Chapter 9 Cardiology Flashcards by Kyle Poulsen

Left ventricular Hypertrophy will have what PMI?

PMI >2.5 cm

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Jugular veins

reflect arterial pressure

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Elevated JVP

98% specific for increased left ventricular end systolic and diastolic blood pressures

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Carotid pulse- brisk

normal

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Carotid pulse- delayed

suggests aortic stenosis

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Carotid pulse- bounding

suggest cardiac insufficiency

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Bruit mumur

Indication of turbulent flow (normally should not hear); could indicate atherosclerosis, CVD

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PMI- tapping

normal

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PMI- sustained

suggest LV hypertrophy (thickening of heart)

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PMI- diffuse

suggests a dilated ventricle from CHF cardiomyopathy

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Lateral displacement from cardiac enlargement

CHF, cardiomyopathy, ischemic heart disease

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Palpation of heaves/lifts

abnormal ventricular movement

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Palpations of thrills/turbulance

may accompany loud, harsh, or rumbling murmurs as in aortic stenoisis, ventricular septal defect, damage heart valve

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MR. AS

Mitral Regurgitation (MR): Aortic stenosis (AS) found only in systole.

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MS. AR

Mitral Stenosis (MS): Aortic regurgitation (AR); found only in diastole

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Mid-systolic murmur

Begins after S1 and stops before S2. Brief gaps are audible between murmur and heart sounds. Typically arise from blood flow across the semilunar valves.

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Holosystolic (pansystolic) murmur

Starts with S1 and stops at S2, without a gap between murmur and heart sounds. These murmurs often occur with regurgitant (backflow) across the atrioventricular valves.

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Late diastolic (presystolic) murmur

Starts in late diastole and typically continues up to S1.

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Early diastolic murmur

Starts after S2, with a discernible gap, and then usua fades into silence before the next S1. These murmurs accompany regurgant flow across incompetent semilunar valves.

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Sustained, high amplitude apical impulse

Suggest left ventricular hypertrophy from pressure overload as in hypertension. If displaced laterally consider volume overload

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Sustained, low amplitude apical impulse

May result from dilated cardiomyopathy

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2nd Left ICS

A palpable S2 suggests increased pressure in the pulmonary artery such as pulmonary hypertension

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2nd Right ICS

A pulsation here can suggust a dilated of aneurysmal aorta

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Left lateral decubitus postion

This position brings out a left sided S3 & S4 and mitral murmurs, especially mitral stenosis

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Lean forward, exhale completely, and stop breathing in expiration

This position brings our aortic mumurs (aortic regurgitation).

Mitral stenosis

Late diastolic crescendo, valve cannot open wide enough and leads to decrease blood flow to body; often occurs w/ Rheumatic fever

Aortic regurgitation

Early diastolic, Descrescendo; leaflets of aortic valve fail to close completely and blood regurgitates from aorta to left ventricle

Aortic stenosis

Midsystolic murmur, crescendo/decrescendo; typically arise from narrowed aortic valve

Mitral regurgitation

Holosystolic murmur; flat; often occurs with backflow across the atrioventricular valves

Mitral Regurgitation- example

Harsh 2/6 medium pitched holosystolic murmur best heart at apex

Aortic Regurgitation- examples

Soft blowing 3/6 decrescendo diastolic murmur heart at lower left sternal border

Coarctation of the Aorta

A pulse in the femoral area or feet will be weaker than pulse in the arms or cartotid. Sometimes pulse may not be felt at all.

Grading of murmurs-1

Very faint, heard only after listener has "tuned in"; may not be heard in all positions

Grading of murmurs-2

Quiet, but heart immediately after placing the stethoscope on the chest

Grading of murmurs-3

Moderately loud

Grading of murmurs-4

Verly loud, with thrill

Grading of murmurs- 5

Very loud with thrill. May be heard when the stethoscope is partly off the chest

Grading of murmurs-6

Very loud with thrill. May be heard when the stethoscope is entirely off the chest

Heart murmurs- Quality

Apply terms like harsh, musical, soft, blowing

Heart murmurs-Pitch

Apply terms like high, medium, or low pitched

Period of rapid ventricular filling as blood flows in early diastole; children/young adults=rapid deceleration of the column of blood against ventricular wall; water faucet; pathological after the age of 40.

Atrial contraction; Immediately preceeds S1; diastole

Cardic Output

SV (stroke volume) X HR (heart rate)

The difference between end-diastolic volume and end-systolic volume; how much blood is pushed out of heart

Ejection fraction

Stroke volume divided by end-diastolic volume; % of how much blood pushed out vs. how much started with

Preload

work imposed on the heart before contraction begins filling

Afterload

the pressure or tension work of the heart (peripheral resistance)

Hypertension s/s

Often none, headache, Target organ damage (nocturia, visual changes, CV complications i.e. MI)

Atrial Fibrillation

Irregularly Irregular

Holosystolic plateau murmur heard at the left 5th intercostal space, midclavicular line.

Mitral Regurgitation

Crescendo-Decrescendo systolic murmur heard at the right second intercostal space, right sternal border

Aortic Stenosis

Crescendo diastolic murmur heard at the left 5th intercostal space, midclavicular line.

Mitral Stenosis

Decrescendo diastolic murmur heard at the right second intercostal space, right sternal border

Aortic Regurgitation

Midsystolic Click

Mitral Valve Prolapse

Between S1 and S2

Systole

Between S2 and S1

Diastole

Systole

Ventricles contract

Diastole

Ventricles relax

Harsh murmurs are typically:

Mitral

Soft, blowing murmurs are typically:

Aortic

Ventricular Septal Defect mimics:

Mitral Regurgitation

Opening Snap

Opening of a stenotic mitral valve

Squatting from a standing position

Increased Mitral and Aortic Regurgitation | Decreased Hypertrophic Cardiomyopathy murmur

Valsalva/Bearing Down

Increased Hypertrophic Cardiomyopathy murmur

S1 is the first heart sound and is produced by:

Closure of the mitral valve

S2 is the second heart sound and is produced by:

Closure of the aortic valve

What type of splitting is always pathological?

Expiratory

Sounds best heard with the diaphragm:

S1, S2, S4, and most murmurs

Sounds best heard with the bell:

S3 and the rumble of mitral stenosis

Chapter 9 Cardiology Flashcards

(69 cards)