Cardiac Hx and physical exam + Heart sound simulation

Question 1

True symptom of CHD

Answer 1

Angina pectoris:
• Supply-demand mismatch in the coronary arteries leads to hypoxia in the myocardium that causes pain.
• Distribution of pain:
○ Chest, left arm, sometimes neck.
○ Also can be R side, jaw, epigastric, or between scapulae

Question 2

Levine’s Sign

Answer 2

• pathopnemonic sign
  ○ Point to sternum

Tips:
• Examine patient from R side

Question 3

Tx for angina pectoris (CHD)

Answer 3

Nitroglycerin works because it vasodilates and increases perfusion.

Question 4

Syncope

Answer 4

• Refers to transient loss in consciousness

Tips:
• Examine patient from R side

Question 5

Properly checking Orthostatic Hypotension:

Answer 5

• After patient has been lying for 5 min, check bp and pulse. Have patient stand up and repeat measurements
○ Orthostatic hypotension = 20 mmHg drop in systolic BP upon standing

Question 6

Why BP different in each arm for Orthostatic Hypotension?

Answer 6

○ Blood flow different to each arm due to different vessels.

○ Stenosis of arteries coming off of branches.

Question 7

Coarctation of the aorta:

physical findings

Answer 7

• If the BP is high in both arms, then determine if the BP is lower in the extremities
  
  • Apply BP cuff to the leg and listen to dorsalis pedis or posterior tibial pulse

—>• Lower BP in the leg raises suspicion for coarctation!!

Question 8

What would you suspect if you can feel Point of maximal impact (PMI)

Answer 8

LBBB (recall that it is a conduction abnormality)

Question 9

Murmur type:

1. systolic ejection
2. pansystolic
3. late systolic
4. early systolic
5. mid-late diastolic

Answer 9

1. systolic ejection:
   - aortic stenosis
   - pulmonic stenosis
2. pansystolic
   - mitral and tricuspid regurg
3. late systolic
   - mitral valve prolapse
4. early diasystolic
   - aortic and pulmonic regurg
5. mid-late diastolic
   - mitral stenosis

MS ARD
MR ASS