zatchot CVS Flashcards
Basic complaints of CVS
- Pain: - coronarogenic (ischaemic) – angina pectoris
- non-coronarogenic - cardialgia
*Interruptions in the work of the heart and palpitation
*Shortness of breath (dyspnea), suffocation
*Edema
*Coughing, hemoptysis
*Headache
*Dizziness, flickering flies before the eyes
*Syncope
explain the Edema duo to CVS dieses
- Location :ankles, shins, feet (at the greatest distance from the heart)
- Quality: dense (elastic), cyanotic, with the formation of a hole (pitting edema),
symmetric - Quantity/Intense :legs only (ankles, shins) or ascites too, etc
- Chronology: constant, frequency (once, twice (or more) per week/month), rare arising / increasing in the evening
- Aggravating factors: increase in the amount of fluid consumed during the day, exercise, long standing position,
- Alleviating factors : taking medications (effectiveness of drug therapy), resting (horizontal position with legs raised), stop of exercise
- Associated manifestations : cough and shortness of breath, a violation of the color and integrity of the skin over edema
explain the Dizziness and Syncope
1-Dizziness, flickering flies before the eyes
- permanent or periodic
- relationship with changes in body
position, interruptions in the work of the
heart, relationship with the rise or fall of
blood pressure
2-Syncope
- frequency of occurrence
- aggravating-alleviating factors:
stuffy room, unpleasant odors,
stress, menses, interruptions in the
work of the heart
explain the Dizziness and Syncope
1-Dizziness, flickering flies before the eyes
- permanent or periodic
- relationship with changes in body
position, interruptions in the work of the
heart, relationship with the rise or fall of
blood pressure
2-Syncope
- frequency of occurrence
- aggravating-alleviating factors:
stuffy room, unpleasant odors,
stress, menses, interruptions in the
work of the heart
explain the Skin covers
1-Colors of skin
- coffee with milk
- pale
- acrocyanosis
Skin rashes and formations :
1-xanthoma 2-trophic changes 3-acrocyanosis
explain the Apex beat
*Location in the V intercostal space, 1,5 cm medial to the
mediaclavicular line
*Mechanism: due to the impact of the apex of the heart on
the chest wall
*Pathology: “Negative push” - with adhesive
(constrictive) percarditis
explain the Shift of apex beat
1-Left shift:
§ On the left side (3-4 см)
§ Dilation and hypertrophy of LV
§ Dilation of RV
§ Fluid or air in right pleural cavity
2-Right shift:
§ Lying on the right side (1-1,5 см)
§ Pleuro-pericardial commissures
3-Disapperas :
§Left-sided hydrothorax
§Hydropericardium
4-Negative: (constrictive pericarditis)
explain the Cardiac (right ventricular) beat
*Location in the III -
4th intercostal space to the left of the sternum extends to the epigastric region
*Mechanism - reduction of enlarged right ventricle
explain the Epigastric pulsation
*Elevation and lowering of the anterior abdominal wall in the epigastric region, synchronous to the contractions of the heart
*Mechanism:
- pulsation of the heart (right ventricle)
- pulsation of the abdominal aorta
- pulsation of enlarged liver
reasons of Pulsation due to contractions of the
abdominal aorta
*Location - below the xiphoid process, with deep inspiration visible worse
*Appears when:
- exhaustion;
- asthenic type of constitution;
- relaxed abdominal wall;
- omission of internal organs;
- aneurysm of the abdominal aorta
explain the Arterial pulse and its Properties
-DF- Pulse is the rhythmical vibration of the arterial walls caused by contractions of the heart, blood discharge into the arterial system, and changes in pressure in this system during systole and diastole
-Properties :
-* Rhythm: regular/irregular
* Pulse rate:
- normal (60-90 per min)
- bradicardia (<60 per min)
- tachycardia (>90 per min)
phases of BP
1 phase – first quiet tones – Systolic BP
2 phase – short compression murmurs
3 phase – loud systolic murmurs
4 phase – decreasing intensity of tones
5 phase – disappearance of tones – Diastolic BP
Borders of relative cardiac dullness
*Represents the true size of the heart
*Use a quiet percussion
*Define three boundaries:
- the right;
- the left;
- the upper
Causes of an increase in the right atrium
*Diseases of the lungs.
*Stenosis of the right AV-hole.
*Tricuspid regurgitation, or lack of tricuspid valve.
*Pulmonary embolism.
*Congenital heart diseases.
*Hypertrophy of the right ventricle
Causes of an increase in the right ventricle
*Pulmonary hypertension.
*The tetrad of Fallot.
*Stenosis of the pulmonary artery mouth.
*Defect of interventricular septum.
Causes of an increase in the left ventricle
*High blood pressure (hypertension).
*Insufficient mitral valve.
*Stenosis of the aortic valve (AV).
*Hypertrophic cardiomyopathy.
*Physical exercise.
*Obesity
Causes of increase of the left atrium
*Obesity.
*Insufficient mitral valve.
*Mitral stenosis.
*Hypertrophic cardiomyopathy.
*Aortic stenosis
Boundaries of absolute dullness of the heart
*The right border is located on the left side of the sternum
*The left border coincides with the boundary of relative dullness or is located 1cm inside of it.
*Upper border at level IV rib
*Expansion (increase) with increasing left ventricle,
displacement of the heart anteriorly, puckering of the ]lungs (pneumosclerosis)
*Reduction (decrease) in emphysema, pneumothorax
The width of the vascular bundle
*It is defined on the II intercostal space
*Use the quietest percussion
*Normally it is 5-6 cm
what is the Heart auscultation points
1 point of auscultation - in the area of apical impulse (MV)
2 point of auscultation - in the II intercostal space to the right of the sternum (AV)
3 point of auscultation - in the II intercostal space to the left of the sternum (PAV)
4 point of auscultation - at the base of the xiphoid process (TV)
5 point of auscultation - III-IV intercostal space to the left of the sternum (AV, MV)
Registration of heart sounds
(auscultatory and phonocardiography)
I sound (S1) - systolic
II sound (S2) - diastolic
III sound (S3) - diastolic
IV sound (S4) - diastolic
Sound 1 (S1), properties and Factors that may influence the
intensity of S1
—properties
* It is registered at the beginning of systole
* In synchronous recording, the PCG and ECG coincide with the S wave
* Occurs mainly in the phase of isovolytic reduction
–Factors :
* Condition of the valves
* Condition of ventricles (velocity of ventricular contraction)
* Metabolic processes in myocardium
* Left ventricular systolic volume
* Thickness of the valves
Sound 2 (S2), properties and Factors that may influence the
intensity of S2
—properties
* Appears at the beginning of diastole (proto diastole)
* It is formed as a result of:
- oscillations of the closed PV and AV (2 components of S2)
- oscillations of the walls of the aorta and pulmonary artery
- oscillations in the diastolic relaxation of the ventricular
myocardium
–Factors :
* Condition of the valves
* Blood pressure level in aorta and pulmonary trunk
* Speed of ventricular relaxation
* Thickness of the valves
The difference between S1 and S2
- Short systolic pause between S1 and S2;
- Long diastolic pause between S2 and S1;
- Best point for auscultation of S1 is apex and low border of
the sternum; - Best point for auscultation of S2 is the 2nd intercostal space to the right and to the left
