Quiz 2 Flashcards
aortic stenosis
systolic murmur
best heard in the second right intercostal space with the client leaning forward. it is harsh, loud and often associated with a thrill. It may radiate to the neck, LSB, and apex. Often associated with an early ejection click, a diminished S2, a heave or sustained apical impulse with LVH, crackles at he lung bases with LV failure, jugular venous distention, hepatomegaly and peripheral edema with right ventricular failure.
S/S include syncope, angina, and dyspnea on exertion with severe stenosis. angina may be present. Tx with medial or surgical intervention.
mitral regurgitation
systolic murmer d/t failure of the mitrial valve between left atria and left ventrircle to close completely during systole, causing backflow of blood from vent to atrial.
best heard in the apex, often with radiation to the left axilla, Pansystolic, high pitched, and blowing and may be associated with a thrill. S1 may be decreased and S3 may be present and a sustained apical impulse d/to LVH may be present.
S/S - dyspnea most common presenting, palpitations common, a fib may develop. c/b enbolism, bacterial endocarditits
aortic regurgitation/insufficiency
diastolic murmur d/t failure of leaflets of aortic valve at exit of ventricle to close completely during diastole, causing backflow of blood from the aorta into the left ventricle.
best heard in the second, third, and fourth interspaces, just to he left of the sternum. a blowing, high pitched and grade III or less. may radiate to the apex, have patient sit and lean forward to auscultate. LVH can result, and will be accompanied by an accentuated apical implulse and a left ventricular heave. commonly caused by infective endocarditis and rheumatic fever.
mitral stenosis
diastolic murmur, result from thickening/stiffening of the mitral valve between the left atrium and left ventricle. grade I to grade IV and low pitched, better heard with the bell at the apex in the left lateral recumbent position. the first heart sounds S1 is loud followed by S2 and a loud opening snap that precedes the murmur.
S/S dyspnea on exertion and hemoptysis d/t pulmonary congestion, crackles may be heard at the lung bases, orthopnea may also be present
when HR is increased as a result of fever, exertion, anxiety or infection, pulmonary congestion worsens and pulmonary edema may result. A fib also worsens in the setting of mitral stenosis, worsening pulmonary congestion. over time can lead to right ventricular hypertrophy
Mitral valve prolapse
MVP, also termed click-murmur syndrome, is a variant of mitral regurgitation and occurs in approx. 10% of women. A portion of the mitral valve ballons into the left atrium giving rise to a mid-systolic click followed by a soft grade 1 murmur that crescendos apex or left sternal border, Some pts with MVP gave only a murmur and no click and others have only a click and no murmur.
Signs and Sx: pts are usually asymptomatic but may complain of palpitations. It is of concern only in that antibiotic prophylaxis is needed in some cases for surgical and dental procedures to avoid the rare chance sub-acute bacterial endocarditis.
levine’s sign
Levine’s sign is a clenched fist held over the chest to describe ischemic chest pain. As the referred pain associated with ischemia radiates to the area of the left proximal forelimb, usually the right, unaffected arm is used to produce the gesture.
Mitral valve prolapse
MVP, also termed click-murmur syndrome, is a variant of mitral regurgitation and occurs in approx. 10% of women. A portion of the mitral valve ballons into the left atrium giving rise to a midsystolic click followed by a soft grade ! murmur that crescendos apex or left sternal border, Some pts hawith MVP gave only a murmur and no click and others have only a click and no murmur.
Sigs and Sx: pts are usually asymptomatic but may complain of palpitations. It is of concern only in that antibiotic prophylaxis is needed in some cases for surgical and dental procedures to avoid the rare chance subacute bacterial endocarditis.
Aortic insufficiency
The most common causes of aortic insufficiency is infective endocarditis associated with rheumatic fever. In acute infectious destruction of the aortic valve, dyspnea, orthopnea and cough are the most common presenting cardiac symptoms resulting rom pulmonary edema. This is often life threatening and prompt treatment is necessary.
Signs and Sx: The greater volume of blood being pumped out of the ventricle increases the systolic pressure, causing a Widened pulse pressure.
congenital defect causing bicuspid valve issues
aortic stenosis
risks for coronary artery disease
smoking, hypertension, father with MI before 55 years of age, high cholesterol
LDL
low density lipoproteins - <100 optimal
S3
S3 s heard at the apex of the heart while pt is lying in the left lateral decubitus position. It is not a normal heard sound and is usually heard after the normal S1 and S2 hearts (lub-dub). It is normally associated with heart failure.
HDL
high density lipoproteins - goal >40
COPD
commonly caused by smoking, onset in middle age (consider alpha-1-antitrypsin deficiency in younger and non-smokers with COPD). Both chronic bronchitis and emphysema are considered COPD.
S/S chronic cough, with sputum production, worse on exertion and progressive over time. Hx of exacerbations during episodes of acute bronchitis. On exam, lung sounds are diminished. Crackles are more common than wheezes. Hyperresonnant on percussion. Barrel chest develops over time. Progressive disease results in right heart failure with abdominal distention, liver tenderness and edema.
Which respiratory phase is longer?
Inspiration
