Cardio 1 Flashcards
(158 cards)
1
Q
Where is the apical impulse heard?
A
5th ICS, 7-9cm from sternum medial to midclavicular line
2
Q
Where is the apical impulse in pregnancy?
A
higher
3
Q
Where is the apical impulse in LVH?
A
more lateral
4
Q
What occurs during diastole?
A
tricuspid/mitral valves open, atrial contraction
5
Q
What occurs during systole?
A
pulmonary/aortic valves open, ventricular contraction
6
Q
what is stroke volume?
A
the volume of blood ejected in one heartbeat/contraction. End-diastolic volume - end-systolic volume
7
Q
what is average stroke volume?
A
70ml
8
Q
what is ejection fraction?
A
functional measurement of stroke volume (SV/EDV)
9
Q
What is normal ejection fraction?
A
60%
10
Q
What is CO?
A
the volume of blood ejected from each ventricle in a one minute interval (SV X HR)
11
Q
What factors affect SV?
A
preload, myocardial contractility, afterload
12
Q
What is preload?
A
volume of load that stretches the cardiac muscle prior to contraction
13
Q
What are causes of increased preload?
A
increased venous return, reduced HR, ventricular/systolic failure, aortic or pulmonic dysfunction
14
Q
What are causes of decreased preload?
A
decreased venous return, impaired atrial function, diastolic failure, mitral or tricuspid dysfunction
15
Q
If there is increased preload, what does it mean for SV?
A
ihigh pre-load = larger stretch = larger contraction = higher SV
16
Q
Inotropy
A
the ability of the heart to contract in response to preload
17
Q
An increase in inotropy can cause an increase in?
A
ejection fraction
18
Q
What is afterload?
A
the load the heart pumps against
19
Q
What factors affect afterload?
A
resistance, aortic/pulmonic valve stenosis
20
Q
A decreased afterload leads to?
A
decreased preload
21
Q
Where is the aortic valve best heard?
A
2nd ICS, right sternal border
22
Q
Where is the pulmonic valve best heard?
A
2nd ICS, left sternal border
23
Q
Where is Erb’s point?
A
3rd ICS, left sternal border
24
Q
Where is the tricuspid valve best heard?
A
4-5th ICS, left sternal border
25
Where is the mitral valve best heard?
5th ICS, left mid-clavicular line - apex
26
What does S1 represent?
closure of the AV valves (particularly the mitral valve)
27
What does S2 represent?
closure of the semilunar valves (particularly aortic)
28
What part of the stethescope best hears S1 and S2?
diaphragm
29
Where is S1 best heard?
at the apex over the mitral area
30
What is responsible for the intensity of S1?
the speed of the mitral valve closing
31
Loud S1 means?
mitral stenosis
32
Soft S1 means?
CHF, severely calcified mitral valve
33
Variable S1 means?
heart block or Afib
34
Where is S2 best heard?
upper sternal border (base)
35
What causes physiological splitting of S2?
during inspiration when there is decreased intrathoracic pressure (increased RV preload and systole = delayed P2, decreased LV preload and systole = earlier A2)
36
what is wide splitting?
S2 splitting gets progressively wider with inspiration
37
What is fixed splitting?
S2 splitting is with with inhalation and exhalation, pathologic
38
What is normal splitting?
wider S2 splitting on inhalation
39
What is paradoxical splitting?
on inhalation, the P2 comes before the A2
40
What can cause wide splitting?
delayed RV contraction, premature LV contraction, Increased RV afterload, decreased LV afterload
41
Examples of diseases with wide splitting
RBBB, WPW, PAH, massive PE, severe mitral regurgitation, restrictive pericarditis
42
What diseases are associated with fixed splitting?
ASD, RV failure
43
What can cause paradoxical splitting?
delay in closure of aortic valve
44
What diseases are associated with paradoxical splitting?
LBBB, aortic valve disease, LV outflow obstruction
45
What are the "gallops"?
S3 and S4
46
When does S3 occur?
early in diastole, low pitched
47
Where is S3 best heard?
apex (left lateral decubitus)
48
What causes S3?
reapid ventricular filling
49
Can S3 be normal?
yes, in children and adults
50
wha can S3 indicate in older adults?
(\>40) abnormal ventricular compliance associated with CHF; also mitral regurgitation, VSD, stiff/dilated ventricle
51
Is S4 ever normal?
No, always pathological
52
When does S4 occur?
immediately before S1 in late diastole ("pre-systolic")
53
What does an S4 gallop suggest?
atrial contraction into a stiff, non-compliant ventricle associated with LVH, HTN, aortic stenosis (resistance to ventricular filling
54
Where do S3 and S4 usually originate?
the left side of the heart
55
what is a summation gallop?
when S3 and S4 are both present in tachycardia making them indistinguishable
56
What do ejection clicks and opening snaps usually indicate?
valvular stenosis
57
What do ejection clicks and opening snaps sound like?
S3 and S4 sounds, brief and crisp, (snaps heard in diastole)
58
When is an aortic ejection click heard?
early systole, everyhwere, not effected by standing
59
When is a mitral valve prolapse heard?
mid systole, best at apex, will occur earlier with standing
60
When do opening snaps occur?
early diastole, low pitched, due to opening of abnormal valves (usually mitral stenosis)
61
What is a murmur?
result of turbulent blood flow through vessels, AKA bruit outside the heart
62
What type of murmur is most common?
systolic murmurs
63
What can cause a continuous murmur?
patent ductus arteriosus, venous hum
64
what murmurs are "flow" murmurs?
systolic
65
What can cause systolic murmurs?
semilunar stenosis, AV regurgitation, MVP, VSD, HOCM, insufficient AV valves, turbulent ejection of blood from a ventricle
66
What can cause diastolic murmurs?
semilunar regurgitation (Aortic), AV stenosis
67
What would be found on PE of mitral valve prolapse?
murmur associated with mitral regurgitation, mid-systolic click (sudden tensing of the mitral valve as it prolapses into the atrium)
68
What type of murmur can be crescendo-decrescendo?
midsystolic (semilunar stenosis)
69
What type of murmur can be pansystolic/holosystolic?
AV regurgitation through the entire systolic cycle
70
What type of murmur can be crescendo?
Mitral stenosis
71
Decrescendo murmurs occur in?
diastole (aortic regurgitation)
72
Crescendo-decrescendo murmurs occur in?
systole (semilunar stenosis)
73
Plateau murmurs occur as?
holosystolic murmurs, mitral regurgitation
74
where does aortic stenosis radiate to?
carotids
75
Where might mitral regurgitation radiate to?
left axillae
76
What is a thrill?
a palpable vibration at a site of partial obstruction noted with murmurs graded 4/6
77
Grade 1 intesnsity is defined as..
very faint, heard after listener is "tuned in", might not be heard in all positions
78
Grade 2 intensity is defined as?
quiet, don't need to "tune in" to hear it
79
Grade 3 intensity is defined as?
moderately loud
80
Grade 4 intensity is defined as?
loud, with palpable thrill
81
Grade 5 intensty is defined as?
very loud with a thrill, may be heard when the stethescope is partly off the chest
82
Grade 6 intensity is defined as?
Very loud, with a thrill, may be heard with the stethescope entirely off the chest
83
Give an example of a high pitched heart sound
VSD (high pressure gradient)
84
Give an example of a low pitched heart sound
Mitral stenosis (large volume of blood over a low pressure gradient)
85
Give an example of a harsh heart sound
combination of both high and low pitches (aortic/pulmonic stenosis)
86
What heart sounds could be "blowing"?
semilunar regurgitation, mitral regurgitation
87
What heart sound could be rumbling
mitral/tricuspid stenosis
88
what heart sounds could be musical?
aortic stenosis, still's murmur
89
What heart sounds could be machine-like?
PDA
90
What is the purpose of the handgrip maneuver?
patient clenches fist which increases after load and increases regurgitation murmurs. Could differentiate between MR and AS
91
What heart sounds might be increased with the handgrip maneuver?
AR, MR, VSD, delayed MVP
92
What heart sound might have decreased intensity wth the handgrip maneuver?
aortic stenosis, HOCM
93
What is the purpose of suatting or supine quickly?
increased venous return = increased preload = increased SV
94
What murmurs might be increased with squatting or laying supine quickly?
AS, PS, TR
95
What murmur might be delayed when squatting or laying supine quickly?
MVP
96
What is the purpose of standing quickly or doing the valsalve maneuver?
decreased venous return = decreased SV, decreased murmur of AS, PS, TR
97
What effect does inspiration have on murmurs?
increases RV preload, decreases LV preload, increases right heart murmurs
98
What effects does exhalation have on murmurs?
increases LV preload, decreases RV preload, increased left heart murmurs
99
What position enhances the murmur associated with aortic regurgitation?
lean forward and hold breath on full inspiration
100
Description of aortic regurgitation
Early diastolic, high-pitched, blowing, decrescendo, best heard at 2nd RICS, increased with leaning forward and holding breath on full inspiration, increased with handgrip maneuver
101
Description of pulmonary regurgitation
early diastolic, high-pitched, blowing, decrescendo, best heard at 2-3 LICS, increased with handgrip maneuver
102
Decscription of mitral stenosis
mid-diastolic, rumbling (bell), PMI, increased in left lateral decubitus position, crescendo associated with opening snap
103
Description of tricuspid stenosis
mid-diastolic, rumbling, may increase with inspiration, wide splitting of S1
104
Description of aortic stenosis
mid-systolic, crescendo-decrescendo, usually harsh but can be musical, best heard at 2nd RICS, may radiate to carotis and decreased with standing or valsalve or handgrip maneuvers
105
Description of pulmonic stenosis
mid systolic, crescendo-decrescendo, harsh, best heard at 2nd LICS and may radiate to left neck, may cause wide S2 splitting
106
Description of mitral valve prolapse
late systole and may be preceded by clicks, best heard over the apex with the diaphragm
107
Description of tricuspid valve prolapse
uncommon except in the rpesence of MVP
108
What is Carvallo's sign?
Tricuspid insufficiency/regurg increased with respiration
109
Description of mitral regurgitation
apex in left lateral decubitus position, high pitched, no change with respiration, may radiate to axillae
110
Description of VSD
left 3-4 ICS along sternal border, increased with handgrip maneuver
111
What are some innocent murmurs in children?
still's murmur, physiologic systolic ejection murmur, cervical venous hum
112
What can cause innocent murmurs in adults?
pregnancy, anemia, thyroid conditions, exercise
113
Characteristics of innocent murmurs?
short, valsalva maneuver decreases intensity
114
Red flags not indicative of innocent murmurs?
pansystolic murmurs, diastolic murmurs, loud murmurs (\>3/6), evidence of heart disease, SOB, fatigue, failure to thrive, cyanosis, pulse deficits
115
Austin flint murmur
mid to late diastolic rumbe associated with AR (can mimic MS)
116
Graham Steell murmur
PR murmur specifically associated with pulmonary HTN, high-pitched, blowing
117
Carey Coombs murmur
mid diastolic murmur heard at the apex during rheumatic fever
118
What are friction rubs?
pathgnomic for pericarditis, leathery/raspy sound, best heard when pt is leaning forward at end of expiration
119
what is an anacrotic pulse?
characterized by two waveforms in the ascending limb of the pulse tracing
120
what might cause an anacrotic pulse?
pulsus parvus et tardus (slow, weak pulse), aortic stenosis
121
what is the dicrotic notch?
normal, marks the end of systole
122
What is bisferiens?
percussion wave followed by a tidal wave seen in AR
123
What is a collapsing pulse AKA?
corrigan's/water-hammer; pistol, shot-like sound heard in AR or in PDA
124
What is quinckes?
see pulse in fingernail
125
Pulsus paradoxus
lose pulse on inhalation
126
pulsus alternans
regular alternation of weak and strong beats
127
What are the 6 P's of acute peripheral pulse defecits?
pain, pallor, pulselessness, poikilothermia, paresthesias, paralysis
128
What is found on PE of someone with chronic peripheral pulse defecits?
decreased capillary refill, decreased hair, growth/shiny appearance to skin, ulcers, pallor/dependent rubor
129
how soon should color return in capillary refill test?
2 seconds, delayed return = PVD
130
What is the ABI?
testing for PAD, systolic pressure from both ankles and both brachial areas using doppler ankle pressure / brachial pressure
131
what is a normal ABI?
1-1.4
132
What is borderline ABI?
0.9-0.99
133
What ABI indicates moderate arterial disease?
\<0.9
134
What ABI indicates severe arterial disease?
\<0.5
135
What are patients with carotid artery stenosis at higher risk of?
stroke
136
Treatment of carotid artery stenosis?
antiplatelets, endarterectomy, stent
137
Where are the carotids located?
between the larynx and anterior border of the SCM at the level of the cricoid cartilage
138
what is a normal carotid artery exam?
smooth rapid upstroke with slower downstroke - no bruits
139
If there is a bruit on carotid artery exam, what does it indicate?
at least 60% block - auscultated with the bell
140
what factors affect venous pressure?
left ventricular output/blood volume, right ventricular insufficiency
141
What are early signs of chronic venous insufficiency?
varicose veins, tan/reddish skin changes, weepy/excoriated skin, pedal edema
142
What are later signs of chronic venous insufficiency?
lipodermatosclerosis
143
What are late signs of chronic venous insufficiency?
venous stasis ulcers
144
How is superficial phlebitis/thrombophlebitis treated?
superficial veins, warm compresses, anti-inflammatories
145
PE findings in DVT
tenderness in calf, swelling, palpable cord, Homan's sign
146
What is homan's sign?
can be performed supine or prone, examiner passively flexes the ankle and can gently squeeze the calf
147
What are splinter hemorrhages?
seen in the fingernails due to bacterial endocarditis
148
What is clubbing?
softening of the nailbed due to hypoxic conditions and subacute bacterial endocarditis
149
What eye changes can occur with cardiac dysfunction?
xanthelasma, corneal arcus (lipi deposits in anterior sclera), conjunctival pallor (in anemia)
150
what heart condition is anemia associated with?
CHF
151
What oral changes can be associated withc ardiac dysfunction?
angular stomatitis (sores at the corners of the mouth)
152
where is S4 heard best?
base
153
what does the presence of S4 indicate?
diastolic CHF
154
what diseases are associated with systolic murmurs?
thin chest wall, fever, anemia, pregnancy, hyperthyroidism
155
true or false: systolic murmurs are physiologic
TRUE
156
true or false: diastolic/pansystolic murmurs are pathologic
TRUE
157
MS. ARD
mitral stenosis, aortic regurgitation, diastolic
158
MR. PASS
mitral regurgitation, physiologic, aortic stenosis, systolic
