Swartz deck Flashcards
The SA node is located at the juncture of what?
the superior vena cava and right atrium
What affect does norepinephrine and acetylcholine have on the heart
Norepinephrine gives a marked increase in the HR and contractility. Acetylcholine slows the heart rate down and decreases contractility
What part of the brain controls the heart
The Medullary cardio-vascular center of the brain
What creates the 1st heart sound?
The closure of the atrioventricular valves (mitral and tricuspid).
What creates the 2nd heart sound
The closure of the semilunar valves (aortic and pulmonary).
What are the 4 major auscultatory areas of the heart and where are they found
1) Aortic - 2nd ICS and Right sternal border
2) Pulmonic - 2nd ICS and Left sternal border
3) Tricuspid - Left lower sternal border
4) Mitral - Cardiac apex, 5th ICS and mid-clavicular line
What is the sequence of opening and closing of the 4 heart valves
MV close TV close
PV open AV open
AV close PV close
TV open MV close
What is the time between the closure of the AV valves and the opening of the SL valves calld
Isovolumetric contraction
A pulmonic ejection click is heard when?
if the pulmonic valve is stenotic
What are 2 ways to call that point at which ejection is completed and the aortic and LV curves separate
Incisura or dicrotic notch
What is the time btwn the closure of the SL valves and the opening of the AV valves called
Isovolumetric relaxation
When does S3 occur?
at the end of the rapid filling of the ventricles
When is S3 and S4 normal
In kids and young adults
What does an S3 in adults possibly mean
Volume overload of the ventricles (CHF and regurgitant valvular lesions may be the cause.
When may an S4 be heard?
At the end of diastole, and after the atrial contracts and the additions 20% of ventricular filling has occurred.
What does an S3 in adults possibly mean?
it’s indicative of a non-compliant or stiff ventricle
Which heart sound is the loudest
S1
What is Poiseuille’s law
The total resistance of vessels connected in parallel is greater than the resistance of a single large vessel (for example the BP of the aorta is less than the branched arteris of the LE.
Describe the characteristics of angina chest pain
Retrosternal and diffuse, radiates left arm, jaw and back, Aching, dull, pressing squeezing. Mild to severe intensity. Lasts minutes. Precipitated by effort, emotion, cold or eating and relieved by rest or NTG
Describe the characteristics of chest pain that is NOT angina
Left inframammary and localized, Radiates up right arm. Sharp, shooting cutting pain. Excruciated intensisty. Lasts seconds, hours, days. Precipitated by respiration, posture and motion.
Accrding to Schwartz what is the definition of ornothopnia?
A symptom of PND, the need for using more pillows to sleep.
What is trepopnea?
A rare form of positional dyspnea where patient will have less dyspnea when lying on either the right or left side
What is Micturition syncope?
A condition that usually happens in men during straining with urination (many times after considerable alcohol consumption.
About 40% of all syncopal events are which kind?
Vasovagal syncope
What is vasovagal syncope?
A sudden fall in systemic vascular resistance without a compensatory increase in cardiac output as a result of vaggotonia. It can be caused by trauma, stress, painful experience, sight of blood etc. Can be preceded by many s/s including nausea, weakness, lightheadness, yawning or sinking feeling
What are some common cardiac causes of dyspnea?
Left Ventricular failure, mitral stenosis
What are some common pulmonary causes of dyspnea?
Obstructive lung disease, asthma, Restrictive LD, Pulmonary embolism, pulm hypertention
Who is mostly affected by carotid sinus syncope?
The elderly. Its a hypersensitive carotid sinus and can occur wearing a tight shirt collar and turning neck to one side.
Who is mostly affected by post tussive syncope?
Those with chronic obstructive lung disease.
What cardiac condition can cause hemoptysis?
Mitral valve stendosis
What are some possible causes of eruptive xanthomatas?
Hyperlipidemia types I - IV and hypertriglyceridemia (TG over 1500)
Where might you see the presence of erythema marginatum?
In a patient w- acute rheumatic fever
Where might you see the presence of Osler’s nodes, painful lesions in the fingers and toes?
In a patient with ineffective endocarditis.
What are splinter hemorrhages in the nail classically associated with?
In a patient with ineffective endocarditis.
What is a crease in the earlobe called and what can it be a sign of?
Lichtstein’s sign. If over 50 y/o it can be a sign of significant CHF
What might be seen in a patient’s mouth with Mitral valve prolapse? How about ineffective endocarditis?
MVP - A highly arched palate
IE - petechiae spots.
In what condition may you see webbing on the neck?
Coarctation of the aorta - Turner’s syndrome
Pulmonary stenosis - Noonan’s syndrome
What are Korotkoff sounds?
Low pitched sounds originating in the vessel that are related to turbulence produced by partially occluding an artery with a blood pressure cuff.
What is the description and cause of an Anacrotic pulse?
Small slow rising, delayed pulse with a notch or shoulder on the ascending limb. Cause aortic stenosis.
What is the description and cause of a Waterhammer (Corrigan’s) pulse?
Rapid and sudden systolic pulse. Cause Aortic Regurg.
What is the description and cause of a Bisferiene’s pulse?
Double peaked pulse with a mid systolic dip. Cause Aortic regurg
What is the description and cause of an Alterman’s pulse?
Alternating amplitude of pulse pressure. Cause CHF
What is the description and cause of a Paradoxical (marked) pulse?
Detected by BP assessment. An exaggerated drop in systolic blood pressuer during inspiration. Cause Tamponade, constricted pericarditis, Chronic obstructive lung disease
What are the 6 grades of murmur intensitiy
Type 1 - Low intensity. often not heard by inexperienced.
Type 2 - Low intensity heard by inexperienced
Type 3 - Medium intensity w/o thrill
Type 4 - Medium intensity w thrill
Type 5 - Loudest with stethoscope and thrill
Type 6- Loudest heard w/o stethoscope, has a thrill
Differences btwn Reynaud’s disease and phenomenon
Both in women
Raynaud’s disease - Usually bilateral, precipitated by cold, no ischemic changes or gangrene or disease association
Reynold’s Phenom - Asymetric, cold increases symptoms, Ischemic changes, gangrene and disease associate common
Diabetes, Atherosclerosis, Thromboangitis obliterans, Reynaud’s disease and Arterial embolism. What age for each
DM and AE - any
Arth - over 60
TO and RD - under 40
Diabetes, Atherosclerosis, Thromboangitis obliterans, Reynaud’s disease and Arterial embolism. Which gender gets?
DM, Arth and AE - either
TO - male
RD - female
Diabetes, Atherosclerosis, Thromboangitis obliterans, Reynaud’s disease and Arterial embolism. What kind of onset
All gradual but AE which is sudden
Diabetes, Atherosclerosis, Thromboangitis obliterans, Reynaud’s disease and Arterial embolism. What is the pain level
DM, Arth, RD - moderate
TO - severe
AE very severe
Diabetes, Atherosclerosis, Thromboangitis obliterans, Reynaud’s disease and Arterial embolism and distal pulses
DM, arth, TO may be absent
RD - present
AE - Absent.
What’s in the RUQ
Liver, gallblader, pylorus, duodenum, pancreas head, R adrenal gland and kidney, Hepatic flexure and portions of ascending and transverse colon
What is in the LUQ
Left lobe of Liver, spleen, stomach , pancreas body, Ladrenal gland and kidney, splenic flexure and portions of descending and transverse colon
What is in the LLQ
Right kidney, cecum, appendix, R ovary, fallopian tube, ureter and spermatic cord, portion of Ascending colon, uterus and bladder (if enlarged)
What is in the RLQ
Left kidney, sigmoid colon, L ovary, fallopian tube, ureter and spermatic cord, portion of descending colon, uterus and bladder (if enlarged)
With referred pain, pain in the substernal area could mean what affected organ?
Esophagus
With referred pain, pain in the shoulder area could mean what affected organ?
Diaphragm
With referred pain, pain in the epigastric area could mean what affected organ?
Stomach, duodenum, GB, liver , bile ducts and pancreas
With referred pain, pain in the Right scapula area could mean what affected organ?
Bilary tract
With referred pain, pain in the midback area could mean what affected organ?
Aorta or pancreas
With referred pain, pain in the periumbilical area could mean what affected organ?
Small intestine
With referred pain, pain in the Hypogastrium area could mean what affected organ?
colon
With referred pain, pain in the sacrum area could mean what affected organ?
Rectum
Differences btwn Ulcerative colitis and Crohn’s disease
Both have diarrhea and extraintestinal manifestations.
UC - Hemotochezia (common), Perirectical fissures, Rectal disease present but anal disease is not
CG - Hemotochezia (rare), Perirectical fistulas or abscesses Rectal disease absent but anal disease is persent
What are symptoms of Cancer of the right colon?
Ill defined pain, infrequent obstruction, brick red bleeding and weakness
What are symptoms of Cancer of the left colon?
colicky pain, common obstruction, red bleeding mixed with stool and infrequent weakness
What are symptoms of Cancer of the rectum
steady and gnawing pain, infrequent obstruction, bright red coating stool and infrequent weakness
