Cardiac Exam Flashcards

1
Q

Cardiac symptoms

A

chest pain
* myocardial ischemia

Low cardiac output symptoms
* dyspnea
* HF symptoms
* syncope

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2
Q

Women’s S/S of Acute myocardial infarction

A

New or different Symptoms in weeks prior to event
* unusual fatigue (70%)
* Sleep disturbance (48%)
* SOB. (42%)
* Indigestion (39%)
* Anxiety (35)

Symptoms during ACS
* SOB (58%)
* Weakness (55%)
* Unusual fatigue (43%)
* Diaphoresis (39%)
* Dizziness (39%)
* Chest pain or pressure (30%)
* No chest discomfort during the event (43%)

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3
Q

ACS in the elderly

A

Unrecognized MI by age
* 18% in men 45-54
* 42% in men 75-84
* 60% in men over 85

Presentation >75 yrs
* Dyspnea
* neuro symtoms - syncope, weakness, acute confusion
* Chest pain or pressure < 50%

Weakness and fatiuge are most often reported

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4
Q

Point of maximal Impulse

A

Normal
* palpabel sensation of underlying left ventricle
* 5th ICS @MCL
* about the area of a nickle
* gentle tap by one finger, single impule
* about 1/3 of systole

Abnormal
* Displaced PMI - usually laterally toward axillary line: indicates increased LV volume
* Unusually forceful, sustained: pressure overload, HTN

Unable to palpate
* Left lateral decubitus position enhances
* may be due to : thick chestwall, obesity, COPD

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5
Q

Aortic heart sound

A
  • 2nd intercostal space, right ternal boarder
    (left side of heart)
  • Heard during S2
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6
Q

Pulmonic Area

A
  • 2nd intercostal space left sternal boarder
  • right side of heart
  • heard during S2
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7
Q

Erbs Point

A
  • 3rd intercostal space, left sternal boarder
  • hear both S1 and S2
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8
Q

Tricuspid area

A
  • 5th intercostal space, Left sternal border
  • right A/V valve
  • heard during s1
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9
Q

Mitral area

A
  • 5th intercostal space, MCL
  • Left AV valve
  • heard during S1
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10
Q

S1

A
  • begining of systole
  • closure of the miral and tricuspid (AV) valves
  • beast heard at the apex (bottom) with diaphram
  • simultaneous with carotid upstroke (pulse)
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11
Q

S2

A
  • Marks the end of systole
  • closure of the aortic and pulmonic valves
  • beast heard at the base (top) with diaphram
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12
Q

Physiologic S2

A
  • widening of normal interval between aortic and pulmonic valve
  • caused by a delay in pulmonic component
  • heard best in pulmonic region (2nd ICS, left sternal border)
  • Split INcreases with INspiration
  • found in adults <30 yrs
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13
Q

Pathologic split S2

A
  • fixed split - no change with inspiration
  • paradoxical split - narrows with inspiration
  • heard best at pulmonic region (2nd ICS, left sternal border)
  • fixed split: often found in uncorrected septal defect
  • Paradoxical: found in conditions that delay aortic clossure such as LBBB
  • will resolve with treatment of underlying condition
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14
Q

S3

A
  • marker of ventricular overload, and or systolic dysfunction
  • heard in early diastole like its hooked on the end of S2 (lub dub-dub) (Kentucky)
  • low pitched-best heard with bell
  • for Dx of HF correlate with additional findings (dyspnea, tachycardia, crackles
  • may not be heard in HF if pt is euvolemic and relatively symptom free
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15
Q

S4

A
  • marker of poor diastolic function
  • most often found in poorly controlled HTN (off meds for weeks) or recurrent myocardial ischemia
  • heard late in diastole, hooked to the front of S1 (presystolic sound)
  • Soft low pitch (higer than s3) best heard with bell
  • dub-lub dub
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16
Q

Heart valve dysfunction

A
  • failure to open - Stenosis
  • Failure to close - Incompetent valves cause regurgitant murmurs
17
Q

Systolic murmurs

A
  • Can be pathologic or benign
  • Mr. Pass MVP

Mitral Regurgitation, Physiologic (innocent, functional): holosystolic

Aortic Stenosis: cresendo-decresendo

SYSTOLIC

Mitral Valve Prolapse: mid systolic with mid systolic click

18
Q

Diastolic Murmurs

A
  • Always Pathologic
  • Ms. Ard

Mitral Stenosis: late diastolic
Aortic Regurgitation: early diastolic
DIASTOLIC

19
Q

Heart murmur grading

A
  1. very faint
  2. quiet but immediately heard
  3. moderately loud without thrill - about as loud as S1/S2
  4. Loud with thrill
  5. very loud with thrill
  6. audible without stethascope
20
Q

Systolic murmur pysiologic vs pathologic

A

Likely benign if all are noted
* negative Hx
* lower grade <4
* no radiation beyond pericordium
* S1 and S2 intact
* no heave or thrill
* PMI WNL
* Softens or disappears with supine to stand position change

Pathologic - echo next step unitl proven otherwise if 1 or more of the following
* abnormal Hx
* higher grade 4 or more
* radiation beyond the pericordium to neck, axilla, other
* S1, S2 obliterated
* Thrill or heave
* PMI displaced
* Increases in intensity with supine to stand

21
Q

Character of murmurs

A

Harsh
* Hears well with bell and diaphram
* aortic stenosis

Rumble
* Low, best with bell
* Mitral stenosis

Blowing
* high, best with diaphram
* aortic regurge

Musical
* Vibratory quality
* still murmur

22
Q

Carotid bruit Vs Radiating murmur

A

Carotid Bruit
* softer
* often unilateral
* differnet sound than chest
* presence of high grade athlersclerotic disease

Radiating murmur
* Louder
* bilateral
* same sound and timing as found in chest