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74 Cards in this Set
- Front
- Back
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Sx: Cardiomyopathy?
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Murmur (S3, S4)
Dyspnea, Cough, Crackles Jugular distention Dependent pitting edema Fatigue |
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Sx: Cardiac failure?
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SOB
Gallop rhythm - S3, S4 Dyspnea Moist cough, Crackles |
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DESCRIBE
Mitral valve prolapse |
Leaflets (1 or both) protruding into LEFT ATRIA
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ETIOLOGY?
Mitral valve prolapse |
Unknown etiology
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What test confirms mitral valve prolapse?
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ECG shows prolapse of mitral valve into LEFT ATRIUM
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What may cause mitral insufficiency (3)?
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- L. ventricular failure
- Mitral valve prolapse - Rheumatic fever |
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Dx: HTN?
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Serial blood pressure readings (2+):
- Systolic >140 - Diastolic >90 |
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Tests to Dx: Mitral Stenosis (3)?
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Cardiac Catherization:
- Diastolic pressure gradient across valve - Elevated L. ATRIAL and PULMONARY wedge pressures Echocardiography: - Thickened mitral valve EKG: - L atrial hypertrophy X-Ray: - Ventricular enlargement |
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Test to Dx: Aortic insufficiency (2)?
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Echocardiography:
- L. ventricular enlargement X-Ray: - L. ventricular enlargement - Pulmonary congestions |
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Sx: MI?
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- Crushing substernal pain (radiates to jaw and arms)
- Lasts longer than anginal pain - Not relieved by rest or nitroglycerin - Diaphoresis, pallor, arrhythmias *May also be asymptomatic |
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Tests to Dx: Angina?
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EKG (during acute pain):
- ST depression - T wave inversion |
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Sx: V-tach?
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- Chest pain
- Diaphoresis - Hypotension - Weak pulse - Dizziness - LOC possible |
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What EKG changes are noted with A-fib (5)?
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- Irregular atrial rhythm
- Rate >400/minue - Uniform QRS complex - Indiscernible PR internal - NO P waves |
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What causes Tricuspid Insufficiency (3)?
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- Endocarditis
- Rheumatic fever - Trauma |
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MECHANISM
Aortic Insufficiency? |
- Blood flow backs into L ventricle (diastole)
- Creating fluid overload in L atrium and pulmonary system |
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Sx: Tricuspid or Mitral Insufficiency (5)?
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- Angina
- Dysnpea - Fatigue - Orthopnea - Peripheral edema |
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MECHANISM:
Mitral Stenosis? |
- Obstructs blood flow from L. ATRIUM to L. VENTRICLE
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Sx: V-fib arrhythmias (3)?
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- Apnea
- Pulselessness - NO palpable BP |
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Tests to Dx: Tricuspid insufficiency?
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Echo:
- Systolic prolapse of tricuspid valve EKG: - R atrial/ventricaular hypertrophy X-Ray: - R atrial dilation - R ventricular enlargement |
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EKG changes noted with V-tach (4)?
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- Ventricular rate 140-220
- NO P waves - Wide/bizarre QRS complex - Starts/stops suddenly |
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Pathologic causes of aortic valve closing early (2)?
What is the ausculatory effect? |
- Mitral Regurgitation
- Right Bundle Branch Block (ASD) Split S2 |
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AORTIC STENOSIS
What are the 3 primary symptoms? |
- Syncope/dizzy spells w/ exertion
- Classic anginal chest pain (70% coronary artery ds) - Heart failure |
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PULMONARY STENOSIS
Dx findings (4)? |
- RVH (vs. LVH)
- Wide split S2 w/ diminished S2P - EC - Normal carotid |
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ASD
EKG findings (2)? |
- Right axis deviation
- Right bundle branch block (what is the effect on the aortic valve?) |
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High-pitched murmurs?
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- VSD
- Mitral Regurg - Tricuspid Regurg - Aortic Regurg |
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Mid-pitched murmurs?
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- Aortic Stenosis
- Pulmonic Stenosis |
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Decrescendo murmurs?
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- Aortic Regurg
- Mitral Regurg |
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AORTIC REGURGITATION
When does it occur? |
- Diastole
- After T, before P |
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MECHANISM:
SOB w/ LVH? |
- Increased pulmonary venous pressure
- Interstitial edema --> Stiff lung --> Dyspnea |
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HOLOSYSTOLOIC MURMURS
Associated clinical conditions (2)? |
- VSD
- Mitral Regur |
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Which is louder: A2 or P2?
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A2
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MECHANISM:
A2 |
- Inspiration
- A2 occurs earlier due to increased ejection of blood |
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MECHANISM:
P2 |
- Inspiration
- Occurs after A2 DUE TO... - Increased VR - Decreased pulmonary resistance THUS... - Slowing pulmonary valve closure |
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PULMONIC STENOSIS
What congenital, non-cyanotic defect may be present in an adult? |
Bicuspid aortic valve
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EJECTION CLICK
Where does it radiate to? |
"Mitral area" at the APEX
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How do you differentiate btw aortic stenosis and pulmonic stenosis?
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Aortic stenosis = LV hypertrophy
Pulmonic stenosis = RV hypertrophy |
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Does OS vary w/ respiration?
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No
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JVP MECHANISMS:
c wave? |
- Upward displacement of tricuspid valve into R. atrium
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MECHANISM:
Fixed S2 split |
- Greater output in RV vs LV
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What is typically heard w/ a L-R shunt?
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- Wide split S2
- Easily heard P2 |
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How is pericardial pain differ from ischemic chest pain?
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- Pleuritic in quality
- Varies w/ respiration and position |
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What is characteristic of ischemic chest pain?
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- Brought on by exertion
- Relieved by rest |
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What causes a stiff (non-compliant) LV (3)?
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- Ischemia
- Hypertrophy - Over distension |
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MITRAL STENOSIS with SINUS RHYTHM
Mechanism of presystolic accentuation murmur? |
- LA contraction forces blood through ABNORMAL mitral valve
- Produces an increasing gradient - Result = Crescendo presystolic murmur |
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EFFECT of VALSALVA
on Mitral Regurg? |
- Valsalva decreases VR to LV
- Decreased blood to LV = less blood is regurgitated - Murmur is quieter (may disappear) |
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What valvular lesion may present w/ syncope?
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Aortic stenosis
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AORTIC STENOSIS
What does it classically present with (3)? |
- Syncope
- SOB (CHF) - Angina-like chest pain |
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DESCRIBE:
Unstable Angina |
- Ischemic pain occurring at rest
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Angina pain vs. MI
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ANGINA
- Pain lasts 1-3 minutes; < 20 minutes - Relieved by nitroglycerin MI - Pain > 20 min - Onset of pain is NOT related to exertion (may awaken pt at night) *Pain is identical in character |
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What causes occasional large wave in the JVP?
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"Cannon" or Giant 'a' waves
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MECHANISM:
"Cannon" or giant waves? |
- R. atrium contracts against large resistance to flow
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MECHANISM:
Intermittent giant 'a' waves? |
AV DISSOCIATION
- R atrium contracts and tricuspid valves has been closed by ventricular contraction (Atrium and ventricle contract at same time; Tricuspid valve closed) |
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What disease states cause GIANT 'a' WAVES (2)?
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- Tricuspid stenosis
- Hugely hypertrophied RV |
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What disease state causes INTERMITTENT GIANT 'a' WAVES?
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V-tach (AV dissociation)
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AV DISSOCIATION:
Causes variation in what (2)? |
- S1 loudness
- Cannon 'a' waves |
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MITRAL STENOSIS
How does S1 vary? |
LOUD S1
due to... - Good contractility - Valve is held open b/c of pressure differential btw LA and LV |
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AORTIC REGURG
How does S1 vary? |
SOFT S1
due to... - Mitral valve closed when LV contraction beings - LV filled w/ blood from aortic regurg - LV pressure > LA pressure - - Thus, CLOSING valve BEFORE ventricular contraction begins |
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CHF
What is a common symptom of heart failure? |
- Fatigue (Low CO)
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What pathologic condition results in NO 'a' wave?
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A-fib
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CHF often causes what valve to leak?
What is the effect on the JVP? |
Tricuspid valve
- Results in tricuspid regurg 'V' Wave > 'A' wave - Tricuspid regurg fills the RV |
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CHF
Affects: RVH or LVH? |
RV
*May result in Tricuspid Regurg |
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Tests to Dx: V-tach?
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AV DISSOCIATION
- EKG - Bedside |
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V-TACH
EKG findings (3)? |
- P waves marching through tracing w/ no connection to ventricular depolarizations
- Fusion beats - Capture beats |
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MECHANISM:
CHF? |
- Fatigue is the most common symptoms
- Low CO - Inability to utilize F/S - CO cannot meet increased bodily O2 needs (exertion, muscular activity) - Muscles forced to use anaerobic metabolism (due to poor blood flow) - Anaerobic metabolic products = sensation of FATIGUE |
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HOLOSYSTOLIC MURMURS
Name 3 |
- Mitral Regurg
- Tricuspid Recurg - VSD |
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What commonly causes TRICUSPID REGURG?
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CHF
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MECHANISM:
S3? |
- Deceleration of rapid filling wave/blood (early diastolic filling) hitting the STIFF ventricular wall (due to over distention)
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S3
Think? |
- LV failure
- Stiff ventricle |
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S4
Think? |
Stiff ventricle
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S4
When is it normal? |
- Athletes
- Young children |
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S3
When is it normal? |
Young children and adults (< 30yrs)
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MECHANISM:
Increased JVP? |
- Increased pressures of RA
- Due to R heart failure |
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Dx: Tricuspid Regurg?
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'V' wave > 'A' wave
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MECHANISM:
Sternal lift? |
COMMONLY
- RV lift due to increased size/hypertrophy of RV RARELY - Mitral regurg - SO MUCH mitral regurg that heart is pushed forward, moving the sternum |
