Cardio

Question 1

Cardiac symptoms

Answer 1

chest pain, palpitations, SOB, edema, syncope

Question 2

syncope

Answer 2

cardio precipitating factors: arrhythmias, aortic stenosis, CVA, hypertrophic cardiomyopathy, MI/ACS, PE
non-cardio: vasovagal, orthostatic hypotension, cough, micturition
resembling syncope: hypocapnia, hypoglycemia, hysterical fainting

Question 3

non cardiac signs

Answer 3

vitals: pulse, RR, BP
Skin: diaphoretic, cyanosis
HEENT: xanthomas, mucous membranes, flame hemorrhages
Neck: JVD, bruit
P/V: clubbing of fingers, splinter hemorrhages

Question 4

upper extremity test

lower extremity

Answer 4

allen’s test (circulation in hand), pulses

edema (grade 1-4), pulses

Question 5

abnormal sounds

Answer 5

gallops (S3, S4), clicks, rubs, murmurs

Question 6

murmurs

Answer 6

intensity (1-6), location, timing, (pitch, quality, radiation, change with respiration or body position)

• stenosis- valves don’t open normally, Pressure overload, hypertrophy=S4
• regurg- causes Volume overload, dilation= S4
• SYSTOLIC: MR ASPSTeR
• DIATSTOLIC: MS PRARTS

Question 7

Congenital heart disease

Answer 7

atrial septal defects
ventricular septal defects
aortic coarctation
tetrology of fallot
patent ductus arteriosus

Question 8

ASD

Answer 8

fixed widely split S2
palpable pulmonary a. pulse
RV heave
if HF developed, 4th heart sound
Eisenmenger's complex: right to left atrial shunt-cyanosis, clubbing, JVD, edema

Question 9

VSD

Answer 9

harsh holosystolic murmur (small, moderate w/ thrill)

LARGE- holosystolic murmur heard throughout precordium with diastolic rumble at apex

Question 10

Aortic coarctation

Answer 10

**Delayed, weak or absent LE pulse
**BP: evaluation in UE systemic HTN and a differential >10mmHg compared with LE
-HTN, epistaxis, prominent neck pulses,
in infancy- heart failure, failure to thrive, irritability, tachpnea, dyspnea- murmur, S4, bruit, corkscrew tortuosity of retinal arterioles on fundi, left arm diameter smaller than right

Question 11

Tetrology of Fallot

Answer 11

pulmonary stenosis
RV hypertrophy
VSD
Overriding Aorta
-PE:
“pink” mild RV-outflow tract obstruction=acyanotic
“cyanosis” severe RV-outflow tract obstruction
-clubbing, exertional dyspnea, acute hypercyanotic episodes and squatting position
-cresendo-decresendo systolic ejection murmur

Question 12

Patent ductus arteriosus

Answer 12

vessel connecting pulmonary artery and aorta open

• continuous “machinery murmur”
• diastolic Graham-Steell murmur

Question 13

Grading

Answer 13

pulses: 0-3 (2+ is brisk, normal)
edema: 1-4 (least pitting to most)
intensity of murmur: 1-6 (inaudible to audible w/o stethoscope)

Question 14

ACS

Answer 14

Vitals changes in BP, P&RR
General: nausea, weak, fatigue, pain
Skin: pale, blue, sweaty
Lungs: SOB, dyspnea
CV: tachycardia, irregular HR, S3, S4,
P/V: JVD
Blood work: troponin, CBC, BMP
Tests: EKG, CXR, Echo, CT

Question 15

CHF

Answer 15

vitals: BP, P&RR, weight increase
general: uncomfortable
skin: peripheral edema
Lungs: BOS, cough, dyspnea, exertion, crackles, wheezing
CV: S3, S4, displaced PMI
PV: JVD, hepatojugular reflex
same testing as ACS (BNP will be high)
Kerley B lines, pulmonary edema, cardiomegaly