N605 Cv

Front 1

PMI

Back 1

apical impulse, usually 5th ICS 7-9cm MSL

Displacement lateral to MCL =LVH
prominent PMI over xiphoid or epigastric area in RVH or COPD

Front 2

AV valves

Back 2

tricuspid and mitral

Front 3

semilunar valves

Back 3

aortic and pulmonic

Front 4

systole

Back 4

ventricular contraction, AV valves closed, SL valves open

Front 5

Diastole

Back 5

ventricular relaxatio, SL closed, AV valves open

Front 6

SI

Back 6

closure of mitral and tricuspid valves systole begins

does not fluctuate with respiration

Front 7

S2

Back 7

closure of aortic and pulmonic valves, diastole begins

inspiration increases R heart filling time

Front 8

S3

Back 8

rapid ventricular filling against stiff/non compliant ventricle

low EF?

Front 9

S4

Back 9

atrial contraction or kick, right before S1

stiff ventricle?

Front 10

Acute Coronary Syndrome

Back 10

acute myocardial ischemia=
-unstable angina
-NSTEMI
-STEMI

Front 11

acute aortic dissection

Back 11

anterior chest pain, often tearing or ripping and often radiating to back or neck

Front 12

sudden onset of dyspnea

Back 12

rule out PE, spontaneous pneumo, anxiety

Front 13

orthopnea

Back 13

dyspnea while lying down, improves with sitting and pillows

common in LHF or MVS or OLD

Front 14

proxysmal nocturnal dyspnea

Back 14

episodes of sudden dyspnea that awaken pt from sleep

Common with LHF, MVS mimics nocturnal asthma attacks

Front 15

prehypertension

Back 15

SBP 120-139
DBP 80-89

Front 16

stage 1 HTN

Back 16

SBP 140-159
DBP 90-99

warrants anti HTN medications

Front 17

stage II HTN

Back 17

SBP>160
DBP>100

Front 18

target BP for patients with DM or CKD metabolic syndrome

Back 18

<130/80

Front 19

Family HX of CHD screening

Back 19

male before 55 yo, and female before 65yo

first degree relative

Front 20

triglyceride identifier metabolic syndrome

Back 20

>150mg/dL

Front 21

HDL identifier metabolic syndrome

Back 21

< 40 men
< 50 women

Front 22

abdominal obesity identifier metabolic syndrome

Back 22

men >40in
women >35in

Front 23

lifestyle modification

Back 23

BMI 18.5-24.9
Na+ < 2.4g daily
minimal 30min cardio exercise
>3500 K+
Alcohol <2 drinks for men, <1 drink for women

Front 24

ideal cardiovascular health

Back 24

-total cholesterol <200,
-untreated BP less than 120/80
-fasting blood glucose <100
-BMI <25
nonsmoking
healthy diet
>150 min of exercise a week

Front 25

Metabolic syndrome

Back 25

cluster of risk factors that increase risk of CVD and diabetes

Front 26

elevated JVP

Back 26

increased left ventricular end diastolic pressure and low left ventricular EF, increases risk of death from HF

8-9cm is considered above normal

Front 27

carotid thrill or bruit

Back 27

indicated aortic stenosis or insufficiency

Front 28

pulsus alternans

Back 28

the rhythm of the pulse remains regular but the force alternated from strong and week ventricular contractions, indicates severe L-HF

Front 29

paradoxical pulse

Back 29

greater than normal drop in systolic pressure during inspiration, suspect pericardial tamponade

Front 30

diminished S1

Back 30

first degree HB

Front 31

diminished S2

Back 31

aortic stenosis

Front 32

murmurs that coincide with carotid upstroke

Back 32

systolic

Front 33

A/B index and values

Back 33

ankle brachial index= arterial ankly systolic/arterial brachial systolic
normal 1-1.4
above 1.4=calcified vessel
below 0.9= PAD
less than 0.5= severe PAD

Front 34

Grading of Murmur I-VI

Back 34

I faint hard to hear
II quiet
III moderately loud
IV loud
V very loud
VI heard without stethoscope

Front 35

diastolic murmur

Back 35

always pathologic

aortic regurgitation
pulmonary regurg
mitral stenosis
tricuspid stenosis (rare)

Front 36

systolic murmur

Back 36

aortic stenosis
pulmonic stenosis
mitral regurg
tricuspid regurg
hypertrophic cardiomyopathy

Front 37

left lateral position auscultation

Back 37

brings out left sided S3 and S4 and mitral murmurs

Front 38

bell auscultation

Back 38

S3 and S4 and murmur of mitral stenosis

Front 39

diaphragm ascultation

Back 39

S1 and S2, aortic and mitral regurg. and pericardial friction rubs

Front 40

midsystolic murmur

Back 40

begins after SI and before S2, blood flow across semi lunar valves

Front 41

pansystolic murmur

Back 41

starts with Si and stops at S2 gaps between murmur and heart sound

blood flow across av valves

Front 42

late systolic murmur

Back 42

starts mid to late systole and persist up to S2

mitral valve prolaps

Front 43

early diastolic murmur

Back 43

immediately after s2 without gap and fads

regurg flow across incomplete semi lunar valves

Front 44

middiastolic murmur

Back 44

start shortly after S2 may fade away or merge into late systolic murmur

turbulent flow across AV valves

Front 45

late diastolic murmur (presystolic)

Back 45

starts late diastole and continues up to S1

Front 46

continuous murmur

Back 46

starts in systole and continues without pause through S2

patent ductus arteriosis

Front 47

cresendo murmur

Back 47

grows louder
presystolic murmur of mitral stenosis

Front 48

decresendo murmur

Back 48

grows softer

early diastolic murmur of aortic regurg.

Front 49

crescendo decrescendo murmur

Back 49

first rises then falls

midsystolic murmur or aortic stenosis and innocent flow murmurs

Front 50

plateau murmur

Back 50

same intensity throughout

pansystolic murmur of mitral regurg

Front 51

grade 1 murmur

Back 51

very faint, only heard if listener tuned in

Front 52

grade 2 murmur

Back 52

quiet but heard immediately

Front 53

grade 3

Back 53

moderately loud

Front 54

grade 4

Back 54

loud with palpable thrill

Front 55

grade 5

Back 55

very loud wiht thrill, may be heard with stethoscope partially off chest

Front 56

grade 6

Back 56

heard with stethoscope off chest

Front 57

PULMONIC PALPITATION

Back 57

DURING EXHILATION INDICATES PHTN

Front 58

AORTIC PALPITATION

Back 58

PALPABLE S2 INDICATES HTN