Flashcards in Cardiac Physical Exam, heart sounds, cardiomyopathies Deck (17):
What are some symptoms that could be cardiac in origin?
dyspnea on exertion
swelling in hands and feet
awakening from sleep short of breath
leg pain with activity
chest pain or pressure
Angina pectoris is the "true symptom of...."?
acute Coronary syndrome, or coronary heart disease
What are some characteristics of pain that might be ANGINA?
• Location - Retrosternal, diffuse
• Radiation - Left arm, jaw, back
• Description - aching, dull, pressing, squeezing, vise-like
• Intensity - mild to severe
• Duration - minutes
• Precipitated by - effort, emotion, eating, cold
• Relieved by - rest, nitroglycerin
What are some characteristics of chest pain that are likely NOT angina?
• Location - left inframammary, localized
• Radiation - right arm
• Description - sharp, shooting, cutting
• Intensity - excruciating
• Duration - seconds, hours, days
• Precipitated by - respiration, posture, motion
• Relieved by - nonspecific
What are some common cardiac causes of dyspnea?
• LV failure
• Mitral stenosis
What are some common pulmonary causes of dyspnea?
• Obstructive lung disease
• Restrictive lung disease
• Pulmonary hypertension
What are the common cardiac causes of syncope?
• Decreased cerebral perfusion due to cardiac rhythm disturbance
• Left ventricular output obstruction
How would you determine if your patient has orthostatic blood pressure?
Have them lie down for 5 min and acclaimate. Then measure blood pressure.
*if their blood pressure drops 20mmHg or more when they stand up...positive test
how can you use a blood pressure cuff to get a better handle on a coarctation of the aorta?
* check pulses in feet vs. legs, especially when young people have hard to control high blood pressure
the heart sound S3 is usually indicative of...
volume overload. Will likely hear this in a patient with DOE and extended JVD
What are the treatments for hypertrophic cardiomyopathy?
• Decrease contractility
○ Beta blockers
• Surgical myomectomy or alcohol ablation
• Implantable cardiac defibrillator
• Transplantation (if EF has suffered or there are other severe symptoms)
what heart sounds are you likely to hear in Aortic Regurgitation?
With the stethoscope diaphragm at the 3rd left intercostal space (3LICS), there are two distinct murmurs (to-and-fro), separated by a pause, which represent the turbulent high velocity flow back and forth across the aortic valve. The increased aortic outflow causes a midsystolic murmur (MSM) ending well before S2. The regurgitant flow begins immediately with aortic valve closure, causing a blowing, decrescendo early diastolic murmur (EDM) best heard in this area adjacent to the high-velocity regurgitant stream. It is helpful to have the patient sit up, lean forward, and exhale to bring out this often subtle murmur.
Moving the stethoscope over the ascending aorta (2RICS), will increase the systolic murmur's intensity. Alternating between 2RICS and 3LICS will bring out systolic (TO-fro) and diastolic (to-FRO) components, respectively.
What are the two examples of systolic ejection murmurs?
• Aortic stenosis
○ 2nd right intercostal space radiating to neck
• Pulmonic stenosis
○ Heart at 2nd/3rd left intercostal spaces
What is the example of a mid-to-late diastolic murmur?
• Mitral stenosis
○ Heard at the apex
What is the example of early diastolic murmur?
• Aortic regurgitation
○ Along left side of sternum
○ Remember the inflow and outflow tracts
• Pulmonic regurgitation
○ Upper left side of sternum
What is the example of late systolic murmur?
• Mitral valve prolapse
○ Heart at apex radiating to axilla