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Physical Diagnosis > Heart > Flashcards

Heart Flashcards

(85 cards)

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1
Q

classic symptoms of acute heart failure

A
  • chest pain or radiating to jaw, neck, arms or back
  • GI discomfort
  • exertional dyspnea
  • pain, pressure or discomfort aggravated or precipitated by physical or emotional stress, heavy meals or cold weather
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2
Q

classic symptoms of chronic right sided heart failure

A

fatigue, dyspnea, and ankle edema which may lead to jugular distension and ascites

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3
Q

classic symptoms of chronic left sided heart failure

A

fatigue, exertional dyspnea, orthopnea, chronic cough and pink frothy sputum

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4
Q

traditional physical exam procedures are performed in this order

A
  • inspection of precordium and veins
  • palpation of precordium and peripheral pulses
  • percussion of heart borders
  • auscultation of normal and abnormal heart sounds
  • BP
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5
Q

what are you looking for on the precordium, during inspection, in relation to heart size

A
  • edema, cyanosis, or clubbing of fingers
  • apical impulse
  • precordial heaves or lifts
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6
Q

where is the apical impulse found and how can it help determine heart size

A

left 5th ICS just medial to mid-clavicular line. If felt lateral to midclavicular line or precardial heaves or lifts are observed then indication of cardiac hypertrophy or displacement

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7
Q

during inspection, what are you looking for in the jugular veins

A
  • engorgement

- accentuated waves

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8
Q

prominent A and V jugular waves indicate what

A

problem with right heart; tricuspid stenosis or regurgitation

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9
Q

distention of the jugular veins usually indicates

A

problem with right heart; tricuspid stenosis or regurgitation

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10
Q

what other signs of right heart failure can be expected when distention of the jugular veins is present

A
  • pitting ankle edema

- failure of veins on back of hand to collapse

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11
Q

what is checked and looked for in the inspection portion of a cardiac exam

A
  • edema, cyanosis, or clubbing of fingers
  • apical impulse
  • jugular vein distention
  • accentuated waves in jugular veins
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12
Q

what is checked and looked for in the palpation portion of a cardiac exam

A
  • apical impulse
  • precordial thrills
  • palpation of peripheral pulses
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13
Q

the most accurate means of measuring heart size

A

P-A chest film from 72”

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14
Q

what is the purpose of percussion during a cardiac exam

A

determine heart size

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15
Q

auscultation site for aortic valve

A

right 2nd ICS next to sternum

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16
Q

auscultation site for pulmonic valve

A

left 2nd ICS next to sternum

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17
Q

auscultation site for tricuspid valve

A

left 4th ICS next to sternum

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18
Q

auscultation site for bicuspid/mitral valve

A

left 5th ICS just inside midclavicular line

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19
Q

the auscultation sites for the valves represents their anatomical location

A

FALSE; simply where they are best heard

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20
Q

what is the recommended procedure for auscultation of the valve sites

A
  • first listen for rate, rhythm, and amplitude
  • second added heart beats
  • third added heart sounds
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21
Q

the diaphragm allows you to hear subtle high pitched abnormalities

A

TRUE

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22
Q

the bell allows you to hear subtle low pitched abnormalities

A

TRUE

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23
Q

the diaphragm must be applied lightly and the bell may be applied firmly

A

TRUE

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24
Q

which valves closing creates the first heart sound/S1/LUBB

A

mitral and tricuspid

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25
which valves closing creates the second heart sound/S2/dup
aortic and pulmonic
26
which heart sound marks the start of systole
LUBB
27
which heart sound marks the start of diastole
dup
28
which heart sound marks the end of diastole
LUBB
29
which heart sound marks the end of systole
dup
30
emptying of the heart
systole
31
filling of the heart
diastole
32
contraction of the heart
systole
33
which atrioventricular valve closes a fraction before the other
mitral closes before tricuspid
34
which heart sound is longer and of lower pitch
S1/LUBB
35
where is the S1/LUBB heard the loudest
mitral valve site (left 5th ICS medial to midclavicular line)
36
what is one way to accentuate the sound of the mitral and tricuspid valves
have the patient in the left lateral recumbent position, bringing the apex closer to the chest wall
37
which heart sound should be in sync with the apical impulse and the carotid pulse
S1/LUBB
38
which semilunar valve closes a fraction before the other
aortic valves closes just before pulmonic
39
which heart sound is shorter and of higher pitch
S2/dup
40
where is the S2/dup heard the loudest
aortic valve site (right 2nd ICS next to sternum)
41
what is one way to accentuate the sounds of the aortic and pulmonic valves
having patient sitting down leaning forward bringing base of heart closer to chest wall
42
what are the added heart beats
- splits - gallops - clicks - snaps
43
when both components of the first heartbeat (mitral & tricuspid) are audible causing a double sound
S1 split
44
where would an S1 split be heard the best
at tricuspid site (4th left ICS next to sternum) right after daistolic pulse
45
an S1 split may be a normal finding in a person of what body type
thin
46
what could an S1 split indicate when not a normal finding
delayed tricuspid closure; RBBB
47
if the cause of an S1 split were RBBB what might you expect
might expect patient profile and associated signs and symptoms of chronic right-sided heart failure
48
what is the best way to diagnose RBBB
EKG
49
when both components of the second heartbeat (aortic & pulmonic) are audible causing a double sound
S2 split
50
type of S2 split
- physiologic - paradoxical - fixed
51
when is a physiologic split heard
during inspiration
52
physiologic S2 split
separation of S2 heart sound caused by late closure of pulmonic valve due to right heart's inability to keep up with the left extra blood being pumped. all made possible by decrease in pressure in thoracic cavity due to the depression of the diaphragm during inspiration
53
when the aortic valve is pathologically delayed, as in left bundle branch block (LBBB), during expiration
paradoxical S2 split
54
when the aortic valve closes after the pulmonic during expiration due to LBBB
paradoxical S2 split
55
If the pulmonic valve is delayed even more than usual, as in the case of a septal defect; where blood from the left heart is shunted to the right heart causing extra workload for the right heart, a split on both phases of respiration may occur
fixed S2 split
56
what is the name of the S2 split present on inspiration and expiration
fixed S2 split
57
blood striking a damaged and therefore stiffened ventricular wall in early diastole creating an audible vibration
ventricular gallop S3/third heartbeat
58
where is a ventricular gallop best heard
apex of the heart with the bell
59
an S3 gallop normally indicates acute or chronic heart failure but it may be functional in which patients
thin
60
describe the cadence of an S3 gallop
same as a fixed S2 split
61
synonyms for S4 gallop
- atrial gallop - presystolic gallop - fourth heartbeat
62
blood striking a damaged and therefore stiffened ventricular wall in late diastole creating an audible vibration
S4 gallop
63
difference between S4 and S3 gallops
S3 early diastole and S4 late diastole
64
describe the cadence of an S4 gallop
same as an S1 split
65
an abrupt stopping of a damaged atrioventricular valve heard in early diastole
opening snap of the atrioventricular valves
66
possible causes of atrioventricular valve opening snaps
- thickening - deformity - calcification - often due to childhood strepthroat or rheumatic fever
67
describe the cadence of atrioventricular valve opening snaps
same as an S2 split
68
mid systolic beat created by thickening, deformity, or calcification of the semilunar valves
ejection clicks of the semilunar valves
69
describe the cadence of an ejection click of the semilunar valves
same as an S1 split
70
causation of splits
a paired valve is delayed
71
causation of gallops
stiff ventricular wall vibration
72
causation of clicks and snaps
calcified valve pops open
73
abnormal heart sounds due to turbulent blood flow
murmurs
74
what usually causes murmurs
primarily faulty valves but can be caused by septal defects
75
grades of murmurs
1 - faint in a quiet room
76
murmur refers to a short, late diastolic murmur
presystolic
77
murmur refers to a short, early systolic murmur
protosystolic
78
murmur extends from S1 to S2 (all of systole)
pansystolic. what is the difference between holosystolic and pansystolic?
79
murmur extends from S1 to S2 (all of systole)
holosystolic. what is the difference between holosystolic and pansystolic?
80
murmur is present throughout systole & into some of diastole
continuous
81
what do murmurs involving right sided heart failure get louder. during inspiration or expiration
inspiration
82
what kind of patients would an innocent murmur be found
- children | - athletes
83
A continuous, rough murmur in he 2nd ICS due to a patent ductus arteriosis, that should have closed after birth
machinery murmur
84
A benign, functional midsystolic murmur heard in children
still's murmur
85
Late diastolic murmur associated with aortic insufficiency; the regurgitant blood is thought to vibrate the mitral valve causing the murmur
austin flint murmur

Physical Diagnosis (8 decks)

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