Cardio PE and Lab findings Flashcards by Emily wiggins

You hear high pitched decrescendo diastolic murmur that is loudest at 3rd/4th left IS. Even better with pt leaning forward with held expiration.

Aortic Regurgitation

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You hear loud rough systolic crescendo-decrescendo murmur at the upper right sternal border. When pt leans forward and it radiates to the right clavicle and neck with a thrill.

Aortic Stenosis

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You hear Late systolic murmur and midsystolic click

MVP

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You hear blowing holosystolic murmur best heard at the apex, with th pt in the left lateral decubitus position

Mitral Valve Regurgitation

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You hear an opening snap, diastolic murmur, loud S1

Mitral Stenosis

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You hear a high pitched diastolic murmur, upper left sternal border

Pulmonic regurgitation

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You hear widened splitting of S2, may hear early systolic click. Harsh crescendo-decrescendo murmur at left 2nd parasteral IS with no radiation, louder with inspiration

Pulmonic Stenosis

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You hear pansystolic blowing murmur loudest on inspiration, best heard at right of left lower sternal border

tricuspid regurgitation

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You hear a short, scratchy diastolic murmur that increases with inspiration. Heard best in lower right and left parasternal borders

Tricuspid stenosis

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EKG: normal P wave and QRS with a long PR interval. Which heart block?

first degree av block

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EKG: progressive delay in PR interval until a normal impulse is dropped. Which heart block?

second degree av block/ mobitz I or wenkebach phenomena

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EKG: constant PR interval with intermittent dropped QRS complexes. Which heart block?

second degree av block/ mobitz II

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EKG: appearance depends on the area initiating conducted beats

third degree av block (complete) with av dissociation

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EKG: 2 R wave peaks and modest QRS widening. maybe wide s2 splitting.

bundle branch/fascicular blocks

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What test do you order for all valvular disorders?

echocardiogram

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In which two valvular disorders would you also want a doppler with the echo?

Aortic Regurgitation, Aortic stenosis

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How do you dx MVP?

echo, holter monitoring or EKG

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Someone presents with anxiety, what valvular disorder should come to mind?

MVP. Sometimes caused by anxiety, sometimes causes anxiety

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How do you dx mitral valve regurgitation?

echo, EKG, CXR, catheterization on if surgery is required to repair/replace valve

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How do you dx mitral stenosis?

echo and EKG. Notched or wide P wave due to atrial hypertrophy

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how do you dx pulmonic regurgitation?

echo. EKG may show RV enlargement and CXR may show pulmonary hypertension

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How do you dx pulmonic stenosis?

echo, duh. But an EKG may also show RV hypertrophy

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What population has a particularly high occurrence of IE?

IV Drug Users

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Name 5 predisposing factors for IE.

congenital heart defects
rheumatic valve disease
bicuspid/calcified aortic valves
MVP
hypertrophic cardiomyopathy

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What causes 50% of community-aquired native valve IE?

Strep viridans

Does IE occur more commonly on the right or left side of the heart?

Left (80%-90%) | Right (30%-70%) - more common with IV drug use

Name 4 potential consequences of IE.

myocardial abscess conduction abnormalities heart failure death!!!

When would you give antibx to prevent IE?

prosthetic valve replacements/repairs previous IE Certain congenital heart disease cardiac transplant recipients with valvulopathy

s/sx IE.

unexplainable fever with murmur | positive blood cultures in pts with valve disease and IV drug users

How do you Dx IE? 4 main things.

``` hx PE 3 serial blood cultures in 24 hr period echo mb also see anemia, high WBC, elevated ESR/CRP ```

SBE. Where would you look and what would you find?

General: fever, tachycardia Skin: pallor Eyes: roth spots Digits: petechiae, mb osler's spots, janeway lesions and splinter hemorrhages (on nails)

Cause of ABE?

Staph/strep | mb fungi after valve replacement

What are 3 causes of noninfectious endocarditis?

catheter injury to valves SLE immune complexes anti-phospholipid syndrome

What are 5 causes of pericarditis?

``` Idiopathic Infections, mostly viral (EBV) Post-MI Connective tissue dz (SLE) Tumors ```

What are commonly the first sxs of acute pericarditis?

chest pain dyspnea pericardial friction rub

How do you Dx pericarditis?

``` Must have 2 of 4: chest pain pericardial friction rub suggestive EKG changes new/worsening pericardial effusion ```

How do you Dx pericardial effusion?

CXR | EKG

how do you dx tamponade?

EKG Echo if there is time otherwise, Pericardiocentesis for dx and tx

how do you dx constrictive pericarditis?

CXR shows pericardial calcification Catheterization confirms High WBC and ESR EKG, Echo are non-specific

Name 5 risk factors for abdominal aortic aneurysms (AAA)?

``` atherosclerosis smoking HTN old age white male ```

Prevalence of AAA?

3/4 of aortic aneurysms | 3x greater in men

PE findings of AAA?

pulsatile mass in abd. or abd. pain

Dx AAA?

US or CT

prevalence of thoracic aneurysms?

1/4 of all aortic aneurysms | affect men and women equally

Name 5 sxs that would make you think thoracic aneurysm?

``` chest/back pain cough dyspnea hoarsness hemoptysis abd pain mb horner's syn. ```

name 5 predisposing factors for aortic dissection

``` cocaine use smoking htn CT disorders Iatrogenic trauma ```

PE findings for aortic dissection?

``` sudden severe pain, looks like MI pulses may wax and wane differing limp bps aortic regurg. murmur in 50% ummm...i don't think we're going to see these much. ```

what testing would you do if you suspect aortic dissection?

``` CXR EKG D-dimer TEE, CTA, MRA once pt is stable CK-MB and troponin to ddx with MI Consult with a cardiothoracic surgeon ```

Where does erythromelalgia occur?

hands and feet

Name 5 conditions that could lead to secondary erythromelalgia?

``` DM SLE RA gout MS ```

What group is most at risk for peripheral arterial aneurysms?

men (20:1) age 65

What are risk factors for Peripheral arterial aneurysms?

atherosclerosis, popliteal artery entrapment, septic emboli

What testing would you order if you suspected peripheral arterial aneurysm?

US MRI CT

What causes peripheral arterial dz?

atherosclerosis resulting in lower limb ischemia. same risk factors as atherosclerosis.

What is the patient picture for peripheral arterial dz?

pain on exertion, relieved by rest (intermittent claudication) numbness and tingling if severe, ulceration

What would you expect to find on PE with PVD?

reduced pulses in feet severely ischemic feet are cold, blue, painful or numb No edema usually

how would you dx PVD?

ankle brachial index. doppler US angiography labs: lipid levels, CRP-hs, homocysteine, fibrinogen, bleeding time

What might Raynaud's be secondary to?

``` CT disease endocrine disorders drug use infections trauma ```

what is the typical pt population for primary raynauds?

<40 yo, often women | no abnormal PE or Hx findings that suggest another cause

what is the typical pt population for secondary raynauds?

>30 yo severe painful attacks, ischemia lesions hx and pe suggest underlying disorder

What is commonly seen with Raynaud's?

migraine HA, variant angina and pulmonary HTN

What most aggravates Buerger's dz?

tobacco

What are 5 risk factors for chronic venous insufficiency?

``` DVT venous HTN sedentary lifestyle trauma obesity ```

What is the progression of Chronic venous insufficiency?

no change>varicose veins>stasis derm>mb ulceration

4 s/sx of chronic venous insufficiency?

sense of fullness heaviness aching paresthesias

What do you want to rule out when dx chronic venous insufficiency?

DVT, done with US

What most commonly causes superficial venous thrombosis?

IV catheterization in upper extremities | varicose veins in lower extremities

What would PE reveal with superficial venous thrombosis?

palpated as a linear indurated cord with local inflammation | mb tenderness, erythema mottling and warmth

What makes varicose veins feel better?

elevation of the legs

What is the best position to assess varicose veins? What else do you want to check?

standing Diabetic neuropathy look for ulcerations look for other sources of pain such as arthritis, arterial insufficiency and intermittent claudication

what are 3 complications of varicosities?

edema eczema painful ulcerations

What 5 potential causes of lymphedema?

``` surgery trauma radiation therapy tumors infection ```

What are the complications of lymphedema?

lymphangitis

What is the main cause of sudden cardiac death in athletes?

hypertrophic cardiomyopathy

Athletic heart syndrome is usually asx. What might you see on PE?

bradycardia laterally displaced PMI ejection murmur additional heart sounds

What testing might you suggest to an athlete with s/sx of athletic heart syndrome?

EKG Echo Stress testing

Cardio PE and Lab findings Flashcards

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