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Cardiology IPAP > Slide set 3 > Flashcards

Slide set 3 Flashcards

1
Q

What sequence do you use to perform a heart exam

A

1-Inspection, 2-Palpation, 3-Auscultation

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2
Q

Skin inspection ABNLs

A

Cyanosis, Pallor, Edema, Clubbing

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3
Q

NL chest shape is

A

2:1 - wider:deep

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4
Q

ABNLs of the chest (5)

A

Pectus Excavatum Pectus Carinatum Barrel Chest
Thoracic kyphoscoliosis
Traumatic flai chest

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5
Q

Pectus excavatum charcteristics

A

AKA funnel chest Lower sternum is depressed Compresses heart/great vessels - causing murmurs

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6
Q

Pectus Carinatum characteristics

A

AKA Pigeon chest Sternum displaced anteriorly (increases A-P dia) Costal cartilage is depressed

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7
Q

What condition is associated with barrel chest

A

Aging COPD

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8
Q

Peripheral cyanosis represents what area

A

Extremities

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9
Q

Central cyanosis represents what area

A

Chest and mouth

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10
Q

Central cyanosis is involved with

A

R to L cardiac/pulmonary shunting

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11
Q

Pts with central cyanosis likely to have (2)

A

Hypoxemia and erythrocytosis

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12
Q

What D/O’s cause shunting

A

VSD, ASD, Pulm HTN, COPD, Congenital heart DZ in PEDS

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13
Q

Central cyanosis hypoxemia means

A

Deoxy blood is being circulated thru body

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14
Q

Pallor usually suggests

A

Inadequate Hgb

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15
Q

Best places to observe pallor (4)

A

Conjunctival vessels, lips, mucous membranes

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16
Q

Cardiogenic edema is usually

A

Bilateral and due to CHF esp. RHF

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17
Q

Where is clubbing typically seen

A

Congenital heart diseases

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18
Q

Palpate these (4)

A

JVP, BP, Pulses, PMI

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19
Q

JVP measurement assess

A

R sided heart fx (cnt tell if there is A-fib or stenosis)

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20
Q

JVP height is represents

A

Right atria pressure = Central venous pressure

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21
Q

NL JVP at highest site of pulsation is

A

less than or equal to 9cm to RA or 0-4cm to sternal angle

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22
Q

Where is the sternal angle in relation to right atrium

A

5cm above RA

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23
Q

JVD is

A

Persistant distention of internal (external sometimes) jugular veins

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24
Q

JVD is usually asscoaited with

A

Volume overload states like CHF

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25
Q

If you cant see this neck BV but can palpate it its

A

Carotid artery

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26
Q

If you can see it this neck BV but cant palpate its

A

Ext jugular vein

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27
Q

Distinguish JVP from carotid pulses

A

JVP fills from above, moves on inspiration, changes with posture

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28
Q

Wave forms of JVP (5)

A

A, C, V, X, Y

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29
Q

A wave corresponds to

A

RA pressure rise in Atrial contract, before S1 sound

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30
Q

A waves are absent in

A

A-fib

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31
Q

X descent corresponds to

A

Atrial relaxation - R vent contracts pullin RA down

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32
Q

X wave may be absent in

A

Severe tricuspid regurgitation, A-fib, R atrial ischemia

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33
Q

C wave represents

A

Tricuspid valve bowing into RA

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34
Q

V wave represents

A

After systole - venous pressure returns increasing atrial pressure

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35
Q

V wave is seen with

A

Severe tricuspid regurgitation, RVF, restrictive cardiomyopathy

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36
Q

Y descent represents

A

Reduced pressure with tricuspid opening - emptying RA during diastole

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37
Q

Factors impairing atrial emptying effect what waves

A

A and Y descent waves

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38
Q

Waves A and C represent what heart sound

A

S1

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39
Q

Wave V represents what heart sound

A

S2

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40
Q

Generally what causes increased pressures in RA

A

Increased Volume and Resistance/compliance conditions

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41
Q

Conditions increasing A waves

A

Conditions with increased resistance such as RVH, Pulm HTN, Complete heart block

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42
Q

Prominent X descent observed in what conditions

A

Constrictive pericarditis and tamponade

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43
Q

Kussmauls sign suggests

A

Impaired filling of right ventricle due to either fluid in pericardial space or uncompliant myocardium/pericardium

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44
Q

Kussmauls causes JVP to

A

Rise with inspiration

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45
Q

Hepato-jugular reflex concept with a pt having R-sided dysfx

A

Applying pressure to liver increases CVP, thus increasing RA pressure, and increasing JVP wave form intensity

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46
Q

BP symmetry includes taking BP where

A

L vs R and arms vs legs

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47
Q

Pulse pressure is

A

Difference between Systolic and Diastolic arterial pressure

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48
Q

Increased pulse pressure typically seen in

A

Aortic regurgitation or conditions increasing stroke volume or contractility

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49
Q

Narrowed pulse pressure typically seen in

A

Hypovolemia, severe LVF or severe mitral stenosis

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50
Q

Conditions that increase stroke volume

A

Anemia, thyrotoxicosis, arteriovenous fistulas

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51
Q

Full pulse exam includes (7)

A

Carotids Brachial Radialis

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52
Q

Purposes of palpating a pulse

A

Patency and LV contraction intensity

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53
Q

What pulse most accurately reflects aortic pulse

A

Carotid pulse

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54
Q

Exam each pulse for these 5 things

A

Rate, Rhythm, Strength, Contour, Symmetry

55
Q

Normal pulse is characterized by

A

Rapid rise, short plateau, gradual descent

56
Q

Dicrotic notch represents

A

A secondary upstroke of the aortic valve closure

57
Q

ABNL pulses (6)

A

Hypokinetic Hyperkinetic Bisferiens pulse
Pulses Alternans
Pulses parvus et Tardus
Pulses Pradoxus

58
Q

Hypokinetic pulse is related to

A

Decreased rate of 1.LV pressure development 2.LV SV

59
Q

Hyperkinteic pulse is related to

A

Increased rate of 1.LV pressure development 2.Large LV SV with decreased peripheral resistance

60
Q

Bisferiens pulse is

A

Pulse with two palpaable beats during systole

61
Q

Bisferiens pulse is seen in

A

HOCM Aortic Stenosis and insufficiency Rapid ejection of an increased SV

62
Q

Rapid ejection of an increased SV is related to

A

Exercise, Fever, PDA

63
Q

Pulsus Alternans is

A

Variation of amplitude in alternate beats due to changing systolic pressures

64
Q

Pulsus Alternans is seen in

A

Severely depressed cardiac function conditions

65
Q

Pulsus Alternans can be confirmed by

A

Measuring the BP

66
Q

Pulsus Pravus et Tardus is

A

Pulse with slow increase of pressure that is late and small in intensity

67
Q

Pulsus Pravus et Tardus is associated w/

A

Aortic Stenosis

68
Q

Pulsus paradoxus is

A

BP drops >10mmHg during inspiration

69
Q

Pulsus paradoxus can be seen in

A

Cardiac Tamponade and others

70
Q

PMI is palpated by

A

Having pt supine or in left lateral position and with hand over pts left lower chest wall

71
Q

A NL PMI represents

A

the apex of the heart in the 4-5th ICS on MCL

72
Q

What happens to PMI with LV hypertrophy

A

Lateral displacement

73
Q

What two etiologies cause PMI displacement

A

Volume over load due to Cardiac Dilation Pressure overload due to Ventricular hypertrophy

74
Q

Volume overload causes what type of PMI impulse

A

Hyperdynamic

75
Q

Pressure overload causes what type of PMI impulse

A

Sustained apical impulse

76
Q

What valvular pathologies cause cardiac dilation

A

AR and MR

77
Q

What conditions cause hypertrophy

A

HTN and AS

78
Q

Thrills represent

A

A palpable murmur

79
Q

What grade is a palpable murmur usually

A

Grade IV to VI

80
Q

Heave or lift is associated with

A

Large ventricle or HF

81
Q

What positions for asuculatations (3)

A

Sitting, Supine, Left lateral

82
Q

In what order are the concerns for auscultation

A
  1. NL heart sounds 2.ABNL heart sounds (S3, S4, clicks, snaps. 3.Murmurs
83
Q

S1 sound is produced by

A

MTV closure

84
Q

S1 is best heard where

A

Apex

85
Q

S1 represents what phase

A

Beginning of systole

86
Q

An increased S1 could mean

A

Shortened PR interval Mild Mitral stenosis High cardica output states (tachycardia)

87
Q

A decreased S1 could mean

A

Prolonged PR interval (1st degree AV block) Mitral regurgitation Severe mitral stenosis Stiff Left ventricle

88
Q

S2 sound is produced by

A

APV closure

89
Q

S2 is best heard where

A

A2 - R 2nd ICS P2 - L 2nd ICS

90
Q

Is A2 or P2 more intense?

A

A2

91
Q

During S2 splitting which valve closes first?

A

A2

92
Q

Variable widened S2 splitting during expiration and inspiration is caused by

A

R-BBB and Pulmonic Stenosis (sound intensity decreased

93
Q

Fixed splitting of S2 that persists during expiration and inspiration is cause by

A

ASD

94
Q

Paradoxical S2 splitting is when

A

A2 closes before P2

95
Q

Paradoxical S2 splitting is caused by

A

L-BBB Aortic stenosis (decreased A2 intensity) Chronic HTN (increased A2)

96
Q

S3 is also known as

A

Ventrical gallop (Slosh-ing-in S123)

97
Q

S3 is best heard at

A

the cardiac apex in the left lateral decubitus

98
Q

S3 intensity can be increased by

A

Increasing venous return (leg raise) Increasing arterial pressure/CO (handgrip)

99
Q

S3 could mean dysfx of what

A

Ventricular dysfx esp >40yo

100
Q

S4 is also known as

A

Atrial Gallop (A-stiff-wall S412)

101
Q

S4 is best heard at

A

Cardiac apex

102
Q

S4 is due to

A

Active atrial filling against a stiff noncompliant ventricle usually related to LVH

103
Q

What causes LVH (4)

A

Chronic HTN Aortic Stenosis Hyertrophic cardiomyopathy

104
Q

Opening snap occurs when

A

Early diastolic

105
Q

Opening snap sounds like

A

A high pitched sound

106
Q

Opening snap heard best where

A

Between the APEX and LSB

107
Q

Opening snap is most commonly due to

A

Mitral Stenosis

108
Q

What does it mean when A2 and OS interval is shortened

A

Worsening Mitral stenosis

109
Q

Ejection clicks occurs when

A

Early to mid-systolic phase

110
Q

Ejection clicks sounds like

A

Sharp high pitched sound

111
Q

Early Ejection clicks due to

A

Stenotic valve reaches its macimum degree of opening (AS & PS & Pulm HTN)

112
Q

Mid-systolic Ejection clicks due to

A

Sudden opening/regurgitation of MV or TV

113
Q

Murmurs are defined as

A

Auditory vibrations due to turbulent blood flow

114
Q

Murmurs are due to 1 of 2 things

A

ABNL blood flow across normal cardiac structure Normal blood flow across ABNL cardiac structure

115
Q

Which type of murmur is almost always pathologic

A

Diastolic murmurs

116
Q

Can systolic murmurs be pathologic or benign?

A

Yes

117
Q

Describing a murmur (5)

A

Duration/timing Location Intensity
Pitch
Shape

118
Q

Murmur pitch refers to

A

Frequency of the sound

119
Q

A high frequency murmur suggests

A

Increased velocity of turbulent blood flow

120
Q

A low freq murmur suggests

A

Reduced velocity of turbulent blood flow

121
Q

Crescendo murmur described as

A

Building in intenstiy

122
Q

Decrescendo murmur described as

A

Reducing intensity

123
Q

Examples of a decrescendo murmur

A

Early diastolic murmur of aortic regurg

124
Q

Crescendo-decrescendo is

A

“diamond-shaped” murmur of aortic stenosis

125
Q

Holosystolic/pansystolic means

A

Unchanged character throughout murmur

126
Q

MC Holosystolic/pansystolic are due to

A

Mitral regurgitation

127
Q

Special manuevers are used to consider their effects on what?

A

Preload and Afterload

128
Q

Preload is a function of venous return how?

A

Increased venous return equals increased preload Decreased venous return equals decreased preload

129
Q

HOCM is an abbreviation for

A

Hypertrophic obstructive cardiomyopathy

130
Q

HOCM is the exception to the rato of blood volume:murmur intensity rule- what is HCM more affected by?

A

Pressure gradient across the valve

131
Q

Afterload is a function of systemic vascular resistance how?

A

Increased SVR equals increased afterload Decreased SVR equals decreased afterload

132
Q

Systemic vascular resistance essentially means

A

BP of the aorta

133
Q

Afterload exacerbates what type of murmur?

A

Regurgitant murmurs and reduces stenotic murmurs

134
Q

Loud or diastolic murmurs are pathologic in nature usually?

A

Yes

Cardiology IPAP (20 decks)

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