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Cardiology 2 > Phys Di 2 > Flashcards

Phys Di 2 Flashcards

1
Q

Where do you listen for aortic valve sounds?

A

right 2nd intercostal space at sternal border

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2
Q

Where do you listen for pulmonic valve sounds?

A

left 2nd intercostal space at sternal border

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3
Q

Where do you listen for tricuspid valve sounds?

A

4th/5th left intercostal space

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4
Q

Where do you listen for mitral valve sounds?

A

left 5th ICS lateral = Apex

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5
Q

What do you listen for with the diaphragm?

A
  • most sounds
  • high pitched murmurs
  • clicks
  • snaps
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6
Q

What do you listen for with the bell?

A
  • low pitched
  • filling sounds
  • such as gallops
  • some murmurs
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7
Q

S1 sound cause

A

closure of the mitral and tricuspid valves

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8
Q

When does S1 occur?

A
  • start of systole

- ventricular contraction

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9
Q

Is splitting of S1 normal?

A
  • no

- asynchrony of mitral and tricuspid closure

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10
Q

S2 sound cause

A

closure of the AP valves

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11
Q

What does S2 occur?

A
  • start of diastole

- ventricular filling

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12
Q

Is splitting of S2 normal?

A
  • it can be (physiological split)
  • related to breathing
  • RIGHT ventricular systole is lengthened with deep inspiration
  • A closes before P
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13
Q

Wide physiological splitting of S2

A
  • abnl
  • occurs during inspiration and expiration but WIDER on inspiration
  • delayed closure of pulmonic valve
  • RBBB or pulm. HTN
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14
Q

fixed splitting of S2

A
  • abnl
  • unaffected by respiration
  • delayed pulmonic valve closure w/ RV output > LV output
  • large ASD; VSD; right heart failure
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15
Q

paradoxic splitting

A
  • abnl
  • audible splitting w/ expiration (disappears during inspiration)
  • delayed aortic valve closure (P2 before A2)
  • aortic stenosis; LBBB
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16
Q

S3 and S4 are best heard:

  • what device
  • what position
  • pt position
A
  • bell
  • mitral position
  • pt in left lateral decubitus position
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17
Q

When are S3 and S4 heard? What do they sound like?

A
  • heard in diastole

- soft and low pitched

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18
Q

What is a loud and intense S3 referred to as?

A
  • ventricular gallop

- “ken-TUCK-y”

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19
Q

normal causes of S3 gallop

A

can be normal in young people

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20
Q

abnormal causes of S3 gallop

A
  • when increased vol. leads to exaggerated diastolic filling
  • CHF
  • regurg
  • shunts
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21
Q

What is the most common cause of the S3 gallop?

A

CHF

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22
Q

specific timing of S3

A
  • EARLY diastole

- related to volume overload

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23
Q

S4 timing

A
  • LATE diastole (just before S1)

- pre-systolic sound

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24
Q

S4 is due to?

A

-d/t PRESSURE overload and stiff ventricles

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25
Q

Describe the S4 heart sound

A
  • “TEN-ne-see”
  • atrial gallop
  • NEVER normal
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26
Q

conditions causing S4

A
  • when ventricles are stiffened by hypertrophy or fibrosis:
  • hypertrophic cardiomyopathy
  • aortic stenosis
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27
Q

What is an extra valve sound?

A
  • short sound

- caused by noisy valve

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28
Q

Examples of extra valve sounds

A
  • opening sound (mitral_
  • ejection click (aortic)
  • non-ejection click (mitral)
  • prosthetic valve sound
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29
Q

Murmurs

A
  • prolonged sound

- cause is disruption of blood flow

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30
Q

murmur causes

A
  • diseased valves
  • high output demands
  • structural defects (ASD, VSD)
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31
Q

misc. extra heart sounds

A
  • overlies heart sounds
  • cause is outside the heart
  • pericardial friction rub
  • precordial knock
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32
Q

Characterization of murmurs

A
  1. timing: systolic or diastolic
  2. location best heard
  3. intensity (grade I-VI)
  4. radiation (carotids, axilla?)
  5. What does it sound like?
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33
Q

Descriptive words for murmur quality

A
  • harsh
  • raspy
  • machine-like
  • vibratory
  • musical
  • blowing
  • grating
  • etc
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34
Q

other considerations of murmurs

A
  • does it crescendo/decresendo?

- is the pitch low or high?

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35
Q

maneuvers to consider with murmurs

A
  • does it change w/ posture?
  • val salva
  • respirations
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36
Q

heart murmur intensity grading

A 
I: barely audible in quiet room
II: quiet but clearly audible
III: moderately loud
IV: loud, associated w/ a thrill
V: very loud, thrill easily palpable
VI: very loud, audible w/o stethoscope, thrill visible
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37
Q

thrill

A
  • a fine, palpable, rushing vibration (palpable murmur)

- intensity IV-VI murmurs can be felt

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38
Q

What can cause a left sternal border thrill?

A

severe mitral regurg

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39
Q

What can cause a right sternal border thrill?

A

severe atrial regurg

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40
Q

The most common murmurs are systolic murmurs d/t what? (3)

A
  • aortic stenosis
  • mitral regurg
  • mitral valve prolapse
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41
Q

systolic murmur flow chart

A

slide 52

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42
Q

aortic stenosis murmur is best heard:

A

upright and 2nd right ICS

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43
Q

aortic stenosis murmur exam findings

A
  • SYSTOLIC murmur
  • harsh, medium pitch, cresc-decrescendo
  • radiates to carotids
  • +/- ejection click
  • like …….. gull ….. or dove…….. ??
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44
Q

Description of aortic stenosis

A

calcification of valve cusps restricts forward flow

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45
Q

causes of aortic stenosis murmur

A
  • congenital bicuspid valve
  • rheumatic fever
  • degeneration
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46
Q

aortic regurg murmur is best heard:

A

upright at left sternal border, leaning forward

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47
Q

aortic regurg murmur exam findings

A
  • early DIASTOLIC

- high pitched, soft, blowing, decrescendo

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48
Q

aortic regurg description

A

valve incompetence allows backflow to left ventricle

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49
Q

aortic regurg murmur causes

A
  • rheumatic fever
  • congenital
  • syphilis
  • marfan syndrome
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50
Q

mitral stenosis murmur best heard:

A
  • left lateral decubitus

- bell** at apex

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51
Q

mitral stenosis murmur exam findings

A
  • opening snap followed by DIASTOLIC rumble

- low pitch, does not radiate

52
Q

mitral stenosis description

A

narrowed valve restricts forward flow

53
Q

mitral stenosis murmur causes

A
  • rheumatic fever
  • 3:1
  • W:M
54
Q

mitral regurg murmur best heard:

A
  • upright at apex

- increases w/ inspiration

55
Q

mitral regurg murmur exam findings

A
  • holosystolic
  • high pitched
  • blowing**
  • quite loud
  • radiates to left axilla (splitting of S2)
56
Q

mitral regurg murmur description

A

valve incompetence allows backflow from V to A

57
Q

mitral regurg murmur causes

A
  • rheumatic fever
  • MI
  • myxoma
58
Q

mitral valve prolapse murmur best heard:

A

-upright at apex and left lower sternal border

59
Q

mitral valve prolapse murmur exam findings

A
  • late SYSTOLIC
  • crescendo murmur preceded by mid-systolic click
  • high pitched, blowing
60
Q

mitral valve prolapse description

A

redundant valve tissue prolapses into atrium late in systole

61
Q

mitral valve prolapse murmur causes

A
  • congenital
  • associated w/ pectus excavatum
  • W>M
62
Q

What are the less common heart murmurs?

A
  • tricuspid stenosis
  • tricuspid regurg
  • pulmonic stenosis (rare)
  • ventricular septal defect
  • patent ductus arteriosus
63
Q

tricuspid stenosis murmur best heard:

A
  • w/ bell

- 4th left ICS

64
Q

tricuspid stenosis murmur exam findings

A
  • diastolic rumble
  • accentuated early and late
  • low pitch, louder on inspiration
  • JVP prominent
65
Q

tricuspid stenosis murmur description

A

calcification of valve cusps restricts forward flow

66
Q

tricuspid stenosis murmur examples of cause

A
  • rheumatic fever
  • congenital defect
  • right atrial myxoma
67
Q

tricuspid regurg murmur best heard:

A
  • diaphragm

- left 4th ICS

68
Q

tricuspid regurg murmur exam findings

A
  • holosystolic
  • soft
  • radiates up left sternal border
  • increased on inspiration
69
Q

tricuspid regurg murmur description

A

valve incompetence backflow to right atrium

70
Q

tricuspid regurg murmur examples of cause

A
  • congenital

- endocarditis (IVDU)

71
Q

pulmonic stenosis murmur best heard:

A

-diaphragm at 2nd left ICS

72
Q

pulmonic stenosis murmur exam findings

A
  • systolic ejection murmur
  • medium pitch
  • coarse
  • increased on inspiration
73
Q

pulmonic stenosis murmur description

A

valve restricts forward flow

74
Q

pulmonic stenosis murmur cause

A

almost always congenital

75
Q

ventricular septal defect murmur best heard:

A

diaphragm at left sternal border

76
Q

ventricular septal defect murmur exam findings

A
  • holosystolic
  • loud, coarse, high pitched
  • does NOT radiate to neck
77
Q

ventricular septal defect murmur description

A

-regurg of blood through defect

78
Q

ventricular septal defect murmur cause

A

congenital

79
Q

PDA murmur best heard:

A

1st-3rd ICSs

80
Q

PDA murmur exam findings

A
  • harsh, loud, continuous murmur
  • machine-like
  • unaltered by posture
81
Q

PDA murmur description

A

left to right shunt through defects

82
Q

PDA murmur cause

A

congenital

83
Q

what are the special maneuvers for systolic murmurs

A
  • squatting/leg elevation
  • valsalva/standing
  • handgrip
  • others
84
Q

special maneuvers effect on preload/afterload

A
  • squatting/leg elevation: increases preload
  • valsava/standing: decreases preload
  • handgrip: increases afterload
85
Q

aortic stenosis murmur changes with special maneuvers

A
  • squatting/elevation: increases
  • valsalva/standing: decreases
  • handgrip: increases
86
Q

mitral valve prolapse murmur changes with special maneuvers

A
  • squatting: decreases
  • valsalva: increases
  • handgrip: no change
  • other: increases in left lateral decubitus
87
Q

hypertrophic cardiomyopathy murmur changes w/ special maneuvers

A
  • squatting: decreases
  • valsalva: increases
  • handgrip: decreases
  • other: increases in left lateral decubitus
88
Q

mitral regurg murmur changes w/ special maneuvers

A
  • squatting: no change
  • valsalva: decreases
  • handgrip: increases
  • other: increases w/ inspiration
89
Q

VSD murmur changes w/ special maneuvers

A
  • none w/ squatting or valsalva
  • handgrip: increases
  • other: increases w/ bilateral aterial occulation (BP cuffs inflated)
90
Q

when is a benign murmur best heart?

A

supine position

91
Q

what is the only change w/ maneuvers for benign murmurs?

A

it disappears w/ valsalva

92
Q

bruit

A

unexpected sound of blood moving through narrowed artery

93
Q

bruit info

A
  • can be radiation of heart murmur
  • can be caused by local obstruction
  • very low pitched and quiet
  • use bell
94
Q

Where to auscultate for bruits

A
  • carotid*
  • aortic*
  • renal*
  • iliac*
  • temporal
  • femoral
95
Q

arterial pulsations

A
  • bounding wave of blood produced by ventricular systole
  • diminishes w/ increasing distance from the heart
  • reflect blood flow and CO
96
Q

review locations for pulses

A

slide 63

97
Q

what comparisons should you check for in palpating pulses?

A
  • compare for b/l symmetry

- compare upper vs lower extremity

98
Q

characteristics of pulse to palpate for

A
  • rhythm/rate (regular or irregular)
  • contour
  • intensity/amplitude(strength)
99
Q

why does deep inspiration normally increase the pulse rate?

A

bainbridge reflext

100
Q

bainbridge reflex

A
  1. inspiration increases chest vol.
  2. this decreases intra-thoracic pressure
  3. venous return to right heart and stretches atra
  4. sends message to medulla to decrease PSNS tone
  5. heart rate increases
101
Q

pulse amplitude scale

A

0: absent
1: diminished, barely palpable
2: expected, normal
3: full, increased
4: bounding

102
Q

patterns can vary d/t changes in:

A
  • rate
  • rhythm
  • intensity/pressure
  • contour
103
Q

what arteries are best for evaluating contour?

A

carotids

104
Q

small and weak pulse description

A
  • barely palpable pulse
  • decreased amplitude
  • no bounding wave of blood
105
Q

bounding pulse description

A
  • increased pulse pressure
  • rapid raise, breif peak, rapid fall
  • sign of: atherosclerosis, PDA, anxiety, hyperthyroidism, exercise
106
Q

water-hammer pulse

A
  • aka collapsing pulse
  • jerky carotid pulse
  • rapid rise, greater amplitude, then quickly collapses
  • rapid upstroke: d/y lg. SV and/or vigorous contraction
  • steep drop/collapse: d/t rapid runoff of blood from the aorta
107
Q

water-hammer pulse is a sign of what condition?

A

aortic regurg

108
Q

pulsus bisferiens

A
  • bifid pulse
  • 2 systolic peaks “double peak”
  • palpable abnormality
  • best palpated in carotid a.
109
Q

pulsus bisferiens is associated with what?

A

-severe aortic regurg +/- aortic stenosis

110
Q

pulsus paradoxus

A

-exaggerated decrease in pulse amplitude (and BP) on inspiration*

111
Q

pulsus paradoxus is a cardinal sign of what?

A

**cardiac tamponade

can also be a sign of constrictive pericarditis, lung dz, large PE

112
Q

pulsus alternans

A
  • pulse intensity alternates b/w those of greater and lesser SV
  • rhythm is regular
  • every other beat is weak
  • better felt in distal arteries
113
Q

pulsus alternans is a sign of what?

A

left ventricular failure**

114
Q

bigeminal pulse

A
  • 2 beats in rapid succession followed by longer interval
  • normal beat followed by PVC
  • regularly irregular
  • every other beat is weak, easily confused w/ alternating pulse
  • 2nd beat is weak and early
115
Q

how do you describe a normal pulse?

A

Rate is 72 bpm and regular, normal intensity and contour, symmetric and synchronous bilaterally. Femoral and radial pulse are synchronous.

116
Q

what to pay special attention to in palpation of edema

A
  • new onset
  • unilater or bilateral
  • dependent
  • pitting or not
117
Q

words to know

A

anasarca; acites; pitting edema;myxedema; lymphedema

118
Q

signs of venous occlusion

A
  • unilateral swelling
  • ruddy
  • congested appearance
  • warm to touch
119
Q

grading the pitting edema

A

0+: none
1+: mild, 2 mm
2+: moderate, 4mm; disappears in 10-15 secs
3+: moderately severe, 6mm; may last > 1min
4+: severe, 8mm; can last > 2 min

120
Q

pulsus paradoxus by sphygmomanometer

A
  • taking BP and noting reading as the dsappear w/ inspiration and reappear during inspiration
  • postive: if difference b/w 2 systolic measurments is >10mmHg
121
Q

why do pulsus paradoxus by sphygmomanometer?

A

if JVD is elevated and suspect cardiac tamponade

122
Q

pulsus paradoxus test is very predictive of what?

A

cardiac tamponade

123
Q

screening test for DVT

A
  • measurement of limb circumference
  • proves if unilateral swelling is present
  • normal is < 1cm difference
124
Q

homan’s sign

A
  • another screening test for DVT
  • pt seated, firmly dorsiflex ankle
  • produces pain in 35% of pts w/ DVT
  • not sensitive, poor predictor
125
Q

ankle-brachial index

A
  • measure systolic pressure in lower leg
  • use doppler to hear korotkoff sounds
  • compare reading to brachial systolic pressure
  • abnl is <1.0
  • predictor of peripheral a. dz, arterial occlusion

Cardiology 2 (13 decks)

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