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73 Cards in this Set
- Front
- Back
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Cardiac Common Symptoms
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-Pain
-Dyspnea -Palpitations |
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Impt. hx questions at beginning of exam
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RULE OUT SERIOUS FIRST
-look for Levine sign and patients with radiating pain down arm -I have an elephant on my chest |
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CC: Palpitations
-what are assoc symtpoms to a ask about |
SOB, lightheaded, dizzy, weak, fatigue
-describe pain(pounding, jumping, turning, fluttering, flopping, skipping) -look for symptoms related to low cardiac output (Systolic failure) |
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CC: dyspnea
-what are impt hx questions |
-constant or intermittent
-during activity or rest -pallativ/provocative factors -does it happen while lying down or at night? |
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CC: dyspnea
what are some common caused to think of in DDx |
-resp, distress, asthma, pneumonia, pneumothorax, pulmonary embolism , myocardial infarction, heart failure, aspiration of foreing body
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CC: orthopnea
what are causes |
-Left heart failure or obstructrive lung dz
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CC; Paroxysmal Noc Dyspnea (PND)
what are causes |
left heart failure, mitral stenosis or asthma
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CC: lightheaded or dizzy or syncope
what are some causes |
-othostatic hypotension assoc with hypovolemia
-orthostatic hypotension: *sys drop greater than 20 *Dia drop greater than 10 |
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what can an exam finding of an auscultatory gap indicate?
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condition associated with arterial stiffness or atherosclerosis
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exam finding is narrow pulse pressure (less than 30 mmHg)
what does this indicate |
conditions assoc with low sroke volume
ex. systolic heart failure, congestive cardiomyopathy, |
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what does an exam finding of a wide pulse pressure (greater than 65 mmHg) indicate
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conditions assoc with large stroke volume
ex. diastolic, hypertrophic cardiomyopathy |
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what does an exam finding of unequal blood pressure indicate?
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1. coarctation of the aorta
2.Occlusive Dz/Aortic Dissectin -can tell the difference b/c coarc is diff b/w upper and lower exteremity while occlusive and aortic is different from left to right |
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what does an exam finging if increased Jug. Ven Pressure indicate?
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1. RIght heart failure
2. Constrictive pericarditis 3. tricuspid stenosis |
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what reflex should be checked with Jug Venous Pressure
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hepatojugular reflex
*pressure on liver increased JVP but should return to normal in 10 sec |
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*Exam finding on palpation shows increased pulsations. what does this indicate
*Exam finding shows a thrill on palpation. what does this indicate |
-hypertrophy of the heart
-thrill=murmur |
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On palpation of the the PMI you find the following. Indicate what each could mean:
-displacement -diameter greater than 3 -amplitute increase -sustained impulse |
displacement=sys heart failure
increased diam=ventricular enlargement increased amp=aortic stenosis or mitral regurg sustained impulse=LVH |
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what does a mid-systolic click indicate?
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mitral valve prolapse
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what does a holosystolic murmur indicate?
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AV valve problems
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what does a late systolic murmur indicate?
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mitral prolapse
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what does an early diastolic murmur indicate?
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a probelm with semilunar valves
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what does a mid/late diastolic murmur indicate
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av valve problem
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you hear a murmur at the 2nd right interspace. what is this likely indicating?
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aortic stenosis
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a murmur at the mid left sternal border. what is this likely to indicate?
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an aortic regurg
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you hear a murmur at the the 2nd and 3rd intercostal space what is this related to?
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pulmonic valves
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you hear a murmer at the left lower sternal border. what is this related to
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tricuspid valve
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you hear a murmur at the apex of the heart (5th intercostal space) what does this indicate
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mitral valve
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what types of murmers are crescendo in systole
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mitral valve prolapse
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what types of murmers are crescendo in diastolic
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mitral stenosis
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what types of murmers are decrescendo during diastole
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aortic regurg
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what type of murmer is cres-decrescen in systole
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aortic stenosis, pulmonic stenosis, an dinnocent flow murmurs
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what type of murmurs have a plateau shape in systole
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mitral regurg and ventricular septal defect
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what type of murmers are higher pitched
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regurg
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what type of murmer is described as blowing?
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regurg
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what type of murmer is described as low and rumbling
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stenosis
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what other systems should ALWAYS be evaluated with cardiac
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peripheral vascular, respiratory and possibly GI if other symptoms are present
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on PE you find:
-normal carotid upstroke -apical impulse at 5ICS localized and tapping quality -S2 split -no murmur, rub or gallop |
normal
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on PE you find:
-slow upstroke of carotid pulse -double apical impulse at 5th ICS -ejection murmurin aortic area -S4G |
aortic valve stenosis
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on PE you find:
-normal carotid pulse -displaced apical impulse -parasternal lift -holosystolic murmur at apex -S3G |
chronic mitral valve regurg
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on PE you find:
-cartod impulse has small volume -apical impulse is moved inferolaterally -apical impulse has 2-3 components -holosystolic murmur at apex -S3G and S4G at apex |
dilated cardiomyopathy
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on PE you find:
-visferiens carotid pulse -apical impulse moved inferolaterally -short aortic area systolic murmur -left sternal border diastolic decrescendo murmur -murmur transmitted to tricuspid and pulmonic areas |
chronic aortic valve regurg
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on PE you find:
-bisferiens carotid pulse -apical impulse has double tapping character -aortic area ejection murmur -possible holosystolic murmur -apical S4G |
hypertrophic obsturctive cardiomyopathy
*can perform valsalve to confirm |
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on PE you find:
-normal carotid impulse -left parasternal lift (RV dilatation) -fixed splitting of S2 -pulmonic area ejection murmur |
atrial septal defect
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on PE you find:
-normal cartoid pulse -normal apical impulse -left lower sternal border holosystolic murmur -no gallop |
ventricular septal defect
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on PE you find:
-normal carotid pulse -radial femoral pulse lag -normal apical impulse -short ejection murmur in aortic area -decrescendo diastolic murmur along left sternal border -ejection murmur in tricuspid area |
coarc of aorta
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what are some impt hx questions to ask when CC is intermittent claudication
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-ChLORIDEPP pain
-how far do you walk before symptoms start -how long do symptoms last _hx os smoling -Hx of DM, High choles and HTN |
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if someone has Pain, pallor, paresthesia, paralysis and pulselessness what should you immediately think
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arterial occlusive dz
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CC: pain when walking in an extremity
-what do you look for to Dx chronic arterial insufficiency |
-pallative/provocative(should get worse with walking and better with rest)
-look for 5p's -pale or dusky red, cool temp, NO EDEMA, loss of hair, ulcerations, gangrene, decreased pulse |
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CC: dull ache in extremity
-what do you look for to dx chronic venous insufficiency |
-pallative/provocative (should get worse with prolonged standed and better with elevation)
-increased leg circumference, pitting edema |
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CC: dizziness, fainting
patient is old or female what do you think |
Acute MI
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CC: dyspnea
PE-lift, S4G, ejection murmur... what type of heart failure |
-Diastolic
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CC: weakness
Pe reveals dilatation of PMI, and S3G what type of heart failure |
-Systolic failure
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CC: chest pain
-what do u look 4 to dx stable angina |
-intermittent pain lasting from 1-15 minutes
-pain is exertional -pain is an area at least size of a silver dollar -PE can be normal is not symptomatic during exam -if symptomatic during exam hear S4G and/or mitral regurf murmur |
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CC; chest pain
-what do you look for to Dx unstable angina pectoris |
-occurs at rest or abrupt frequency increase
-same symptoms and signs otherwise as stable angina -may have fatigue and dyspnea |
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someone has the 5 P's, how do you differentiate this from PAD to Dx acute arterial embolism
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-hx of claudication that may have sudden severe onset
-may have MI, afib, mitral valve dz, prosthetic heart valves or endocaditis |
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Patient is tachycardic and tachypnic. PE reveals a paradoxical pulse and elevation of Central venous pressure. what does this indicate
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pericardial tamponade emergency
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CC; leg heaviness and tiredness for past month
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-think immediately varicose veins
*look for factors such as female or fam hx |
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CC: dull ache or pressure in leg
-how do you dx varicose veins from chronic venous insufficiency |
--legs feel heavy
- signs of torutous vessles confirmed by palpation -Brodie trendelenberg test |
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-what are some clues that indicate DVT
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-bed rest
-restricted leg motions -CHF -shock -truama(surgery) -pregnancy |
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what is PE of DVT reveal
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-asymptomatic
-aching pain and tightness with swelling -possible tachycardia, anxiety and fever |
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CC: unilateral leg swelling
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think venous thrombosis
PE reveals-warmth, redness, tenderness along involved vein, palpable cord, increased skin turgor |
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CC: hemoptysis
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-think PUlmonary ethromboembolis
_Dx by tread of Chest Pain, Dyspena and Hemoptysis _sudden onset |
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CC: substernal neck or back pain
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-thoracic aortic aneurysm
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CC: mild to moderate abdominal pain (or lower back)
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AAA
-PE reveals pulsating abdominal mass |
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CC: sudden onset severe persistent anterior chest pain
what two ddx should come to to mind |
1. acute MI
2. aortic dissection |
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how can you differentiate acute MI from aortic dissection
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aortic dissection has a loss or differential of pulses along with murmurs
(no murmurs in MI) |
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what is this set of characteristics describing?
Precordium: *tapping apex beat *diastolic thrill at apex *parasternal life Auscultation: *Loud S1 *diastolic opening snap followed by rumble with presystolic accentuation *afib may be pulse pattern *cold extremities |
mitral stenosis
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what is this set of characteristics describing?
Precordium: *apical systolic thrill *apex displaced to left Auscultation: *apical systolic regurgitant murmur following a decreased s1 *radiating to axilla *often hear s3 due to increased left ventric EDV |
mitral regurg
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what is this set of characteristics describing?
Ausculation: *mid systolic or late click .14 sec or more after s1 *often followed by a high pitched ysstolic murmur (squatting may cause murmur to decrease) |
mitral valve prolapse
note: common in women younger than 30 |
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what is this set of characteristics describing?
precordium: *basal systolic thrill *apex displaced anteriorly and laterally Carotids: *slow upstroke to a delayed peak Auscultation: *a2 diminished or paradoxically ejection systolic murmur radiating to carotids Cold extremities |
Aortic stenosis
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what is this set of characteristics describing?
precordium: *apex displaced laterally and anteriorly *thrill often palpable along left sternal border and in the jugular notch Carotids: *double sytolic wave Auscultation: *decrescendo diastolic murmur along left sternal border *M1 and A2 are increased |
aortic regurgitation
note: often assoc with Marfans and rheumatoid arthritis |
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what is this set of characteristics describing?
Precordium: *RV parasternal life *systolic thrill at tricuspid area Ausculation: *holosystolic murmu increaseing with inspiration *V wave in jugular venous pulse *systolic liver pulsation |
Tricuspid regurg
note: usually secondary to pathology elsewhere in heart |
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what is this set of characteristics describing?
Precordium: *normal pulse *break parasternal life *lift over pulmonary artery Auscultation: *systolic ejection murmur in pulmonic area *low pitched diastolic rumble over tricuspid area *persistent wide splitting of S2 |
atrial septal defect
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what is this set of characteristics describing?
tachycardia, friction rub, diminished heart sounds and enlarged heart t percussion (with effusion) *pulsus paradoxicus, neck vein distention, narrow pulse pressure and hypotension (w tamponade) |
pericarditis
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