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Flashcards in Cardiac history and PE Deck (27):
1

Stable angina definition

recurrent chest pain of at least two months in duration, related in a predictable fashion to a given level of exercise or emotional stress, and fairly constant in its degree of intensity, duration, location and quality

2

Atypical angina definition

may be unrelated to exertion or have unusual quality or location. Implies a high risk of impending acute coronary syndrome requiring aggressive action including possible cardiac catheterization.

3

Acute coronary syndrome definition

comprises a spectrum of recent onset presentations ranging from “unstable angina” with ischemia without irreversible damage to “myocardial infarction” involving myocardial necrosis. May begin at rest or with physical activity/ emotional stress

4

Symptoms of acute coronary syndrome

Dyspnea, diaphoresis, nausea, vomiting, profound weakness, or gaseous distention. Palpitations, lightheadedness, dizziness or syncope due to arrhythmias. Inferior infarcts may also cause hiccups due to diaphragm irritation

5

Common causes of chest pain (other than acute coronary syndrome)

musculoskeletal pain (precipitated by palpation), pericarditis (exacerbated by cough/deep breath and positional change), pneumonia (with rales, cough and fever), GERD (worse at night)

6

Symptoms to look for in patient with any form of cardiac disease

discomfort/pain in chest Faintness or dizziness (from low CO, overtreatment with diuretics, arrhythmias)
Stroke
Irregularity of your heart beat
Shortness of breath during physical activity (dyspnea)
Swelling of your feet (edema)
Awakening from sleep short of breath
Trouble sleeping while lying flat
Pain in your legs during physical activity
discomfort/pain in chest Faintness or dizziness (from low CO, overtreatment with diuretics, arrhythmias)
Stroke
Irregularity of your heart beat
Shortness of breath during physical activity (dyspnea)
Swelling of your feet (edema)
Awakening from sleep short of breath
Trouble sleeping while lying flat
Pain in your legs during physical activity

7

Common distribution of pain with MI

from sterum, through left chest and into left arm (more ulnar side)

8

Less common distributions of pain with MI

Right chest/arm, left jaw, epigastrium, back

9

important questions to ask during cardiac exam (ROS)

Have you ever had or been told of: A "heart attack“ or a “heart murmur”
An abnormal electrocardiogram
High blood pressure
High cholesterol or blood lipids
Diabetes or high blood sugar
A problem with your thyroid gland
Rheumatic fever Have you ever had or been told of: A "heart attack“ or a “heart murmur”
An abnormal electrocardiogram
High blood pressure
High cholesterol or blood lipids
Diabetes or high blood sugar
A problem with your thyroid gland
Rheumatic fever

10

Social history questions to ask

smoking, alcohol, coffee (> 3 cups of coffee or tea per day), Has your weight changed in past year?

11

Family history questions to ask

Have any parent, siblings or other relatives had: heart disease, HTN, diabetes, death of unknown cause

12

How to find jugular venous pressure

Find internal jugular vein on the right side with the head turned slightly to the left

13

Steps in examining carotid arteries

1-2 fingers btw larynx and anterior border of sternocleidomastoid at level of cricoid cartilage- fell for amplitude, upstroke and character. Also ausculatate both carotids for bruits.

14

How to find the apex in cardio exam

Apex beat is located in the 5th intercostal space in the mid-clavicular lilne. Start by using entire hand then become more specific. Feel for amplitude, character, displacement

15

Where do you palpate the right ventricle?

In the epigastriumor lower left sternal border. Feel for lifts

16

Where do you palpate for pulmonic and aortic lifts?

pulmonic: left 2nd and 3rd intercostal space around the mid-clavicular line (slightly more medial). Aortic: right 2nd intercostal space around mid-clavicular line

17

Where should you listen for S2 heart sounds?

pulmonic area (listen for split and amplitude)

18

Where should you listen for S1 and S4?

tricuspid area

19

Where should you listen for S3?

apex (mitral area)

20

What kinds of murmurs should you listen for and where do you listen?

systolic murmurs: listen at aortic, pulmonic, tricuspid and mitral areas. Diastolic regurgitant murmurs: Listen at left sternal border for pulmonic and aortic (may be best when sitting up), and at the tricuspid and mitral areas. Also listen for tricuspid and mitral stenosis (low pitchd murmurs) or rapid early filling after regurgitant murmurs.

21

How to identify pericarditis?

listen for a rub in several precordial sites

22

In cardio exam, you should examine abdomen for ______________, and the legs/feet for _____________

hepatomegaly/ascites, and edema

23

systolic ejection murmurs- examples and location

Aortic stenosis (2nd right intercostal space, radiates to neck) and pulmonary stenosis (2-3 left intercostal space)

24

Pansystolic (holosystolic) murmurs- example and locations

mitral regurgitation (apex radiates to axilla), and tricuspid regurgitation (left lower sternal border radiates to right lower sternal border)

25

Late systolic murmur- example and location

mitral valve prolapse (apex radiates to axilla)

26

Early diastolic murmur- ex. And location

aortic regurgitation (along left side of sternum) and pulmonic regurgitation (upper left side of sternum)

27

Mid-to -late diastolic murmur- ex and location

mitral stenosis (apex)