1 cardio lecture Flashcards
1
Q
Angina
A
- the main manifestation of the coronary artery disease (CAD)
-
Typical angina (definite):
1) Substernal chest discomfort with a characteristic quality and duration that is2) provoked by exertion or emotional stress and 3) relieved by rest or NTG. - Atypical angina (probable): meets 2 of the above characteristics.
- Noncardiac chest pain: meets one or none of the typical anginal characteristics. (AHA 2009
2
Q
CAD
A
discrepancy between the amount of oxygen supplied to the cardiac tissue and the needs;
- other cause of angina: inflam.involving the coronary art.(syphilis, vasculitis); angina“with normal coronary arteries“
3
Q
Typical angina
A
- S:Precordial area
- R:left uper limb cubital side to last 2 fingers
- C:Constriction ppressure squeezing
- T:no more than 15 minutes
- E:Extra demand on the heart exercise, an emotional upset, exposure to cold, a heavy meal
- rest nitroglycerine
- S:Aanxiety dyspnea
4
Q
Atypical angina
A
- S:Interscapular, upper part of the body, epigastrium; sometimes: just in areas of radiation
- R: jaw Posterior limbs posterior Thorax
- C: weakness discomfort
5
Q
[*] Prinzmetal angina (variant angina):
A
- Coronarian spasm – hyperactivity of sympathetic nervous system
- During sleeping (REM phase- rapid eye movement)
- Severe pain, anxiety, dyspnea
- Same hour of the night (or day)
- Elevation of the ST segment (diff.dg. with acute myocardial infarction)- occurs only during the crisis !!!
6
Q
Non-ischaemic pain:
Pericarditis
A
Pericarditis
- Substernal pain, like a “knife”(dry p.) or pressure (p.effusion) or absent
- Left border of the sternum or epigastrium radiating to the neck and arms
- increases: pressure over the thorax, respiratory movements
- decreases: leaning forward – antalgic position in dry pericarditis and against dyspnea in pericardial effusion !
7
Q
Pain due to aortic causes
A
- Aortitis (syphilis)
- Aortic aneurysm
- Acute dissection of aorta:
–suddenly and maximal intensity onset;
–anterior thoracic pain is associated with anterior arch or aortic root dissection
8
Q
Forms of dyspnea in cardiac patients:
A
–Exertional d. – progressive: the intensity of the effort leading to dyspnea declines progressively
–Dyspnea at rest with orthopnea
–Paroxysmal d.: ACUTE LVF- 3 types:
9
Q
–Paroxysmal dyspnea
A
Nocturnal paroxysmal dyspnea
- a sudden awakening of the patient, after a couple hours of sleep, with a feeling of severe anxiety, breathlessness, and suffocation- orthopnea
- the manifestations are relieved spontaneously
- Episodes of this may be so frightening that the patient may be afraid to resume sleeping
Cardiac Asthma
- Bronchial obstruction is associated
Acute pulmonary Edema
- Transsudate al alveoli level
- Severe dyspnea and cough- frothy pink sputum
10
Q
Exertional d. – progressive: the intensity of the effort leading to dyspnea declines progressively
A
- the degree of activity necessary to induce this symptom: difference between healthy-cardiac subjects
- CHRONIC LVF (CAD, hypertensive cardiopathy, valvular heart diseases etc)
- The severity of d. decreases when RIGHT cardiac failure occurs !!! – pulmonary stasis decreases when peripheral (sistemic) stasis develops
11
Q
–Dyspnea at rest with orthopnea
A
[*] LV advances
[*] is relieved with elevation of the head - “how many pillows do you need?”
[*] develops when the patient is awake, within min.after the recumbency
[*] Cough- nonproductive, during recumbency- an “orthopnea equivalent.”
12
Q
Palpitations:
A
- An unpleasent sensation in which a person is aware of an irregular, hard, or rapid heartbeat.
- Due to hyperexcitability of the central nervous system or abnormal cardiac function (rhythm, the force of contraction)
- A very common symptom
- Physiological cond. (coffee, smoking, effort, stress)
- Cardiac diseases- arrhythmias (any cardiopathy)
13
Q
Palitations
The correlation with a cardiopathy is supposed when:
A
- Palpitations- persistent and frequent
- Associatedwith chest pain,dyspnea
- history of a cardiac disease
14
Q
Orthopnea
A
Acute LVF
15
Q
Immobile
A
during crisis off angina
16
Q
Agitation, no specific position to relieve the pain
A
AMI
17
Q
Squatting
A
congenital cardiopathy (redistribution of the blood to the brain)
18
Q
Leaning forward-
A
pericarditis
19
Q
corvisart face
A
20
Q
cyanosis
A
–Central: congenital cardiopathy (R L shunt)
–Periph.: RCF
–Mixed: cor pulmonale
21
Q
Palor
A
Low cardiac output
- CF
- Arrythmias
- acute myocardial infarction
- crisis of angina
Cafe au lait : pallor+ cyanosis –> infectios endocarditis
22
Q
Jaundice
A
Chronic liver stasis
RCF
Chronic Pericarditis
23
Q
clubbing finger
A
- congenital cardiopathies
- endocarditis
- cor pulmonale
24
Q
Meynet nodules
A
reuhmatic fever
(on the back of the wrist, the outside elbow, and the front of the knees), erytema marginatum (well-demarcated edge and clearing central portion)
25
signs for infectious endocarditis
[\*] Osler nodes:
–Septic embolisation- fingers, toes
[\*] Janeway lesions:
–Haemorrage the thenar and hypothenar eminences
[\*] splinter haemorrhages on fingernail
26
Fever (37-38 Celsius):
infective endocaditis
27
Systolic epigastric pulsations:
- right ventricle dilatation= Harzer sign,
- abd.aortic aneurysm,
- tricuspid regurgitation
* thin people: N.!- abdominal aorta
* -Emphysema: low position of the diaphragm allows the transmission of the normal activity of the RV
* -Hepatomegaly-stasis: the normal abd.aortic pulsations are transmitted to the enlarged liver
28
apex impulse
= the point of maximum outward movement of the left ventricle during systole
- corresponds to the onset of ventricular ejection or systole
- one third of the systole
* *-IVth – VI th intercostal space** on the midclavicular line
- Dorsal, lateral decubitus (! A correction of 2cm.to the right)
- Area of 2 cm2
- **Location, amplitude, size**
29
Apex impulses
Displacement
**With normal position of trachea:**
–Left ventricular enlargement - the apex is displaced downwards and laterally.
–Right ventricular enlargement - the apex will displaced laterally.
–Cardiomegaly
–Pectus excavatum (unusual location)
–Situs inversus/ dextrocardia
**With shifted trachea**
–Away from the hemithorax in case of: pleural effusion, pneumothorax
–Towards the hemithorax: atelectasis, fibrosis (Pressure differrence)
30
increased intenity of apex impulses
–LV hypertrophy,
–Pressure overload: aortic stenosis, systemic hypertension- forceful sustained (a dome-shaped impulse)
–Volume overload: aortic, mitral regurgitation- produces a less sustained impulse- hyperdynamic apex impulse
31
decreased intenity of apex impulse
–Dextrocardia
–apex behind a Rib
–Pericarditis (left)
–Obesity and thick chest wall
–Pericardial effusion
–Emphysema
32
**Double apex beat**
[\*] atrial contraction (atrial hypertrophy) or late outward movement of a ventricular aneurysm
33
Tapping apex beat-
the first sound is loud and may be felt
34
2. Thrill
= a palpable murmur- a vibration produced by the physical energy of a loud sound
-“le fremissement cataire” = purring of a cat
* diastolic thrill, Vth left intercostal space, increased in left lateral decubitus- mitral stenosis
* Systolic thrill, 2nd right intercostal space- aortic stenosis
35
Pericardial rub
- pericarditis (dry)
- During diastole and systole
- Increased when leaning forward
36
murmur grading
I/VI Barely audible
II/VI Audible after a few seconds of auscultation, low intensity
III/VI Immediately audible, moderate intensity
IV/VI Loud intensity without a precordial thrill
V/VI Loud intensity with a precordial thrill
VI/VI Loudest intensity, precordial thrill, audible with stethoscope slightly away from thoracic wall
37
murmur
–Described according to their timing in the cardiac cycle; duration
–Location
–Radiation
–quality- tonal effect (rumbling)
–Pattern-shape
–Frequency (pitch)- relates to the velocity of the blood; high pitched murmurs occur when the blood flow from a high pressure chamber to a lower
–Grade (degree of intensity)– I-VI
–Increased- decreased intensity
