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41 Cards in this Set

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What are the causes of dyspnea?
Orthopnea
Paraxysmol nocturnal dyspnea (PAD)
What is orthopnea?
Recumbent position reduces blood pooling and increases left ventricular blood volume

Patients need to sleep in an upright position.
What happens during Paroxysmal Nocturnal Disease?
Caused by increased venous return to the left ventricle increasing left ventricular pressure and causing pulmonary congestion
How can you differentiate between cardiac or pulmonary causes?
Chest X ray
What are anginal pain symptoms?
Pain in central location
Pain radiates to arm, neck, jaw
Pain is squeezing and or pressure.

Pain is exertional and reoccurs predictably at the same excercise level from day to day
Pain is relieved by rest or nitroglycerin
Pain can resemble heartburn
Pain is not prolonged
What are some symptoms for myocardial infarction?
Same in character as anginal pain but more prolonged

May not responsd to rest or nitrates

Other symptoms associated: dyspnea, nausea, diaphorises, syncope
What is Atypical chest pain?
Not consistent with angina
Pain associated with pulmonary disorders may be pleuretic
Chest pain may be reproduced by physical maneuvers (chest palpatations). Location and quality differ from angina.
GI pain (reflux or PUD: temporarily associated with food and with body position
Pain from anxiety or hyperventilation is often sharp and fleeting or prolonged and localized
Palpatations
aware of heartbeat
skipping, fluttering, pounding, racing
-tachycardia, premature contractions
Supraventricular tachycardia
Sudden onset and termination
Sinus tachycardia
gradual onset and termination
What are some palpatations without evidence of cardiac disease?
sinus tachycardia
supraventricular tachycardia (SVT
premature atrial/ventricular beats
What do you do with most patients who have SVT, sinus tachycardia or premature atrial/ventricular beats
Most patients only require reassurance.
SVT can by cured by radiofrequency ablation if necessary
What are 2 causes of syncope?
Syncope can be cardiac or neurological
What are main causes for syncope caused by cardiac reasons?
vasodepressor syncope (simple faint)
ventricular tachycardias
complete heart block
sick sinus syndrome
bradycardias
How can you determine if syncope is of cardiac origin?
Sudden onset without warning
Sensation of rapid heart action before syncope
Lack of aura or siezure activity
Effort syncope (left ventricular obstruction) - aortic stenosis
Vasodepressor syncope - often in young, ansious, dehydrated, upright - often has accompanying autonomic symptoms like sweating, nausea and yawning
What can cough with hemoptysis be associated with?
Pulmonary embolism

Mitral stenosis

Left ventricular failur
What kind of cough would you get from pulmonary vascular congestion from left ventricular failure or mitral stenosis?
The cough is usually dry
What kind of sputum is seenwith pulmonary edema?
Foamy whit sputum
What is the origin of cough?
It is of pulmonary origin and is accompanied by wheezing.
What kind of cough is associated with pulmonary embolism, mitral stenosis, left ventricular failure
Cough with hemoptysis
What is the most common cause of peripheral edema?
Venous insufficiency
What can a late ventricular failure signal?
It can signal right ventricular failure
What can accompany cardiac peripheral edema or right ventricular failure?
Elevated jugular venous pressure.

Heptatic congestion
If there is peripheral edema and no ventricular failure what can it indicate?
constrictive pericarditis
For cardiac peripheral edema what must you rule out first?
Noncardiac causes such as
-chronic renal failure
-hypoalbuminemia
What happens during peripheral cyanosis in the extremities?
It is decreased blood flow to skin (vasoconstriction)
It is transient and not associated with clubbing.
What happens during central cyanosis?
It is usually from abnormal saturation in pulmonary transit or right to left shunt.

Fingers and toes are often clubbed.
What are some characteristics of Marfan's Syndrome?
Striking height, excessively long extremities, sparse subcutaneous fat, longer hyperextensible fingers.
What common cardiac abnormalities are associated with Marfan's syndrome?
Marfan's is associated with cardiac abnormalities like
-aortic regurgitation
-aortic dilation
-aortic dissection
-mitral valve prolapse
What is the first heart sound?
It is the mitral then tricuspid valve closure then selent aortic and pulmonic valve opening.
What is the second heart sound?
It is the aortic then pulmonary valve closure
What happens to the second heart sound during inspiration?
Normally, this 2nd heart sound is split and widens upon inspiration.
What happens to the second heart sound during atrial septal defect (ASD)?
Normally it has a fixed split sound.
What is a paradoxic split?
A paradoxic split is when the aortic closure is prolonged until after pulmonary valve closure. So they are transposed.
What happens with a paradoxic split?
It widens during expiration.
When does a paradoxic split happen?
It happens during a
Left bundle branch block
Left ventricular hypertrophy
Ectopic beats originating in right ventricle.
Pacemaker beats originating in right ventricle.
Why does a third sound happen?
It happens when the chordae tense as blood distends the left ventricles during diastole.
In who does a third sound happen and when is it normal?
It happens in normal young adults
It also happens in older adults with left ventricular overload (AI, MR)
Poor left ventricular function (diastole)
When is a 4th sound caused?
A fourth sound is caused by atrial kick from atrial contraction as blood hits stiff noncompliant left ventricle.

Markedly decreased LV diastolic function
Moderately decreased diastolic function
Mitral stenosis
Bicupside aortic valve, mild AS, PS.
When can you hear a 4th sound?
A fourth sound can be heard during HTN, AS, HOCM (athletes sudden death). ischemia
When are systolic murmurs heard?
Early
Mid
Pansystolic
Late
Normal, bicuspid aortic valve, mild PS
AS, PS, HOCM
MR, TR, VSD
Mitral valve prolapse