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CPD 2 > week 1- CV 1 > Flashcards

week 1- CV 1 Flashcards

1
Q

• What is the cardiac cycle?

A

o 1 complete filling of R atrium to expulsion of blood through aortic valve into circulation after oxygenation.

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2
Q

• What occurs during systole?

A

o mitral and tricuspid valves close (S1)
o aortic and pulmonic valves open
o ventricles contract to Eject blood through Aortic and Pulmonic valves
o pressure in ventricles is high

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3
Q

• what occurs during diastole?

A

o closure of Aortic and Pulmonic valves (S2) signifies start of diastole
o mitral and tricuspid valves open
o atria empty, ventricles relax and fill,
o pressure in ventricles is low

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4
Q

• what is electrical conduction in normal sinus rhythm (NSR)?

A

o right atrium/SA node, to AV node, to the ventricles/Bundle of His, to bundle branches/right and left ventricles.
o SA node is pacemaker - sets rhythm in normal hearts
o NSR = 60-100 beats /min at rest, faster in infants (110-150).

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5
Q

• What are the inherent rates of different parts of the heart?

A

o SA node: 75/min
o AV node: 60/min
o Ventricles: 30-40/min

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6
Q

• What are the “emergency rates?”

A

o 150-250/min (extreme tachycardia)

o less than 30/min (extreme bradycardia)

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7
Q

• what is escape rhythm?

A

o initiated by lower centers when SA node fails to initiate impulses, its rhythmicity is depressed, or its impulses are completely blocked.

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8
Q

• What hx info must be gathered for CV exam?

A

o thorough HPI (current symptoms), complete PM and F Hx (DM, HTN, Hyperlipidemia, Kidney Dz), thorough ROS
o Pain? (chest, arm, back, neck, jaw – w/ or w/o exertion) CRUCIAL!
o Palpitations?
o Syncope, dizziness, lightheadedness?
o SOB, DOE, breathlessness, Paroxysmal nocturnal dyspnea, orthopnea?
o Edema?

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9
Q

• What general PE and vitals are done for CV exam?

A

o General appearance: acute distress? breathing ease? Cyanosis? alertness? mobility? Weight loss. Syndromes: Down, Marfan’s, Turner’s
o Vitals: BP, RR, T, HR
o BP: both arms, orthostatic (hypotension, fall of >10 should fu)
o RR: inc (anxious, hypoxic, pleuritic pain (also shallow), dec (moribund)
o T: hi: mb RF, endocarditis, post-MI

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10
Q

• How is pulse palpation and auscultation done for CV exam?

A

o Assess peripheral pulses (arms and legs): rate and rhythm, Intensity, symmetry, mb difficult in muscular or obese people, check for variations in pulse from beat to beat or w/ resp
o Carotid: intensity and symmetry, Auscultate to distinguish murmurs (originate in heart and great vessels) from carotid bruits (dt atherosclerosis)

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11
Q

• What veins are inspected in CV exam?

A

o Peripheral: for varicosities, inflammation and tenderness
o Neck: for height, which is proportional to right atrial pressure
o Jugular: pt reclined at 45 d; identify highest pt pulsations detected and measure distance b/w sternal angle. Normal: 1cm is significant.

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12
Q

• How do you do chest inspection and palpation in CV exam?

A 
o	Patient lies supine w/ slightly elevated head. 
o	Deformities/Congenital abnormalities
o	Visible precordial impulses, heaves
o	Thrills
o	Apex, PMI
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13
Q

• What are major findings in chest auscultation?

A

o heart sounds, murmurs, rubs

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14
Q

• what areas is chest auscultation done?

A

o Listen in all areas w/ diaphragm (high-pitched sounds), then bell (low pitched sounds). Use very little pressure when listening with the bell.
o Aortic area: 2nd ICS, right of sternum
o Pulmonic area: 2nd ICS, left of sternum
o Erb’s point: 3rd ICS, left of sternum
o Tricuspid area/RV: lower half sternum and parasternal area on right
o Mitral area/LV: 5th ICS at or just medial to midclavicular line.
o If difficult to hear, or pt obese, listen in L Lat decubitus OR leaning forward (pt leaning way over, with arm over dr’s shoulder), pt holds exhale so steth is closer to chest wall

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15
Q

• What are heart sounds? Characteristics?

A

o brief sounds indicating opening and closure of valves)
o Note if systolic or diastolic
o by location, timing, radiation, intensity, pitch and quality
o mb variations of sounds with respiration

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16
Q

• what are systolic sounds?

A 
o	S1 (normal): high pitched, dt mitral (mostly) and tricuspid valve closure, often split
o	clicks (abnormal): higher pitched than S1, shorter duration; Heard in mitral or tricuspid valve prolapse, from abnormal tension of chordae tendineae; may come and go or vary from exam to exam
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17
Q

• what are diastolic sounds?

A

o Diastolic sounds – S2 (normal), S3 (abnormal in adults), S4 (abnormal), opening snap (abnormal)
o S2 (normal): lower pitched, dt closure of aortic and pulmonic valves, commonly split (aortic closes first)
o S3 (abn in adults): early diastole, dt noncompliant, dilated ventricle (mb normal in kids)
o S4 (abn): late diastole, augmented ventricular filling caused by atrial contraction, more common than S3
o OS, opening snap (abn): early diastole, high pitched

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18
Q

• What helps differentiate the cause of murmurs?

A

o Timing and location

19
Q

• What are the systolic murmurs?

A

o Ejection, regurgitant, shunt

20
Q

• What are ejection murmurs?

A

o Dt turbulent blood flow thru a valve or outflow tract (mb normal in infants and children)
o Pulmonary or Aortic Stenosis (PS, AS), dilation of the aorta or pulmonary artery (PA).
o Mid-systolic, getting louder as flow becomes more obstructed (crescendo)

21
Q

• What are regurgitant murmurs?

A

o Dt retrograde or abnormal blood flow.
o Mitral or Tricuspid regurgitation/insufficiency, ventricular septal defect
o Tend to be holosystolic, i.e., longer duration than ejection murmurs

22
Q

• What are shunt murmurs?

A

o Dt abnormal openings between vessels or heart chambers
o Patent ductus arteriosis (fetal structure that shunts blood flow from descending aorta to pulmonary artery), ventricular or atrial septal defects

23
Q

• What are diastolic murmurs?

A

o Always abnormal
o Aortic or pulmonic regurgitation - early diastole, begin right after S2.
o Mitral or Tricuspid Stenosis – mid diastole

24
Q

• What are continuous murmurs?

A

o Always abnormal

o Congenital defects such as patent ductus arteriosis

25
Q

• What is pericardial friction rub?

A

o dt movt of inflamed visceral and pericardial layers
o High pitched, squeaking sound
o Best heard w/ pt leaning forward or on hands and knees during held expiration.

26
Q

• What lung PE is done for CV exam?

A

o Complete lung auscultation to assess for fluid accumulation which may occur in various cardiac disorders including heart failure

27
Q

• What abdomen PE is done for CV exam?

A

o Find and palpate the liver edge
o Assess for fluid wave, ascites
o SM
o Assess AA for bruit, aneurysm

28
Q

• What PE is done on legs in CV exam?

A 
o	Inspect: edema
o	Inspect: peripheral vascular dz
o	Femoral pulse
o	Varicose veins (assess for inflammation, tenderness) 
o	Stasis dermatitis, ulcers
29
Q

• What are some common cardiac sxs?

A

o Chest pain, palpitations, orthostatic/postural hypotension, postural tachycardia syndrome (POTS), syncope, edema

30
Q

• How do you eval for chest pain?

A

o Men and women may manifest pain of cardiac origin differently!
o Hx: Location, duration, character, quality, triggering and relieving factors, Radiation of pain (pain from the ear to the abdomen could be cardiac in origin!), PMH, risk factors for CAD
o PE: appearance, vitals, chest exam/auscultation, abdomen, extremities
o Tests: pulse oximetry, ECG, CXR, cardiac enzymes

31
Q

• What is ddx for chest pain?

A

o MI, unstable angina, dissecting aortic aneurysm, pulmonary embolism, pericarditis, malignancies, angina, pneumothorax, pneumonia, pancreatitis, pleurisy, GI dz, anxiety, herpes zoster, musculoskeletal problems

32
Q

• What are palpitations? What eval is done?

A

o any conscious sensation of heart activity, Assoc w/ many arrhythmias.
o Hx: Duration, character, triggers, onset/offset; Ask pt to tap out the beat if possible; Weakness, lightheadedness, syncope indicates a potentially serious arrhythmia; Other concomitant sxs; Substance use or abuse, Caffeine
o PE: Vitals, chest auscultation, thyroid exam
o Tests: ECG, 24 hr, or long term event monitor; pulse oximetry. Serum electrolytes, CBC, thyroid (TSH, free T4/T3), mb intracellular minerals, heavy metals, food allergies

33
Q

• What is ddx of palpitations?

A

o normal with exercise and emotion
o W/ arrhythmia: more likely to be cardiac disease: extrasystoles, tachy-, brady- arrhythmias
o W/o: arrhythmia (more likely to be non-cardiac): anxiety, anemia, fever, thyrotoxicosis, hypoglycemia, allergy, pheochromocytoma, aortic aneurysm, migraine, drugs, diaphragm flutter, coffee, tobacco, panic disorder

34
Q

• What is Orthostatic/Postural Hypotension? What eval is done? Ddx?

A

o Fall in BP >20/10 mmHg when assuming upright position, with sxs of faintness, lightheadness, dizziness, etc.
o Hx: Triggers (drugs, bed rest, fluid loss), Sxs of autonomic insufficiency (visual impairment, incontinence, constipation, heat intolerance, impotence); Sxs of CV, neuro, or malignant disorders
o PE: After pt is supine for 5 min, stand and measure BP at 1 and 3 mins; If no increased HR, consider autonomic impairment; >100 bpm suggest hypovolemia.
o Tests: ECG, electrolytes, glucose. Next: neurotransmitter urine test, adrenal function, heart rate variability
o Ddx: Hypovolemia dt dehydration, drug side effects or hemorrhage.

35
Q

• What is Postural tachycardia syndrome (POTS)?

A

o Exaggerated inc HR dt postural change w/o inc BP.
o Dx Criteria is sustained HR inc >30 bpm or inc to 120 or > in first 10 mins of tilt.
o Mb dt inc sympathetic tone.
o Dx in younger patients with postural intolerance. W:M 5:1.

36
Q

• What is syncope? What eval is done?

A

o Transient LOC dt inadequate cerebral perfusion.
o Hx: Current meds, drugs, details of syncope and pre-syncope event w/ assoc sxs
o PE: appearance (pallor, diaphoresis), vitals, orthostatic BP, cardiac auscultation of chest and neck
o Tests: vitals, resting ECG, pulse ox, HCT, electrolytes, cardiac enzymes

37
Q

• What is ddx of syncope?

A

o Circulatory issues: Vasovagal reaction w/ anxiety; Carotid sinus syncope (sensitive carotid sinus or lung disease); Volume or electrolyte depletion
o Cardiac: arrhythmias, output obstruction
o Neuro: szs, CV disease
o Metabolic: hypoglycemia, hyperventilation, hypoxia
o Drugs: antidepressants, antihypertensives

38
Q

• What is edema?

A

o Inc interstitial fluid vol w/ or w/o inc blood volume.
o May appear as unexplained weight gain, tight rings or shoes, facial puffiness, swollen extremities, enlarged abdomen (ascites), pitting edema
o may be local or generalized.

39
Q

• What is ddx of edema?

A

o CHF (dependent edema), pericardial dz, liver dz, nephrotic syndrome (low albumin), myxedema, hemiplegia, trichinosis, lymphedema (more localized), protein-losing enteropathy, idiopathic

40
Q

• What are some non-invasive CV procedures?

A

o Plain radiography
o ECG: arrhythmias, myocardial ischemia, enlarged chambers
o Echocardiography: valvular disorders, chamber hypertrophy or dilation, cardiomyopathies, heart failure, pericarditis
o EBCT: assess coronary arteries (electron beam now obsolete and a multislice or multi detector row is used, MSCT or MDCT), Quantify calcification, Assess atherosclerosis
o MRI/MRA: mediastinal eval, aorta
o PET: myocardial perfusion
o Radionuclide Imaging: Myocardial Perfusion studies, Thallium, Technetium (sestamibi most common)
o Stress Testing: screen CAD

41
Q

• What are the invasive CV procedures?

A 
o	for more intensive artery assessment
o	Cardiac Catheterization 
o	CABG (coronary artery bypass graft)
42
Q

• What are types, causes of arterial hypertension?

A

o Primary: multifactorial and poorly understood, genetics and lifestyle
o Secondary: dt another pathological process
o Excessive alcohol, BCP, sympathomimetics, corticosteroids, cocaine

43
Q

• What are ssx of AHTN?

A

o Usu asx
o Dizziness, facial flushing, HA, fatigue, epistaxis, nervousness (usually complicated HTN)
o Sometimes S4
o !! Know when it’s an Emergency.

44
Q

• How is AHTN diagnosed?

A 
N: S  lt 120, AND D lt 80
Pre S 120-139, OR D 80-89
1: S 140-159, OR D 90-99
2: S gtet 160, OR D gtet 100
2 BP readings (supine or seated, then standing after 2 minutes), on 3 separate days.  avg is used for dx

CPD 2 (10 decks)

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