Slide set 3 Flashcards
(134 cards)
1
Q
What sequence do you use to perform a heart exam
A
1-Inspection, 2-Palpation, 3-Auscultation
2
Q
Skin inspection ABNLs
A
Cyanosis, Pallor, Edema, Clubbing
3
Q
NL chest shape is
A
2:1 - wider:deep
4
Q
ABNLs of the chest (5)
A
Pectus Excavatum Pectus Carinatum Barrel Chest
Thoracic kyphoscoliosis
Traumatic flai chest
5
Q
Pectus excavatum charcteristics
A
AKA funnel chest Lower sternum is depressed Compresses heart/great vessels - causing murmurs
6
Q
Pectus Carinatum characteristics
A
AKA Pigeon chest Sternum displaced anteriorly (increases A-P dia) Costal cartilage is depressed
7
Q
What condition is associated with barrel chest
A
Aging COPD
8
Q
Peripheral cyanosis represents what area
A
Extremities
9
Q
Central cyanosis represents what area
A
Chest and mouth
10
Q
Central cyanosis is involved with
A
R to L cardiac/pulmonary shunting
11
Q
Pts with central cyanosis likely to have (2)
A
Hypoxemia and erythrocytosis
12
Q
What D/O’s cause shunting
A
VSD, ASD, Pulm HTN, COPD, Congenital heart DZ in PEDS
13
Q
Central cyanosis hypoxemia means
A
Deoxy blood is being circulated thru body
14
Q
Pallor usually suggests
A
Inadequate Hgb
15
Q
Best places to observe pallor (4)
A
Conjunctival vessels, lips, mucous membranes
16
Q
Cardiogenic edema is usually
A
Bilateral and due to CHF esp. RHF
17
Q
Where is clubbing typically seen
A
Congenital heart diseases
18
Q
Palpate these (4)
A
JVP, BP, Pulses, PMI
19
Q
JVP measurement assess
A
R sided heart fx (cnt tell if there is A-fib or stenosis)
20
Q
JVP height is represents
A
Right atria pressure = Central venous pressure
21
Q
NL JVP at highest site of pulsation is
A
less than or equal to 9cm to RA or 0-4cm to sternal angle
22
Q
Where is the sternal angle in relation to right atrium
A
5cm above RA
23
Q
JVD is
A
Persistant distention of internal (external sometimes) jugular veins
24
Q
JVD is usually asscoaited with
A
Volume overload states like CHF
25
If you cant see this neck BV but can palpate it its
Carotid artery
26
If you can see it this neck BV but cant palpate its
Ext jugular vein
27
Distinguish JVP from carotid pulses
JVP fills from above, moves on inspiration, changes with posture
28
Wave forms of JVP (5)
A, C, V, X, Y
29
A wave corresponds to
RA pressure rise in Atrial contract, before S1 sound
30
A waves are absent in
A-fib
31
X descent corresponds to
Atrial relaxation - R vent contracts pullin RA down
32
X wave may be absent in
Severe tricuspid regurgitation, A-fib, R atrial ischemia
33
C wave represents
Tricuspid valve bowing into RA
34
V wave represents
After systole - venous pressure returns increasing atrial pressure
35
V wave is seen with
Severe tricuspid regurgitation, RVF, restrictive cardiomyopathy
36
Y descent represents
Reduced pressure with tricuspid opening - emptying RA during diastole
37
Factors impairing atrial emptying effect what waves
A and Y descent waves
38
Waves A and C represent what heart sound
S1
39
Wave V represents what heart sound
S2
40
Generally what causes increased pressures in RA
Increased Volume and Resistance/compliance conditions
41
Conditions increasing A waves
Conditions with increased resistance such as RVH, Pulm HTN, Complete heart block
42
Prominent X descent observed in what conditions
Constrictive pericarditis and tamponade
43
Kussmauls sign suggests
Impaired filling of right ventricle due to either fluid in pericardial space or uncompliant myocardium/pericardium
44
Kussmauls causes JVP to
Rise with inspiration
45
Hepato-jugular reflex concept with a pt having R-sided dysfx
Applying pressure to liver increases CVP, thus increasing RA pressure, and increasing JVP wave form intensity
46
BP symmetry includes taking BP where
L vs R and arms vs legs
47
Pulse pressure is
Difference between Systolic and Diastolic arterial pressure
48
Increased pulse pressure typically seen in
Aortic regurgitation or conditions increasing stroke volume or contractility
49
Narrowed pulse pressure typically seen in
Hypovolemia, severe LVF or severe mitral stenosis
50
Conditions that increase stroke volume
Anemia, thyrotoxicosis, arteriovenous fistulas
51
Full pulse exam includes (7)
Carotids Brachial Radialis
52
Purposes of palpating a pulse
Patency and LV contraction intensity
53
What pulse most accurately reflects aortic pulse
Carotid pulse
54
Exam each pulse for these 5 things
Rate, Rhythm, Strength, Contour, Symmetry
55
Normal pulse is characterized by
Rapid rise, short plateau, gradual descent
56
Dicrotic notch represents
A secondary upstroke of the aortic valve closure
57
ABNL pulses (6)
Hypokinetic Hyperkinetic Bisferiens pulse
Pulses Alternans
Pulses parvus et Tardus
Pulses Pradoxus
58
Hypokinetic pulse is related to
Decreased rate of 1.LV pressure development 2.LV SV
59
Hyperkinteic pulse is related to
Increased rate of 1.LV pressure development 2.Large LV SV with decreased peripheral resistance
60
Bisferiens pulse is
Pulse with two palpaable beats during systole
61
Bisferiens pulse is seen in
HOCM Aortic Stenosis and insufficiency Rapid ejection of an increased SV
62
Rapid ejection of an increased SV is related to
Exercise, Fever, PDA
63
Pulsus Alternans is
Variation of amplitude in alternate beats due to changing systolic pressures
64
Pulsus Alternans is seen in
Severely depressed cardiac function conditions
65
Pulsus Alternans can be confirmed by
Measuring the BP
66
Pulsus Pravus et Tardus is
Pulse with slow increase of pressure that is late and small in intensity
67
Pulsus Pravus et Tardus is associated w/
Aortic Stenosis
68
Pulsus paradoxus is
BP drops >10mmHg during inspiration
69
Pulsus paradoxus can be seen in
Cardiac Tamponade and others
70
PMI is palpated by
Having pt supine or in left lateral position and with hand over pts left lower chest wall
71
A NL PMI represents
the apex of the heart in the 4-5th ICS on MCL
72
What happens to PMI with LV hypertrophy
Lateral displacement
73
What two etiologies cause PMI displacement
Volume over load due to Cardiac Dilation Pressure overload due to Ventricular hypertrophy
74
Volume overload causes what type of PMI impulse
Hyperdynamic
75
Pressure overload causes what type of PMI impulse
Sustained apical impulse
76
What valvular pathologies cause cardiac dilation
AR and MR
77
What conditions cause hypertrophy
HTN and AS
78
Thrills represent
A palpable murmur
79
What grade is a palpable murmur usually
Grade IV to VI
80
Heave or lift is associated with
Large ventricle or HF
81
What positions for asuculatations (3)
Sitting, Supine, Left lateral
82
In what order are the concerns for auscultation
1. NL heart sounds 2.ABNL heart sounds (S3, S4, clicks, snaps. 3.Murmurs
83
S1 sound is produced by
MTV closure
84
S1 is best heard where
Apex
85
S1 represents what phase
Beginning of systole
86
An increased S1 could mean
Shortened PR interval Mild Mitral stenosis High cardica output states (tachycardia)
87
A decreased S1 could mean
Prolonged PR interval (1st degree AV block) Mitral regurgitation Severe mitral stenosis Stiff Left ventricle
88
S2 sound is produced by
APV closure
89
S2 is best heard where
A2 - R 2nd ICS P2 - L 2nd ICS
90
Is A2 or P2 more intense?
A2
91
During S2 splitting which valve closes first?
A2
92
Variable widened S2 splitting during expiration and inspiration is caused by
R-BBB and Pulmonic Stenosis (sound intensity decreased
93
Fixed splitting of S2 that persists during expiration and inspiration is cause by
ASD
94
Paradoxical S2 splitting is when
A2 closes before P2
95
Paradoxical S2 splitting is caused by
L-BBB Aortic stenosis (decreased A2 intensity) Chronic HTN (increased A2)
96
S3 is also known as
Ventrical gallop (Slosh-ing-in S123)
97
S3 is best heard at
the cardiac apex in the left lateral decubitus
98
S3 intensity can be increased by
Increasing venous return (leg raise) Increasing arterial pressure/CO (handgrip)
99
S3 could mean dysfx of what
Ventricular dysfx esp >40yo
100
S4 is also known as
Atrial Gallop (A-stiff-wall S412)
101
S4 is best heard at
Cardiac apex
102
S4 is due to
Active atrial filling against a stiff noncompliant ventricle usually related to LVH
103
What causes LVH (4)
Chronic HTN Aortic Stenosis Hyertrophic cardiomyopathy
104
Opening snap occurs when
Early diastolic
105
Opening snap sounds like
A high pitched sound
106
Opening snap heard best where
Between the APEX and LSB
107
Opening snap is most commonly due to
Mitral Stenosis
108
What does it mean when A2 and OS interval is shortened
Worsening Mitral stenosis
109
Ejection clicks occurs when
Early to mid-systolic phase
110
Ejection clicks sounds like
Sharp high pitched sound
111
Early Ejection clicks due to
Stenotic valve reaches its macimum degree of opening (AS & PS & Pulm HTN)
112
Mid-systolic Ejection clicks due to
Sudden opening/regurgitation of MV or TV
113
Murmurs are defined as
Auditory vibrations due to turbulent blood flow
114
Murmurs are due to 1 of 2 things
ABNL blood flow across normal cardiac structure Normal blood flow across ABNL cardiac structure
115
Which type of murmur is almost always pathologic
Diastolic murmurs
116
Can systolic murmurs be pathologic or benign?
Yes
117
Describing a murmur (5)
Duration/timing Location Intensity
Pitch
Shape
118
Murmur pitch refers to
Frequency of the sound
119
A high frequency murmur suggests
Increased velocity of turbulent blood flow
120
A low freq murmur suggests
Reduced velocity of turbulent blood flow
121
Crescendo murmur described as
Building in intenstiy
122
Decrescendo murmur described as
Reducing intensity
123
Examples of a decrescendo murmur
Early diastolic murmur of aortic regurg
124
Crescendo-decrescendo is
“diamond-shaped” murmur of aortic stenosis
125
Holosystolic/pansystolic means
Unchanged character throughout murmur
126
MC Holosystolic/pansystolic are due to
Mitral regurgitation
127
Special manuevers are used to consider their effects on what?
Preload and Afterload
128
Preload is a function of venous return how?
Increased venous return equals increased preload Decreased venous return equals decreased preload
129
HOCM is an abbreviation for
Hypertrophic obstructive cardiomyopathy
130
HOCM is the exception to the rato of blood volume:murmur intensity rule- what is HCM more affected by?
Pressure gradient across the valve
131
Afterload is a function of systemic vascular resistance how?
Increased SVR equals increased afterload Decreased SVR equals decreased afterload
132
Systemic vascular resistance essentially means
BP of the aorta
133
Afterload exacerbates what type of murmur?
Regurgitant murmurs and reduces stenotic murmurs
134
Loud or diastolic murmurs are pathologic in nature usually?
Yes
