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Year 2 PCM III > CV and PV Pitcher > Flashcards

CV and PV Pitcher Flashcards

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1
Q

What do you note on characterization of peripheral pulses

A

how they feel and if you can feel them

how symmetric they are

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2
Q

What is a thrill and what does it feel like

A

valve problem, feels like a virbation

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3
Q

what position accentuates sounds best

A

supine, 30 degrees

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4
Q

leaning forward accentuates what pathology

A

aortic murmurs and pericarditis

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5
Q

left lateral decubitus accentuates what pathology

A

mitral murmurs

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6
Q

what causes a bruit

A

tubulance in artery outside heart itself

use bell

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7
Q

what is grading for murmurs

A

1 very faint
2 quiet, easily heard in quiet rrom
3 moderately loud
4 loud palpable thrill
5 very loud thrill and with stethoscope barely off chest
6 very loud, thrill, stethoscope off the chest

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8
Q

What can cause a split S1

A

normal variant or abnormal from RBBB or PVC

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9
Q

if S1 and S2 are both split what could it be

A

RBBB and PVC

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10
Q

what is a wide or fixed S2 and what could cause it

A

no respiratory variation

delayed pulmonic closure from stenosis or RBBB

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11
Q

What can cause S3

A

occurs at transition of rapid to slow ventricular filling
LV myocardial damage, CHF, MI (dilated CM)
sudden limitation of normal ventricular relaxation during filling stage in diastole

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12
Q

What are ways of early detection of dilated myocardium

A

BNP, pro-BNP doppler echo

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13
Q

Where is S4 best heard

A

apex in L lateral decubitus

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14
Q

what is going on in heart that causes S4

A

vibration of LV from atriak kick

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15
Q

What can cause S4 pathologically

A

thickening of ventircular walls from a higher work load, and some stiffening
HTN, aortic valve stenosis, pulmonic valve stenosis, hypertrophic CM

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16
Q

What is an ejection click

A

sound occurring at moment of maximal P with sudden tensing of a valve root

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17
Q

when do you hear an aortic ejection click

A

early systolic

at onset of L ventricular ejection, aortic root suddenly stretched

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18
Q

what can cause an aortic ejection click

A

dilated aneurysm of aortic root, coarctation of aorta, HTN
aortic valve stenosis and aortic regurg
(anything that over works root of aortic valve)

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19
Q

what is character of aortic stenosis murmur

A

systolic crescendo-decrescendo pattern, medium pitch, harsh

transmits sound to carotid aa

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20
Q

What are Sx of aortic stenosis

A

dyspnea on exertion, angina, syncope

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21
Q

What pathologies can lead to aortic stenosis

A

rheumatic disease, congenital bicuspid valve, calcification of valve

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22
Q

What is an Austin Flint murmur

A

early diasolit high pitch blowing decresendo murmur from high pressure back flow through narrow orifice. aortic regurg

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23
Q

what pathologies are behind aortic regurg

A

rheumatic disease, congenital bicuspid valve, endocarditis (strep, Staph, haemophilus)

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24
Q

what is a pulmonic ejection click

A

sudden root tensioning, very early systole

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25
what can cause pulmonic ejection click
pulmonary HTN, aneurysm dilating the root | pulmonary valve stenosis or regurg can alter stress on the root of the valve
26
What is sound of pulmonic stenosis
systolic crescendo decrescendo murmur | most asymptomatic
27
what are Sx of pulmonic stenosis
exertional dyspnea, chest pain, syncope
28
What extra heart sound is heard with pulmonic stenosis
S4
29
What is a graham steell murmur
pulmonary regurg | soft diastolic decrescendo
30
what can cause pulmonary regurg
pulmonary HTN: mitral stenosis, LV failure, obstructive sleep apnea, emphysema, idiopathic pulmonary HTN
31
what is sound of tricuspid stenosis
diastolid low pitch rumble best hera with bell openeing snap over tricuspid area accentuated by inspiration
32
What can cause tricuspid stenosis
rheumatic valvular disease, congenital heart disease, carcinoid tumor impeding R ventricular filling increases central venous P
33
What is sound of tricuspid regurg
early holosytolic at LSB diaphragm high pitch blowing accentuated with inspiration
34
what can cause tircuspid regurg
ebstein congenital anomaly, thin valve predisposing to failure
35
What is sound of mitral valve stenosis
opening snap in diastole
36
what valve in heart is most often affected by Rheumatic heart disease
mitral
37
What is sound of mitral valve prolapse
click and murmur | louder with valsalva and standing
38
What is mitral valve prolapse assoc with
anxiety or panic attacks | dyspnea, non-anginal chest pain, palpitations, syncope
39
What is sound of mitral valve regurg
holosystolic (pansystolic) murmur | loud high pitch, best at apex, can radiate to left axilla
40
What are Sx of HOCM
exercise induced dyspnea, angina, syncope
41
Where is a systolic ejection murmur heard best in HOCM
LSB and apex
42
what is lab test fo choice for HOCM
restin echo
43
What type of murmur do you hear with PDA
pansystolic and most of diastole may have thrill often machine like in quality and can radiate to back
44
majority innocent murmurs are from what
benign pulmonary branch stenosis
45
bruit in thyroid, what do you suspect
graves, increased blood flow
46
What can cause pericarditis
infectino of pericardium, MI, metastasis to pericardium, post cardiac surgery assoc with recent respiratory viral infection
47
What is best test to Dx pericarditis
echo
48
What is sound from constrictive pericarditis
pericardial knock, heard widely over precordium
49
What are the 3 phases of pericardial rub
atrial systole, ventricular systole, ventricular diastole | triphasic
50
Wha tis TTE and TEE
transthoracic endoscopy | transesophageal endoscopy
51
what are risk factors for murmurs
smoking, HLD, HTN
52
What medications are used for murmurs
Bblockers ACEI ARB peripheral vasodialtors
53
what are surgeries for murmurs
valve replacement or repair, stent endarterectomy
54
What are Sx of intermittent claudication
pain, tension and weakness of a limb when walking which intesifies with continued walking, resolving only when activity stops
55
What are risk facotrs for intermitten claudication
aortic stenosis anemia polycythemia atherosclerosis
56
What do you find on PE with intermitten claudication
poor pedal pulses, ulcerations, palor, cool, shiny and hairless skin, bruit may be heard
57
How do we Dx intermittent claudication
History and PE segmental BP ABI <0.9 contrast agiography
58
What is tx for intermittent claudication
meticulous foot care, smoking cessation lower lipids, walk cilostazole (pletal), phentoxifylline revascularization procedures
59
the lower the ABI index gets tells you what about severity of PAD
lower = worse PAD
60
What are risk factors for carotid artery stenosis
older male HTN, DM smoking, HLD, heart disease
61
What do you use to Dx carotid a stenosis
bruit, dopper ultrasound | MRA and angiogrpahy if dopler and ultrasound are +
62
Tx for carotid a stenosis
``` endarterectomy if >69% occluded elective endarterectomy >50% stenosis stents risk factor management aspirin prophylaxis ```
63
What is a pseudoaneurysm
dilation or hematoma that may or may not involve layers of vessel wall which is contained and does not dissect
64
When do aneurysms become painful
expanding or leaky
65
What type valve defect can aortic ascending aneurysm cause
aoritc regurg
66
Where are 75% AAA located
distal to renal aa
67
What is Dx tool for AAA
if bruit with bell then US or CT angiography | Contrast CT if not emergent
68
What is Tx for aneurysm
elective graft | betablockers to reduce shear stress unless hypotensive already
69
What is raynaud phenomenon assoc with
scleroderma, lupus, peripheral neuritis, polyarteritis
70
What other problems is raynaud disease assoc with
none
71
What is Tx raynaud
``` avoid or stop smoking avoid cold temperatures aboid Bblockers manage stressors CCB ```
72
What are large vessel vasculitis
takayasu aortitis: aorta and major branches "pulseless disease"
73
what are the medium vessel vasculitis
polyarteritis nodosa | wegeners granulomatosis
74
what are the small vessel vasculitis
HSP: palpable purpura abdomen and legs, children more than adults assoc with IC
75
Sx polyarteris nodosa
fatigue, weakness, fever, wt loss, HA, abdominal pain | elevated WBC neutrophils
76
how do you confirm Dx polyarteritis nodosa
biopsy
77
Tx for polyarteritis nodosa
steroids and immune modulating agents

Year 2 PCM III (5 decks)

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