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105 Cards in this Set

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chest pain: precise local tenderness to touch, pressure and percussion
superficial chest pain
chest pain: intensified or related to thoracic movement
pleuritic
chest pain: sharp or stabbing pain that is localized precisely
pleuritic
chest pain: depe to sternum or vaguely placed within center of chest
deep
causes of superficial chest pain
disorders of the skin, subcutaneous or nerves
causes of pleuritic chest pain
disorders of ribs, costal cartilage, intercostal structures or parietal pleura
strangling chest pain that feels like heaviness or squeezing
angina
chest pain that is precipitated by activity, relieved by rest/nitroglycerin
angina
what diagnosis of chest pain is made by assessment of the patient's history?
angina
chest pain at rest, night or regular times of the day without exercise?
variant angina
chest pain that is caused by spasms of the coronary artery
variant angina
how do you make the diagnosis of MI?
ECG and serum enzyme patterns
how do you make the diagnosis of angina?
it is a clinical diagnosis based on the patients history
chest pain: deep continous chest discomfort that is made worse by moving
pericarditis
sudden onset of excruciating chest pain that has a tearing quality often felt on the back
aortic dissection
what is the most common cause of retrosternal discomfort?
esophageal pain
chest pain: burning quality that is induced by lifting, stooping, bending or lying down
esophageal pain
chest pain that is induced by offending food (italian sausage pizza with extra peppers) and reliefed by antacids, belching or nitroglycerin
esophageal pain
chest pain in younger individuals that is in the left pectoral region, associated with palpitations and fears of cardiac diseases in the patient
anxiety
chest pain: sharp or stabbing pain that is fleeting that is associated with stress
anxiety
can chest pain that is ischemic in origin be pointed to a specific area?
no
what is the most common cardiac symptom?
dyspnea
what is the mechanism of cardiac dyspnea?
increased lung stiffness (decreased compliance) due to increased plmonary intersitial fluid. L CHF
what is paroxysmal nocturnal dyspnea?
sudden onset of dyspnea hours after assuming recumbent position that subsides after sitting up right
sudden onset of dyspnea hours after assuming recumbent position that subsides after sitting up right
paroxysmal nocturnal dyspnea
sudden dyspnea that occurs right after lying down
orthopnea
what are the causes of PND?
L ventricular dysfunction or CHF
what are the causes of orthopnea?
L CHF
subjective awareness of cardiac activity - 'heart skips a beat'
palpitations
what information should be obtained from a patient with palpitations?
sense of heart rate and rhythm (slow, fast, regular, irregular) and associated symptoms: anxiety, excitement, smoking, EtOH, meds, drugs; relieving factors
sudden temporary loss of consciousness
syncope
define vascular syncope
temporary loss of cerebral perfusion - common faint occurs with pt upright lack of perfusion caused by decreased TPR, no musclar activity, shock, dehydration etc
what is the most common type of syncope?
vascular
define cardiac syncope
decreased CO or can't increase CO enough to meet demands; due to dysrhythmias; not postural
what type of syncope is associated with effort?
cardiac - that is an ominous sign
what is claudication
aching, cramping or painful sensation in muscles of extremities associated with activity due to skeletal muscle ischemia (like angina)
which type of edema is associated with cardiac issues?
pitting edema
what are 4 causes of edema?
CHF, hepatic/renal disease, malnutrition/malabsorption, local venous/lyphatic disease
what is the most likely cause of single extremity edema?
local venous/lymphatic disease - increased local hydrostatic pressure
what are 3 things that carotid pulses tell us?
assess potential abnormalities or cerebral blood supply, it provides an index to timing of cardiac cycle events, wave forms aid in cardiac diagnosis
what is the upstroke of the carotid pulses simultaneous with?
the first heart sound
what is the strenght of the carotid pulse dependent on?
strength of the pulse is dependent on pulse pressure which is the difference between systolic and diastolic pressures
what do the jugular pulse pressures allows to obtain information on?
gives us information on preload and right ventricular function
how do you distinguish the arterial from venous pulse in the neck?
venous is more undulant and displays more than one impulse per cardiac cycle, it is affected more by respiration and by patient position and is generally not palpable
which vein - internal or external jugular should be used to look at jugular pulse?
internal - external has valves that alters pulse wave patterns
what does venous pressure estimation give us information about?
provides information about venous return to the right atrium
what is the zero point when estimating venous pressure?
right atrium is the true zero reference, the sternal angle of Louis is the clinical zero point
what is normal venous pressure?
7-9 cm
what does low venous pressure suggest?
reduced venous return (hypovolemia)
what does high venous pressure suggest?
volume overload or obstruction to venous emptying or impedance to atrial emptying
what is the a wave of venous pulse?
atrial systole right before S1 = produced by atrial contraction, coincident with atrial systole just before the carotid pulse
should the a wave be larger or smaller than the v wave?
larger
what is the v wave of venous pulse?
atrial filling = venous distension coincident with filling the atrium during systole just before the tricuspid opens
what is a giant a wave?
giant a waves suggest the right atrium is contracting against increased resistance or right atrial pressure is elevated (tricuspid stenosis, pulmonic stenosis, R ventricular hypertrophy, pulmonary hypertension)
what is a large regurgitant v wave?
regurge of blood from the right ventricle to the right atrium during systole - tricuspid valve incompetence
what type of venous wave pulse would be seen with tricuspid stenosis?
giant a wave
what type of venous wave pulse would be seen with pulmonic stenosis?
giant a wave
what type of venous wave pulse would be seen with right ventricular hypertrophy?
giant a wave
what type of venous wave pulse would be seen with pulmonary hypertension?
giant a wave
what type of venous wave pulse would be seen with tricuspid vlave incompetence (regurge)?
large regurgitant v wave
what type of venous wave pulse would be seen with arrhythmias with loss of coordination between atria and ventricule systoles?
cannon waves
what is a cannon save?
a large a wave due to atrial systole at the same time as ventricular systole (pressure against closed tricuspid valve), not regular like giant a waves but irregular due to dyssynchrony of atrial and ventricular systoles
what is kussmaul sign?
an inspriatory increase in venous pressur or filling (normally with inspiration there is a fall in pressure)
kussmaul signs are clues to what 3 disease states?
kussmaul signs are indicative of constrictive pericarditis, pericardial tamponade and severe heart failure
what is the hepatojugular reflux?
pressure on RUQ causes filling of nect viens when the patient is supine
what does a depatojugular reflux indicate?
reflux of venous blood from hepatic and mesenteric venous systems
what is parvus et tardus?
a low amplitude small volume, late upstroke carotid pulse associated with aortic stenosis
what is parvus et tardus associated with?
aortic stenosis
what is bisferiens in regards to carotid pulse?
a carotid pulse with two points seen in aortic regurg, hypertrophic and obstructive cardiomyopathy
when is a carotid pulse that is bisferiens seens?
in aortic regurg, hypertrophic and obstructive cardiomyopathy
what is S1 associated with?
mitral and tricuspid valves closure, apical impulse
where is S1 loudest?
at the apex
what causes S2?
aortic and pulmonary valves closing
where is S2 loudest?
at the base
is S2 normally split?
yes - the split is normally increased on inspiration
what is S3 caused by?
early diastole = ventricular failure
where is S3 best heard?
best heard with the bell at the apex
what is S4 due to?
late diastole - ventricular pressure or compliance problems, HTN, aortic stenosis, MI
when are clicks heard?
systole
what is a mid systolic click caused by?
mitral prolapse
when are snaps heard?
diastole
what are snaps associated with?
mitral stenosis
what are the two types of systolic murmurs?
regurgitant and ejection
what is a systolic regurgitant murmur caused by?
backward flow across the AV valve ro across the chamber
murmur: plateau, holosystolic, blowing (high frequency)
systolic regurgitation
what is a systolic ejection murmur caused by?
forward flow from one high pressure system to another
murmur: systolic, crescendo-decresendo, diamond shpaed, harsh, intensity peaks at greatest flow
systolic ejection murmur
what are the 2 diastolic murmurs?
early and late - always PATHOLOGICAL!
what causes a early diastolic murmur?
backflow from the great vessels to the ventricules
how can early diastolic murmurs be heard best?
with the patient seated and leaning forward - they are soft
murmur: diastolic, decrescendo, high frequency (blowing)
early diastolic murmur
what causes late diastolic murmurs?
flow from one low pressure area to another
how can late diastolic murmurs be heard best?
with the bell at the apex
mumur: diastolic, rumbling (low frequency)
late diastolic murmur
what causes continous murmurs?
PDA or AV fistula, they continue thorughout systole and diastole sometimes called 'machine murmurs'
which murmurs are heard loudest at the apex?
regurgitant murmurs (with S3) and late diastolic murmurs
which murmurs are heard loudest at the base?
ejection murmurs and early diastolic murmurs
what ejection murmur at the base of the heart radiates to the carotids?
aortic stenosis
what murmur at the apex of the heart radiates to the axilla?
mitral regurg
sustained apical impulse, S4, paradoxically split S2 (only sometimes), ejection murmur at the base that radiates to the carotids?
aortic stenosis
lateral apical impulse, S3, holosystolic murmur at the apex that radiates to the axilla
mitral regurg
wide pulse pressure - bisferiens, lateral apical impulse, S3, diastolic decrescendo murmur at base
aortic insufficiency
increased jugular pressure, diastolic snap and diastolic rumbling at the apex
mitral stenosis
what is paradoxical S2 splitting?
splitting decreases with inspriation
what is fixed splitting of S2?
wide split that is not affected by respiration - seen in atrial septial defects