Mosby 14 Flashcards

Question

Chest pain description: character

Answer 1

aching, sharp, tingling, burning, pressure, stabbing, crushing, or clenched fist sign

Answer 2

radiating down arms, to neck, jaws, teeth, scapula; relief with rest or position change

Answer 3

interference with activity, need to stop all activity until subsides, disrupts sleep, how severe on a scale of 0 to 10

Answer 4

anxiety; dyspnea; diaphoresis; dizziness; nausea or vomiting; faintness; cold, clammy skin; cyanosis; pallor; swelling or edema (noted anywhere, constant or at certain times during day)

Answer 5

rest, position change, exercise, nitroglycerin, digoxin, diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, nonsteroidal antiinflammatory drugs, antihypertensives

Answer 6

dyspnea on exertion, chest pain, palpitations, orthopnea, paroxysmal nocturnal dyspnea, anorexia, nausea, vomiting beta-blocker

Answer 7

dry, wet, nighttime, aggravated by lying down ACE inhibitors

Answer 8

Chest pain Fatigue Cough Difficulty breathing Loss of conciousnes

Answer 9

aggravated by exertion (how much?) worsening or remaining stable lying down or eased by resting on pillows (how many? or sleep in a recliner?) paroxysmal nocturnal dyspnea

Answer 10

palpitation, dysrhythmia, unusual exertion, sudden turning of neck (carotid sinus effect), looking upward (vertebral artery occlusion), change in posture

Answer 11

Cardiac surgery or hospitalization Rhythm disorder Acute Rheumatic feverl unexplained fever, swollen joins, Sydenham chorea (St. Vitus dance), abdominal pain, skin rash (erythema marginatum) or nodules Chronic illness: hypertension, bleeding disorder, hyperlipidemia, diabetes, thyroid dysfunction, coronary artery disease, obesity, congenital heart defect

Answer 12

Long QT syndrome Diabetes Heart disease Dyslipidemia Hypertension Obesity Congenital heart defects

Answer 13

Emplyoment w/ physical, env hazards (e.g. heat/stress) Tabacoo Nutritional status Diet Weight Alcohol Releaxation Hobbies Exercise Sexual activity Illegal drugs

Answer 14

• **Gender** (men more at risk than women; women’s risk is increased in the postmenopausal years and with oral contraceptive use) • **Hyperlipidemia** • **Elevated homocysteine** level • **Smoking** • **Family** history of **cardiovascular disease**, diabetes, hyperlipidemia, hypertension, or sudden death in young adults • **Diabetes mellitus** • **Obesity**: dietary habits including an excessively fatty diet • **Sedentary lifestyle** without exercise • **Personality type**: intense, compulsive behavior with feelings of hostility; negative emotions, pessimistic attitude, failure to share emotions

Answer 15

◆**Tiring easily** during feeding ◆ **Breathing change**s: more heavily or more rapidly than expected during feeding or defecation ◆ **Cyanosis**: perioral during eating, more widespread and more persistent, related to crying ◆ Weight gain as expected ◆ **Knee-chest** position or other position favored for rest ◆ **Mother’s health** during **pregnancy**: medications taken, unexplained fever, illicit drug use

Answer 16

◆ **Tiring during play**: amount of time before tiring, activities that are tiring, inability to keep up with other children, reluctance to go out to play ◆ **Naps**: longer than expected ◆ **Positions**: squatting instead of sitting when at play or watching television ◆ **Headaches** ◆ **Nosebleeds** ◆ **Unexplained joint pain** ◆ **Unexplained fever** ◆ **Expected height** and **weight gain** (and any substantiating records) ◆ **Expected physical** and **cognitive** **development** (and any substantiating records)

Answer 17

◆ **History** of **cardiac disease** or surgery ◆ **Dizziness** or faintness on standing ◆ Indications of heart disease during pregnancy, including progressive or severe dyspnea, progressive orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, and chest pain related to effort or emotion

Answer 18

◆ Common symptoms of cardiovascular disorders: confusion, dizziness, blackouts, syncope, palpitations, coughs and wheezes, hemoptysis, shortness of breath, chest pains or chest tightness, impotence, fatigue, leg edema: pattern, frequency, time of day most pronounced ◆ If heart disease has been diagnosed: drug reactions: potassium excess (weakness, bradycardia, hypotension, confusion); potassium depletion (weakness, fatigue, muscle cramps, dysrhythmias); digitalis toxicity (anorexia, nausea, vomiting, diarrhea, headache, confusion, dysrhythmias, halo, yellow vision), interference with activities of daily living; ability of the patient and family to cope with the condition, perceived and actual; orthostatic hypotension

Answer 19

200 mg/dL 100 mg/dL 70 mg/dL

Answer 20

LDL levels Diet Exercise No smoking Monitor BP, glucose, inflamatory, lipids anually

Answer 21

Crackles in the lugs Engorgement of liver Peripheral edema

Answer 22

◆ Effect of a barrel chest or pectus deformity ◆ Xanthelasma ◆ Funduscopic changes of hypertension ◆ Ascites or pitting edema ◆ Abdominal aortic bruit

Answer 23

Left vencticular hypertrophy

Answer 24

Righte ventricular hypertrophy

Answer 25

point of maximal impulse (PMI)

Answer 26

overlying fluid or air or to displacement beneath the sternum

Answer 27

dextrocardia, diaphragmatic hernia, distended stomach, or a pulmonary abnormality

Answer 28

fine, palpable, rushing vibration, a palpable murmur, often, but not always, over the base of the heart in the area of the right or left second intercostal space indicates turbulence or a disruption of the expected blood flow related to some defect in the closure of one of the semilunar valves (generally aortic or pulmonic stenosis), pulmonary hypertension, or atrial septal defect

Answer 29

Heart is more maleable than chest and it will conform shape Chest radiograph

Answer 30

◆ **Aortic valve area:** second right intercostal space at the right sternal border ◆ **Pulmonic valve area:** second left intercostal space at the left sternal border ◆ **Second pulmonic area:** third left intercostal space at the left sternal border ◆ **Tricuspid area:** fourth left intercostal space along the lower left sternal border ◆ **Mitral (or apical) area:** at the apex of the heart in the fifth left intercostal space at the midclavicular line

Answer 31

Pulmonic valve area: second left intercostal space at the left sternal border (during inspiration)

Answer 32

Pitch, intensity, duration, timing (in cardiac cycle)

Answer 33

Toward apex S1 is lower in pitch and longer than S2

Answer 34

Systole begins too early: Blood veolicty increased (anemia, fever, hyperthyrodism, anxiety, exercise) Stenosis of mitrial valve

Answer 35

Complete heart block Gross disruption of rhythm Increase of overlying, tissue, fat Pulmonary hypertension Fibrosis and calcification e.g. due to RF

Answer 36

``` Systemic hypertension (S2 may ring or boom), syphilis of the aortic valve, exercise, or excitement accentuates S2 ``` Pulmonary hypertension, mitral stenosis, and congestive heart failure accentuate P2 The valves are diseased but still fully mobile; the component of S2 affected depends on which valve is compromised.

Answer 37

A shocklike state with arterial hypotension causes loss of valvular vigor. The valves are immobile, thickened, or calcified; the component of S2 affected depends on which valve is compromised. Aortic stenosis affects A2. Pulmonic stenosis affects P2. Overlying tissue, fat, or fluid mutes S2 giving

Answer 38

Pulmonary valve

Answer 39

Vibration of ventricle during passive diastole Quiert, low pitched, difficult to hear Increased filling pressure or decreased ventricular compliance

Answer 40

vibration in the valves, papillae, and ventricular walls late diastole (presystole) \* can be confused with s1 elderly, increased resistance because of loss of complance of ventricular walls

Answer 41

Increasing venous return (e.g. raising leg or grip hand)

Answer 42

DELAYED PULMONIC CLOSURE right bundle branch block stenosis of pulmonary valve pulmonary hypertension delays emptying mitral regurgitation (cause early closure of aortic valve)

Answer 43

WHEN OUTPUT OF RIGHT VENTRICLE IS GREATER THAN OF THE LEFT Large atrial septal defect ventricular septal defect left-to-right shunting

Answer 44

AORTIC VALVE IS DELAYED

Answer 45

Pericardial friction rub

Answer 46

Prologned extra sound during sys or diastole Due to disruption of the blood flow

Answer 47

Regurgitation

Answer 48

**DETECTION** Heard with bell at apex, patient in left lateral decubitus position **FINDING** Low-frequency diastolic rumble, more intense in early and late diastole, does not radiate; systole usually quiet; palpable thrill at apex in late diastole common; S1 increased and often palpable at left sternal border; S2 split often with accented P2; opening snap follows P2 closely Visible lift in right parasternal area if right ventricle hypertrophied Arterial pulse amplitude decreased **DESCRIPTION** Narrowed valve restricts forward flow; forceful ejection into ventricle Often occurs with mitral regurgitation Caused by rheumatic fever or cardiac infection

Answer 49

**DETECTION** Heard over aortic area; ejection sound at second right intercostal border **FINDINGS** Midsystolic (ejection) murmur, medium pitch, coarse, diamond shaped,\* crescendodecrescendo; radiates along left sternal border (sometimes to apex) and to carotid with palpable thrill; S1 often heard best at apex, disappearing when stenosis is severe, often followed by ejection click; S2 soft or absent and may not be split; S4 palpable; ejection sound muted in calcified valves; the more severe the stenosis, the later the peak of the murmur in systole Apical thrust shifts down and left and is prolonged if left ventricular hypertrophy is also present **DESCRIPTION** Calcification of valve cusps restricts forward flow; forceful ejection from ventricle into systemic circulation Caused by congenital bicuspid (rather than the usual tricuspid) valve, rheumatic heart disease, atherosclerosis May be the cause of sudden death, particularly in children and adolescents, either at rest or during exercise; risk apparently related to degree of stenosis

Answer 50

**DETECTION** Heard at apex and along left sternal border **FINDINGS** Murmur fills systole, diamond shaped, medium pitch, coarse; thrill often palpable during systole at apex and right sternal border; multiple waves in apical impulses; S2 usually split; S3 and S4 often present Arterial pulse brisk, double wave in carotid common; jugular venous pulse prominent **DESCRIPTION** Fibrous ring, usually 1 to 4 mm below aortic valve; most pronounced on ventricular septal side; may become progressively severe with time; difficult to distinguish from aortic stenosis on clinical grounds alonea

Answer 51

**DETECTION** Heard over pulmonic area radiating to left and into neck; thrill in second and third left intercostals space **FINDINGS** Systolic (ejection) murmur, diamond shaped, medium pitch, coarse; usually with thrill; S1 often followed quickly by ejection click; S2 often diminished, usually wide split; P2 soft or absent; S4 common in right ventricular hypertrophy; murmur may be prolonged and confused with that of a ventricular septal defect **DESCRIPTION** Valve restricts forward flow; forceful ejection from ventricle into pulmonary circulation Cause is almost always congenital

Answer 52

**DETECTION** Heard with bell over tricuspid area **FINDINGS** Diastolic rumble accentuated early and late in diastole, resembling mitral stenosis but louder on inspiration; diastolic thrill palpable ov er right ventricle; S2 may be split during inspiration Arterial pulse amplitude decreased; jugular venous pulse prominent, especially a wave; slow fall of v wave **DESCRIPTION** Calcification of valve cusps restricts forward flow; forceful ejection into ventricles Usually seen with mitral stenosis, rarely occurs alone Caused by rheumatic heart disease, congenital defect, endocardial fibroelastosis, right atrial myxoma

Answer 53

**DETECTION** Heard best at apex; loudest there, transmitted into left axilla **FINDINGS** Holosystolic, plateau-shaped intensity, high pitch, harsh blowing quality, often quite loud and may obliterate S2; radiates from apex to base or to left axilla; thrill may be palpable at apex during systole; S1 intensity diminished; S2 more intense with P2 often accented; S3 often present; S3-S4 gallop common in late disease If mild, late systolic murmur crescendos; if severe, early systolic intensity decrescendos; apical thrust more to left and down in ventricular hypertrophy **DESCRIPTION** Valve incompetence allows backflow from ventricle to atrium Caused by rheumatic fever, myocardial infarction, myxoma, rupture of chordae

Answer 54

**DETECTION** Heard at apex and left lower sternal border; easily missed in supine position; also listen with patient upright **FINDINGS** Typically late systolic murmur preceded by midsystolic clicks, but both murmur and clicks highly variable in intensity and timing **DESCRIPTION** Valve is competent early in systole but prolapses into atrium later in systole; may become progressively severe, resulting in a holosystolic murmur; often concurrent with pectus excavatum

Answer 55

**DETECTION** Heard with diaphragm, patient sitting and leaning forward; Austin- Flint murmur heard with bell; ejection click heard in second intercostal space **FINDINGS** Early diastolic, high pitch, blowing, often with diamondshaped midsystolic murmur, sounds often not prominent; duration varies with blood pressure; low-pitched, rumbling murmur at apex common (Austin-Flint); early ejection click sometimes present; S1 soft; S2 split may have tambour-like quality; M1 and A2 often intensified, S3-S4 gallop common In left ventricular hypertrophy, prominent prolonged apical impulse down and to left Pulse pressure wide; waterhammer or bisferiens or Corrigan pulse common in carotid, brachial, and femoral arteries (see Chapter 15) **DESCRIPTION** Valve incompetence allows backflow from aorta to ventricle Caused by rheumatic heart disease, endocarditis, aortic diseases (Marfan syndrome, medial necrosis), syphilis, ankylosing spondylitis, dissection, cardiac trauma

Answer 56

**DETECTION/FINDINGS** Difficult to distinguish from aortic regurgitation on physical examination **DESCRIPTION** Valve incompetence allows backflow from pulmonary artery to ventricle Secondary to pulmonary hypertension or bacterial endocarditis

Answer 57

**DETECTION** Heard at left lower sternum, occasionally radiating a few centimeters to left **FINDINGS** Holosystolic murmur over right ventricle, blowing, increased on inspiration; S3 and thrill over tricuspid area common In pulmonary hypertension, pulmonary artery impulse palpable over second left intercostal space and P2 accented; in right ventricular hypertrophy, visible lift to right of sternum Jugular venous pulse has large v waves **DESCRIPTION** Valve incompetence allows backflow from ventricle to atrium Caused by congenital defects, bacterial endocarditis (especially in IV drug abusers), pulmonary hypertension, cardiac trauma

Answer 58

Still murmurs Younger (blood flowing from large chamber to blood vessels) They are usually grade I or II, usually midsystolic, without radiation, medium pitch, blowing, brief, and often accompanied by splitting of S2

Answer 59

The result of a structural anomaly that is not severe enough to cause a clinical problem

Answer 60

Inspiration-increase Expireation-decrease

Answer 61

Valsalva - Increase

Answer 62

Squatting to standing (rapidly for 30 seconds) - Increase Standing to squatting (rapidly) - Decrease Passive leg elevation to 45 degrees, patient supine - Decrease

Answer 63

Handgrip - Increase

Answer 64

Transient arterial occlusion (sphygmomanometer placed on each of patient’s upper arms and simultaneously inflated to 20 to 40 mm Hg above patient’s previously recorded blood pressures; intensity noted after 20 seconds) _ increase Inhalation of amyl nitrate (three rapid breaths from a broken ampule) (Not routinely recommended) - decrease

Answer 65

No maneuver distinguishes this murmur; the diagnosis can be made by exclusion

Answer 66

sinus dysrhythmia

Answer 67

heart disease or conduction system impairment

Answer 68

Polycythemia

Answer 69

Congential heart disease

Answer 70

Acrocyanosis Dissapears after few days/hours after birth

Answer 71

transposition of the great vessels, tetralogy of Fallot, tricuspid atresia, a severe septal defect, or severe pulmonic stenosis

Answer 72

pure pulmonic stenosis, Eisenmenger complex, tetralogy of Fallot, or large septal defects

Answer 73

Innocent - transition from fetal to pulmonic circulation

Answer 74

infant’s liver may enlarge before there is any suggestion of moisture in the lungs, and that the left lobe of the liver may be more distinctly enlarged than the right

Answer 75

**DESCRIPTION** Bacterial infection of the endothelial layer of the heart and valves **PATHOPHYSIOLOGY** Individuals with valvular defects, congenital or acquired, and those who use intravenous drugs are particularly susceptible **SUBJECTIVE** Fever, fatigue Murmur Sudden onset of congestive heart failure **OBJECTIVE** ``` Signs of neurologic dysfunctions Janeway lesion (small erythematous or hemorrhagic macules appearing on the palms and soles) Osler nodes (appear on the tips of fingers or toes and are caused by septic emboli) ```

Answer 76

**DESCRIPTION** Heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary or systemic circulation **PATHOPHYSIOLOGY** Decreased cardiac output causes decreased blood flow to the tissues May be left or right sided Left sided is characterized as systolic or diastolic Diastolic CHF is result of advanced glycation cross-linking collagen and creating a stiff ventricle unable to dilate actively Diastolic CHF occurs in older adults whose tissue is exposed to glucose for a longer period of time and in individuals with diabetes mellitus **SUBJECTIVE** Fatigue Orthopnea Breath difficulty, shortness of breath Edema **OBJECTIVE** Symptoms can develop gradually or suddenly with acute pulmonary edema Systolic CHF has a narrow pulse pressure Diastolic CHF has a wide pulse pressure

Answer 77

**DESCRIPTION** Sudden inflammation of the pericardium **PATHOPHYSIOLOGY** If persists the pericardial effusion may increase and result in cardiac tamponade **SUBJECTIVE** Initially, chest pain is sharp or stabbing Movement or inspiration may aggravate the pain Pain may be most severe when supine, relieved when leaning forward **OBJECTIVE** Scratchy, grating, triphasic friction rub on ascultation, comprises ventricular systole, early diastolic ventricular filling, and late diastolic atrial systole Easily heard just left of the sternum in third and fourth intercostal spaces

Answer 78

**DESCRIPTION** Excessive accumulation of effused fluids or blood between the pericardium **PATHOPHYSIOLOGY** Seriously constrains cardiac relaxation, impairing access of blood to the right heart Common causes: pericarditis, malignancy, aortic dissection, and trauma **SUBJECTIVE DATA** Anxiety, restlessness Chest pain Difficulty breathing Discomfort, sometimes relieved by sitting upright or leaning forward Syncope, light-headedness Pale, gray, or blue skin Palpitations Rapid breathing Swelling of the abdomen or arms or neck veins **OBJECTIVE** Beck’s triad (jugular venous distention, hypotension, and muffled heart sounds) Chronically and severely involved pericardium may also scar and constrict, limiting cardiac filling; heart sounds are muffled, blood pressure drops, the pulse becomes weakened and rapid, and paradoxic pulse becomes exaggerated

Answer 79

**DESCRIPTION** Enlargement of the right ventricle secondary to pulmonary malfunction **PATHOPHYSIOLOGY** Usually chronic, occasionally acute Chronic common cause: chronic obstructive pulmonary disease (COPD) Acute causes: massive pulmonary embolism and acute respiratory distress syndrome (ARDS) Results from chronic pulmonary disease; alterations in pulmonary circulation leads to pulmonary arterial hypertension, which imposes a mechanical load on right ventricular emptying **SUBJECTIVE** Fatigue Tachypnea Exertional dyspnea Cough, hemoptysis **OBJECTIVE** Evidence of pulmonary disease Wheezes and crackles on auscultation Increase in chest diameter Labored respiratory efforts with chest wall retractions Distended neck veins with prominent A or V waves Cyanosis Left parasternal systolic heave Loud S2 exaggerated in the pulmonic region

Answer 80

**DESCRIPTION** Ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium **PATHOPHYSIOLOGY** Most commonly affects left ventricle Atherosclerosis and thrombosis are the common underlying causes **SUBJECTIVE** Deep substernal or visceral pain that often radiates to the jaw, neck, and left arm Discomfort may be mild, especially in older adults or patients with diabetes mellitus **OBJECTIVE** Dysrhythmias are common S4 is usually present Distant heart sounds Soft, systolic, blowing apical murmur Thready pulse Blood pressure varies, although Video/Animation hypertension is usual in the early phases

Answer 81

**DESCRIPTION** Focal or diffuse inflammation of the myocardium **PATHOPHYSIOLOGY** Results from infectious agents, toxins, or autoimmune diseases such as amyloidosis **SUBJECTIVE** Initial symptoms vague Fatigue Dyspnea Fever Palpitations **OBJECTIVE** Cardiac enlargement Murmurs Gallop rhythms Tachycardia Dysrhythmias Pulsus alternans

Answer 82

CANADA * *C Cardiac:** valve stenosis, Stokes-Adams attacks, other conduction disturbances * *A Arteriovenous:** “steal” syndromes * *N Nervous:** psychologic, autonomic, vagal, coughing * *A Anemia**, altered blood (CO) * *D Drugs**, diabetes, alcohol, poisons * *A Altitude**, acute fevers

Answer 83

**DESCRIPTION** Conduction disturbances either proximal to the bundle of His or diffusely throughout the conduction system **PATHOPHYSIOLOGY** May result from a variety of causes: ischemic, infiltrative, or, rarely, neoplastic Antidepressant drugs, digitalis, quinidine, and many other medications can be precipitating factors **SUBJECTIVE** Transient weakness Syncope Cardiac syncope may occur acutely without warning; sometimes diminished sensibility, a “gray-out” instead of a “black-out,” may precede the event Strokelike episodes Rapid or irregular heartbeat **OBJECTIVE** Labile heart rates Rhythm disturbances

Answer 84

**DESCRIPTION** Four cardiac defects: ventricular septal defect, pulmonic stenosis, dextroposition of the aorta, and right ventricular hypertrophy **PATHOPHYSIOLOGY** Surgical correction is recommended, currently initiated after the first “spell" **SUBJECTIVE** Dyspnea with feeding, poor growth, exercise intolerance Paroxysmal dyspnea with loss of consciousness and central cyanosis (tetralogy spell) **OBJECTIVE** Parasternal heave and precordial prominence, systolic ejection murmur over the third intercostal space, sometimes radiating to the left side of the neck; a single S2 is heard (Fig. 14-24) Older children develop clubbing of fingers and toes

Answer 85

**DESCRIPTION** Opening between the left and right ventricles **PATHOPHYSIOLOGY** Significant number (30% to 50%) of small defects close spontaneously, during the first 2 years of life **SUBJECTIVE** Recurrent respiratory infections If large VSD, rapid breathing, poor growth, symptoms of congestive heart failure **OBJECTIVE** Arterial pulse is small, and jugular venous pulse is unaffected Holosystolic murmur, often loud, coarse, high-pitched, and best heard along the left sternal border in the third to fifth intercostal spaces Distinct lift is often discernible along left sternal border and the apical area A smaller defect causes a louder murmur and a more easily felt thrill than a large one

Answer 86

**DESCRIPTION** Failure of the ductus arteriosus to close after birth **PATHOPHYSIOLOGY** Blood flows through the ductus during systole and diastole, increasing pressure in the pulmonary circulation and consequently workload of the right ventricle **SUBJECTIVE** Small shunt can be asymptomatic; a larger one causes dyspnea on exertion **OBJECTIVE** Dilated and pulsatile neck vessels Wide pulse pressure Harsh, loud, continuous murmur heard at the first to third intercostal spaces and the lower sternal border, with a machine-like quality Murmur is usually unaltered by postural change, unlike murmur of a venous hum

Answer 87

**DESCRIPTION** Congenital defect in the septum dividing the left and right atria **SUBJECTIVE DATA** Often asymptomatic Heart failure rarely occurs in children but can often occur in adults **OBJECTIVE** Diamond-shaped systolic ejection murmur often loud, high pitched, and harsh, heard over the pulmonic area May be accompanied by a brief, rumbling, early diastolic murmur Does not usually radiate beyond the precordium Systolic thrill may be felt over the area of the murmur, along with a palpable parasternal thrust S2 may be widely split Sometimes murmur may not sound particularly impressive, especially in overweight children; if there is a palpable thrust and radiation to the back, it is more apt to be significant

Answer 88

**DESCRIPTION** Systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection **PATHOPHYSIOLOGY** Characterized by a variety of major and minor manifestations May result in serious cardiac valvular involvement of mitral or aortic valve; tricuspid and pulmonic are not often affected Affected valve becomes stenotic and regurgitant Children between 5 and 15 years of age are most commonly affected Prevention—adequate treatment for streptococcal pharyngitis or skin infections—is the best therapy **SUBJECTIVE** Fever Inflamed swollen joints Flat or slightly raised, painless rash with pink margins with pale centers and a ragged edge (erythema marginatum) Aimless jerky movements (Sydenham chorea or St. Vitus dance) Small, painless nodules beneath the skin Chest pain Palpitations Fatigue Shortness of breath **OBJECTIVE** Murmurs of mitral regurgitation and aortic insufficiency Cardiomegaly Friction rub of pericarditis Congestive heart failure

Answer 89

Carditis, Polyarthiritis, Chorea, Erythema maginatum, Subcutaneus Nodules Fever, Arthalgia, Preious RF, Acute Phase Reaction, Prolonged PR

Answer 90

**DESCRIPTION** Condition causing inflammation in walls of small and medium-sized arteries throughout the body, including coronaryn arteries **PATHOPHYSIOLOGY** Named after Dr. Tomisaku Kawasaki, the physician who first identified the disease in 1967 Also called mucocutaneous lymph node syndrome because it also affects lymph nodes, skin, and mucous membranes Frequently (80% of the time) affects infants and children under 5 years of age **SUBJECTIVE** High fever, lasting longer than 5 days Conjunctivitis Cracked, red, and inflamed lips Strawberry tongue, white coating on tongue or prominent papillae on the back of the tongue Cervical lymphadenopathy Erythema of the palms of the hands and soles of the feet Joint pain (arthralgia) and swelling, frequently symmetric Irritability Tachycardia **OBJECTIVE** Diagnosis is usually made based on the patient having most of the classic symptoms

Answer 91

Fever of at least 5 days’ duration together with four of the following five findings: • Painless bulbar conjunctival injection without exudate • Changes in extremities including erythema, edema, and desquamation • Polymorphous (macular, morbilliform, or target lesions) erythematous rash of the trunk and extremities. • Changes in the lips and oral cavity including diffuse oral or pharyngeal mucosal erythema; erythematous, dry/fissured, or swollen lips; red “strawberry” tongue • Cervical lymphadenopathy (≥1.5 cm in diameter), usually unilateral

Answer 92

**DESCRIPTION** Caused by deposition of cholesterol, other lipids, and by a complex nflammatory process **PATHOPHYSIOLOGY** Leads to vascular wall thickening and narrowing of the lumen **SUBJECTIVE DATA** May be asymptomatic Angina pectoris, shortness of breath, palpitations Family history of close relatives with atherosclerotic disease, early death, or dyslipidemia **OBJECTIVE** Dysrhythmias and congestive heart failure

Answer 93

**DESCRIPTION** Abnormal leaking of blood through the mitral valve, from left ventricle into left atrium **SUBJECTIVE** Acute mitral regurgitation has symptoms of decompensated congestive heart failure Shortness of breath Pulmonary edema Orthopnea Paroxysmal nocturnal dyspnea Decreased exercise tolerance Chronic compensated mitral regurgitation may be asymptomatic Patients may be sensitive to small shifts in intravascular volume and are prone to develop congestive heart failure **OBJECTIVE** High-pitched pansystolic murmur radiating to axilla May also have a third heart sound

Answer 94

**DESCRIPTION** Pain caused by myocardial ischemia **PATHOPHSYIOLOGY** Occurs when myocardial oxygen demand exceeds supply Can be recurrent or present as initial incidence **SUBJECTIVE** Substernal pain or intense pressure radiating to the neck; jaws; and arms, particularly the left Often accompanied by shortness of breath, fatigue, diaphoresis, faintness, and syncope **OBJECTIVE DATA** No definitive examination findings suggest angina Tachycardia, tachypnea, hypertension, and/or diaphoresis Ischemia may lead to presence of crackles due to pulmonary edema or a reduction in the S1 intensity or an S4 Physical examination may suggest other comorbidities that place the patient at higher risk for anginal symptoms, such as COPD, xanthelasma, hypertension, evidence of peripheral arterial disease, abnormal pulsations on palpation over precordium, murmurs or arrhythmias

Answer 95

**DESCRIPTION** Amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart **PATHOPHYSIOLOGY** Heart contractility may be reduced Causes heart failure **SUBJECTIVE** Palpitations, lower extremity edema, fatigue, reduced activity tolerance **OBJECTIVE** Pleural effusion Arrhythmia Lower extremity edema Dilated neck veins Hepatomegally or ascites Electrocardiography or echocardiography shows small, thickened left ventricle; right ventricle may also be thickened

Answer 96

**DESCRIPTION** Thickening and calcification of aortic valves **SUBJECTIVE** Does not usually cause symptoms **OBJECTIVE** Midsystolic (ejection) murmur

Mosby 14 Flashcards

(139 cards)