descents not prominent
- pulse not affected by abdominal pressure
32
jugular vein characteristics
- 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
5 portions of jugular venous pulse wave
- A wave: atria contracts
- X descent: first decent
- C wave: closure tricuspid
- V wave: volume increases
- Y descent: smaller, final descent
34
Jugular venous pulse wave
| - two prominent portions of wave visible on neck exam
- A wave: most prominent, back flow of blood into vein as right atrium contracts
- V wave: increase in pressure as right atrium fills
35
5 JVP wave abnormalities
1. Large A wave
2. cannon A wave
3. steep X and Y descents
4. Larve V wave
5. Kussmaul's sign
36
Large "A" wave in JVP d/t what (3)
- tricuspid stenosis
- pulmonary HTN
- pulmonary valve stenosis
37
Cannon "A" wave in JVP d/t what (4)
- atrial fib
- heart block
- v tach
- VVI pacing (pacemaker)
38
Steep X and Y descent in JVP d/t what (1)
constructive pericarditis
39
Large "V" wave in JVP d/t what
tricuspid regurg
40
Kussmaul's sign in JVP d/t what
constructive pericarditis
41
In cardiac tamponade, what is visible in jugular vein
JVD
| NO kussmaul's sign
42
When is measurement of jugular venous distention helpful?
pericardial dz
43
What does the height of JVD help estimate?
right atrial pressure
44
What is elevated jugular venous pressure a cardinal finding in (2)
1. cardiac tamponade
| 2. constructive pericarditis
45
disorders that increase JVD
- cardiac tamponade (#1)
- pericardial effusion
- constructive pericarditis
- left side heart failure
- lung disease
- pulmonary HTN
46
How to measure JVD
| what is abnormal measurement
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
location of apical pulse
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
Abnormal apical pulse findings (3)
- absence even in left lateral decubitus position (pericardial fluid)
- displacement lateral or downward (cardiomegaly)
- lift occurs - ventricular hypertrophy present
49
What should you do if you see an intense apical pulse
palpate for a thrill
50
describe a lift (palpation of apical pulse)
- strong precordial pulse, more vigorous than expected
- can be seen or palpated
ex: lift along left sternal border = RV hypertrophy or severe MR
51
Describe a thrill (palpation of apical pulse)
fine, palpable, rushing vibration
