Chapter 4- Evaluation of the patient with cardiovascular disease Flashcards by Darian Oldham

What are the cardiovascular causes of chest pain?

Angina
Myocardial infarction
Pericardiitis
Aortic dissection

How well did you know this?

Not at all

Perfectly

What is the location of angina?

Location- Retrosternal region; radiates to or occasionally isolated to neck, jaws, shoulders, arms (usually left) or epigastrum

How well did you know this?

Not at all

Perfectly

What is the quality of angina?

Quality- Pressure squeezing, tightness, heaviness, burning, indigestion

How well did you know this?

Not at all

Perfectly

What is the duration of angina?

Duration <2-10 mins

How well did you know this?

Not at all

Perfectly

What are the aggravating or alleviating factors of angina?

Aggravating or alleviating factor- precipitated by exertion, cold weather, or emotional stress; relieved by rest or nitroglycerin; variant (prinzmetal) angina may be unrelated to exertion, often early in the morning

How well did you know this?

Not at all

Perfectly

What are the associated sx and signs with angina?

Associated symptoms or signs- dyspnea; S3, S4, or murmur of papillary dysfunction during pain

How well did you know this?

Not at all

Perfectly

What is the location of myocardial infarction?

Same as angina

How well did you know this?

Not at all

Perfectly

What is the quality of myocardial infarction?

Same as angina although more severe

How well did you know this?

Not at all

Perfectly

What is the duration of myocardial infarction?

Variable; usually longer than 30 mins

How well did you know this?

Not at all

Perfectly

What are the aggravating or alleviating factors of myocardial infarction?

Unrelieved by rest of nitroglycerin

How well did you know this?

Not at all

Perfectly

What are the associated sx and signs of myocardial infarction?

Dyspnea, nausea, vomiting, weakness, diaphoresis

How well did you know this?

Not at all

Perfectly

What is the location of pericarditis?

Left of the sternum; may radiate to neck or left shoulder, often more localized than pain of myocardial ischemia

How well did you know this?

Not at all

Perfectly

What is the quality of pericarditis?

Sharb, stabbing, knifelike

How well did you know this?

Not at all

Perfectly

What is the duration of pericarditis?

Last many hours to days; may wax and wane

How well did you know this?

Not at all

Perfectly

What are the aggravating or alleviating factors of pericarditis?

Aggravated by deep breathing, rotating chest, or supine position; relieved by sitting up and leaning forward

How well did you know this?

Not at all

Perfectly

What are the associated sx and signs of pericarditis?

Pericardial friction rub

How well did you know this?

Not at all

Perfectly

What is the location of aortic dissection?

Anterior chest; may radiate to back, interscapular region

How well did you know this?

Not at all

Perfectly

What is the quality of aortic dissection?

Excruciating, tearing, knifelike

How well did you know this?

Not at all

Perfectly

What is the duration of aortic dissection?

Sudden onset, unrelenting

How well did you know this?

Not at all

Perfectly

What are he aggravating or alleviating factors of aortic dissection?

Usually occurs in setting of hypertension or predisposition, such as marfans syndrome

How well did you know this?

Not at all

Perfectly

What are the associated sx or signs of aortic dissection?

Murmur of aortic insufficiency; pulse of blood pressure asymmetry; neurological deficeit

How well did you know this?

Not at all

Perfectly

What are the noncardiac causes of chest pain?

PE (chest pain is often not present)
Pulmonary HTN
Pneumonia w/ pleurisy
Spontaneous pneumothorax
Musculoskeletal disorders
Herpes zoster
Esophageal reflux
Peptic ulcer
Gallbladder disease
Anxiety states

How well did you know this?

Not at all

Perfectly

What is the location of pulmonary embolism?

Substernal or over region of pulmonary infarction

How well did you know this?

Not at all

Perfectly

What is the quality of pulmonary embolism?

Pleuritic (with pulmonary infarction) or angina-like

How well did you know this?

Not at all

Perfectly

What is the duration of pulmonary embolism?

Sudden onset (minutes to hours)

What are the aggravating or alleviating factors of pulmonary embolism?

Aggravated by deep breathing

What are the associated sx and signs of pulmonary embolism?

Dyspnea, tachypnea, tachycardia; hypotension, signs of acute right ventricular heart failure, and pulmonary HTN with large emboli; pleural rub; hemoptysis with pulmonary infarction

What is the location of pulmonary hypertension?

Substernal

What is the quality of pulmonary hypertension?

Pressure oppressive

What is the duration of pulmonary hypertension?

What are the aggravating or alleviating factors of pulmonary hypertension?

Aggravated by effort

What are the associated sx or signs of pulmonary hypertension?

Pain usually associated with dyspnea, signs of pulmonary HTN

What is the location of pneumonia with pleurisy?

Located over involved area

What is the quality of pneumonia with pleurisy?

Pleurtic

What is the duration of pneumonia with pleurisy?

What are the aggravating or alleviating factors of pneumonia with pleurisy?

Aggravated by breathing

What are the associated sx and signs of pneumonia with pleurisy?

Dyspnea, cough, fever, bronchial breath sounds, rhonchi egophony, dullness to percussion, occasional pleural rub

What is the location of spontaneous pneumothorax?

Unilateral

What is the quality of spontaneous pneumothorax?

Sharp, well localized

What is the duration of spontaneous pneumothorax?

Sudden onset; last many hours

What are the aggravating or alleviating factors of spontaneous pneumothorax?

Aggravated by breathing

What are the associated sx and signs of spontaneous pneumothorax?

Dyspnea; hyeperressonace, and decreased breath and voice sounds over involved lungs

What is the location of musculoskeletal disorders?

Variable

What is the quality of musculoskeletal disorders?

Aching, well localized

What is the duration of musculoskeletal disorders?

Variable

What are the aggravating or alleviating factors of musculoskeletal disorders?

Aggravated by movement; hx of exertion or injury

What are associated sx and signs of musculoskeletal disorders?

Tender to palpation of with light pressure

What is the location of herpes zoster?

Dermatomal distribution

What is the quality of herpes zoster?

Sharp, burning

What is the duration of herpes zoster?

Prolonged

What are the aggravating or alleviating factors of herpes zoster?

None

What are the associated sx and signs of herpes zoster?

Vesicular rash appears in area of discomfort

What is the location of esophageal reflux?

Substernal or epigastric; may radiate to neck

What is the quality of esophageal reflux?

Burning, visceral discomfort

What is the duration of esophageal reflux?

10-60 minutes

What is the aggravating or alleviating factors of esophageal reflux?

Aggravated by large meal, recumbency; relief with antacid

What are the associated sx and signs of esophageal reflux?

Water brash

What is the location of peptic ulcer?

Epigastric | Substernal

What is the quality of peptic ulcer?

Visceral, burning, aching

What is the duration of peptic ulcer?

Prolonged

What are the aggravating or alleviating factors of peptic ulcer?

Relief with food, antacid

What is the location of gallbladder disease?

Right upper quadrant; epigastric

What is the quality of gallbladder disease?

Visceral

What is the duration of gallbladder disease?

Prolonged

What are the aggravating or alleviating factors of gallbladder disease?

Spontaneous or following meals

What are the associated sx or signs of gallbladder disease?

Right upper quadrant tenderness may be present

What is the location of anxiety states?

Often localized over precordium

What is the quality of anxiety states?

Variable location often moves from place to place

What is the duration of anxiety states?

Varies; often fleeting

What are the aggravating or alleviating factors of anxiety states?

Situational

What are the associated sx and signs of anxiety states?

Sighing respiration; often chest wall tenderness

What is the class I classification of functional status?

Uncompromised | Ordinary activity does not cause symptoms, Sx occur only with strenuous or prolonged activity

What is the class II classification of functional status?

Slightly compromised | Ordinary physical activity results in symptoms; no sx at rest

What is the class III classification of functional status?

Moderately compromised | Less than ordinary activity results in sx; no sx at rest

What is the class IV classification of functional status?

Severely compromised | Any activity results in sx, sx may be present at rest

What are the effects of respiration on physiology and ausculatory events?

Increase venous return with inspiration | Increase heart murmurs and gallops with inspiration; splitting of S2

What are the effects of valsalva (initial high BP, phase I, followed by lower BP, phase II) on physiology and ausculatory events?

Decreased BP, venous return, and LV size (phase II) | Increased HCM, decreased AS, MR, and MVP click earlier in systole; murmur prolongs

What are the effects of standing on physiology and ausculatory events?

Increased venous return and LV size | Increased HCM, decreased AS, MR, and MVP click earlier in systole; murmur prolongs

What are the effects of squatting on physiology and ausculatory events?

Increased venous return, systemic vascular resistance, LV size Increased AS, MR, AI, decreased HCM, and MVP click delayed; murmur shortens

What are the effects of isometric exercise (eg handgrip) on physiology and ausculatory events?

Increased arterial pressure and CO | Increased gallops, MR, AI, MS, and decreased AS, HCM

What are the effects of post PVC or prolonged R-R interval on physiology and ausculatory events?

Increased ventricular filling and contractility | Increased AS, little change in MR

What are the effects of amyl nitrate on physiology and ausculatory events?

Decreased arterial pressure, LV size, and increased CO | Increased HCM, AS, MS, decreased AI, MR, austin flint murmur, and MVP click earlier in systole; murmor prolongs

What are the effects of phenylephrine on physiology and ausculatory events?

Increase arterial pressure, CO, and decreased LV size | Increased MR, AI, decreased AS, HCM, and MVP click delayed; murmur shortens

What are the loud intensity heart sounds?

S1- short PR interval, mitral stenosis with pliable valve A2- systemic hypertension, aortic dilation, coarctation of aorta P2- pulmonary HTN, and thin chest wall

What are the soft intensity heart sounds?

S1- Long PR interval, mitral regurgitation, poor left ventricular function, mitral stenosis with rigid valve, and thick chest wall A2- calcific aortic stenosis, aortic regurgitation P2- valvular or subvalvular pulmonic stenosis

What are the varying intensifying heart sounds?

S1- artial fibrillation and heart block

What conditions have a single S2?

Pulmonic stenosis Systemic HTN Coronary artery disease Any condition that can lead to paradoxical splitting of S2

What conditions have a widely split S2 with normal respiratory variation?

``` Right bundle block branch Left ventricular pacing Pulmonic stenosis Pulmonary embolism Idiopathic dilation of the pulmonary artery Mitral regurgitation Ventricular septal defect ```

What conditions have a fixed split S2?

Artial septal defect | Severe right ventricular dysfunction

What conditions have paradoxically split S2?

``` Left bundle branch block Right ventricular pacing Angina, MI Aortic stenosis Hypertrophic cardiomyopathy Aortic regurgitation ```

What grade of murmur is a barely audible murmur?

Grade 1

What grade of murmur is a murmur of median intensity?

Grade 2

What grade of murmur is a loud murmur with no thrill?

Grade 3

What grade of murmur is a loud murmur with a thrill?

Grade 4

What grade of murmur is a very loud murmur; stethoscope must be on the chest to hear it; may be heard posteriorly?

Grade 5

What grade of murmur is a murmur audible with stethoscope off the chest?

Grade 6

Chapter 4- Evaluation of the patient with cardiovascular disease Flashcards

(96 cards)