Flashcards in CV Lecture Deck (78)
What is the MC chief complaint for cardiac events?
What is the true symptom of CV disease?
What is angina pectoris?
-Crushing, squeezing chest pain
-Usually on exertion
-True symptom of CVD
End diastolic volume at the beginning of systole directly related to stretch (Starling's law)
Define stroke volume
Volume of blood pumped from one ventricle of the heart with each beat
Amount of resistance that the L side of the heart has to overcome to eject blood ("squeeze")
How can fever affect HR and respirations?
How can hypothermia affect HR and respirations?
How do you directly measure blood pressure?
Insertion of intra-arterial catheter (A-line)
How do you indirectly measure BP?
BP cuff and stethoscope
What can happen to BP if cuff is too small?
What BP finding indicates supravalvular aortic stenosis?
Difference in BP of 20+ mmHg between arms
What BP finding indicates coarctation of aorta?
-If BP is high in both arms, take BP in the legs
-If legs have lower BP, then could be coarctation of aorta
What does jugular venous pulse reflect?
What are the components of a jugular venous pulsation?
What is the "a" wave?
-Part of JVP
-Reflects slight rise in atrial pressure that accompanies contraction
-Occurs before S1 and carotid pulse
What is the "x descent"?
-Part of JVP
What is the "v wave"?
-Part of JVP
-Atria begin to fill
What is the "y descent"?
-Part of JVP
-Blood flows into RV
What does the hepatojugular reflex assess?
Why does the hepatojugular reflex occur?
Inability of R side of heart to accommodate increased venous return
What is the normal response of hepatojugular reflex?
Jugular veins show a transient increase during first few cardiac cycles of compression followed by a fall to baseline
What are the different types of carotid upstroke?
-Delayed (possible AS)
-Bounding (possible AR)
Use finger pads to palpate for ____ in the CV PE
Heaves or lifts
Use ball of hand to palpate for ____ in the CV PE
What is a laterally displaced PMI suggestive of?
The PMI can be described as:
-Sustained (suggests LV hypertrophy from HTN or AS)
-Diffuse (suggests dilated ventricle from CHF or cardiomyopathy)
In the L lat decubitus position, a PMI 3+ cm is an indicator of:
If the PMI is displaced to the right, this may indicate:
How may the PMI present in a COPD patient?
Felt in the epigastrium
If the PMI is palpated in the normal position in a COPD patient, what can this indicate?
Presence of a heave with a lateral retraction felt along the left parasternal border is suggestive of:
Name where all of the auscultation points are on the chest
-Aortic: R 2nd ICS
-Pulmonic: L 2nd ICS
-Erb's point: L 3rd ICS
-Tricuspid: L 4th ICS
-Mitral: L 5th ICS mid-clavicular line
Apex in L lateral decubitus position with the bell will detect:
Mitral stenosis murmur (low pitched diastolic)
Diaphragm of stethoscope on the chest is best used to listen for:
High pitched sounds like S1, S2, S4 and most murmurs
Bell of stethoscope on the chest is best used to listen for:
Low pitched sounds like S3 and rumble of mitral stenosis
Which heart sounds are accentuated by inspiration?
S3 and S4 originating in R side of heart
Why are most murmurs or sounds originating in R side of heart accentuated by inspiration?
Because of increased return of blood that occurs and increased RV output
S1 is muffled or decreased in patients with:
-Pleural and pericardial effusions
Normally, the tricuspid valve closes a split second ____ the mitral valve
(aka splitting of S1)
When can splitting of S1 occur?
-PVCs of LV origin
What is reverse splitting of S1?
When tricuspid valve closes BEFORE mitral
-Occurs with LBBB, RV pacing, severe MS, left atrial myxoma
When is the intensity of A2 increased?
-Coarctation of aorta
-Aortic aneurysm in thin ppl
-Tetralogy of Fallot
-Transposition of great vessels
When is the intensity of A2 decreased?
-Decreased systemic arterial pressure
When is the intensity of P2 increased?
Normally, the aortic valve closes ____ the pulmonary valve
What is reverse splitting of S2?
Aortic valve closes AFTER pulmonic valve
(aka paradoxical split)
When does an S3 occur?
Rapidly rushing flow of blood from atria is suddenly decelerated by the ventricle when it reaches its elastic limit
In a normal ventricle, when does S3 occur?
Volume loaded conditions
In a ventricle with decreased compliance, when does an S3 occur?
With a normal amount of blood entering during diastole
Is S3 always normal or always abnormal?
-It can be pathological
-Can also be a normal variant in 40 yo or younger
What does an S3 present with heart failure indicate?
Conditions associated with pathological S3:
-Ischemic heart disease
-MR or TR
-Systemic and pulm HTN
-Volume overload (renal failure)
Late diastolic sound heard just before S1 that corresponds to late ventricular filling through active atrial contraction
Conditions a/w S4:
-LVH from systemic HTN
-RVH from pulm HTN or stenosis
-IHD from acute MI or angina
How do S1 and S2 differ from S3 and S4?
-S1 and S2 are high pitched and best audible with diaphragm
-S3 and S4 are low pitched and best heard with bell
What is an opening snap?
-High pitched diastolic sound
-Produced by rapid opening of mitral valve in MS or tricuspid in TS
-Closer to A2 means more severe stenosis
What is a systolic ejection click?
-High pitched, early part of ventricular systole
-Can be valvular or vascular
-Intensity decreases with increased valve calcification
What is a non-ejection systolic click?
-High pitched systolic sound that follows S1
-A/w mitral or tricuspid valve prolapse
What 3 factors can contribute to development of heart murmurs?
1. High flow rate through normal or abnormal orifices
2. Forward flow through a constricted or irregular orifice OR into a dilated vessel or chamber
3. Backward or regurgitant flow through an incompetent valve
How do we identify or describe heart murmurs?
-Timing (systole or diastole)
-Quality (harsh, blowing, etc.)
-Relationship to respiration
-Relationship to position
How are murmurs described by shape?
-Crescendo (rises in intensity from S1 to S2)
-Decrescendo (decreases in intensity after S2)
-Crescendo-decrescendo (rises and then falls between S1 and S2)
Describe the murmur of AS:
-Mid to late systolic
-Narrow pulse pressure
-Parvus tardus pulse
-Radiates to carotid
Describe the murmur of MR:
-Radiates to axilla
How is PMI affected with MR?
Laterally displaced and diffuse
Describe the murmur of PS:
Similar to AS just in pulmonic area
Describe the murmur of TR:
Similar to MR just in tricuspid area
What does a ventral septal defect (VSD) sound like and where is it best heard?
-Radiates to R of sternum
-Best heard in tricuspid area
How does a venous hum sound and where is it best heard?
-Radiates to R side of neck
-Heard best above clavicle
What does an innocent murmur sound like?
What are the systolic murmurs?
What are the diastolic murmurs?
Describe murmur of MS:
Describe murmur of AR:
-Wide pulse pressure
-Laterally displaced PMI
What is an Austin Flint murmur?
Apical diastolic murmur a/w AR - mimicking MS
How do continuous murmurs develop?
Results from a communication between high pressure arterial and low pressure venous chamber or vessel
What is the best example of a continuous murmur?
Patent Ductus Arteriosus (PDA)