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43 Cards in this Set
- Front
- Back
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Physical exam
What does Obesity/cyanosis suggest? |
sleep apnea, RH failure
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Physical exam
Tall w/ long arms and fingers |
Marfan's syndrome
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Phys exam
Cachexia |
End stage heart failure
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Phys exam
Slender, nervous |
HyPERthryoidism
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Phys exam
Slow, non-pitting edema |
HyPOthryoidism
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Phys exam
Febrile, ill, skin lesions |
Endocarditis
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What is pulsus paradoxus
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systolic pressure fall >10mm Hg from cardiac tamponade (fluid fills pericardium)
- during INSPIRATION (neg pressure --> RH^ --> septum pushed into left --> LH dimensions, stroke volume decrease --> drop in systolic BP |
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What are three positions to measure jugular venous waveform?
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supine, 45 degrees, upright
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What does jugular venous waveform tell us?
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fluid status in right heart, cardiac rhythm
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a-wave
abnormality |
right atrial contraction
- giant = AV dissociation, ^RA volume, restriction to RV filling |
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c-wave
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closure of tricuspid valve
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x-descent
abnormality? |
RA relaxation
RV contraction - neg. slope = constriction (tamponade, pericarditis) |
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v-wave
abnormality? |
RA filling
- ^ amplitude = tricuspid regurgitation |
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y-descent
abnormal? |
tricuspid valve opening, RA filling
- decreased slope = impeded flow across tricuspid (stenosis, RV hypertrophy) - increased slope = constriction (pericarditis, early disastole, limited RV filling, rapid atrial emptying) |
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Here is the PMI?
1. What does lateral displacement mean? 2. inferior displacement? 3. larger? |
mid-clavicular, 5th intercostal
1. ventricular dilation (not hypertrophy) 2. obstructive lung disease 3. LV hypertrophy |
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How is the normal arterial pulse best assessed?
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Bedside using the carotid artery
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Instances of increased carotid upstroke?
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1. AORTIC INSUFFICENCY
(LV SV^ = ^ systeolic volume = ^upstroke w/ peak amplitude - aka "water-hammer pulse" (pulse pressure ^) -reduced peripheral resistance - sepsis - anemia - throtoxicosis -peripheral AV malformation -fever |
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What is Kussmail's sign?
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paradoxic increase in jugular venous pressure during inspiration
- (inability of RH to accomodate increased flow, constrictive heart disease ) |
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Classic example of increased carotid upstroke
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aortic insufficiency
(water-hammer pulse) ^ LV volume = ^ systolic volume = ^upstroke - reduced arterial resistance (compensatory ^ in CO) |
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What causes bisferiens pulse?
(spike and dome wave) |
hypertrophy
obstructive cardiomyopathy |
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What causes pulsus Alternans?
(strong pulse followed by a weak pulse) |
severe LV dysfunction
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What causes pulsus parvus?
(diminished and delayed) |
aortic stenosis
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What are the four precordial sites for listening to heart sounds?
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1. Aortic (2nd right interspace)
2. Pulmonic (2nd left interspace) 3. Tricuspid (4th left lateral sternal interspace) 4. Mitral (cardiac apex) |
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What generates S1?
When does it occur? Which component occurs first? |
close of AV valves
- prior to upstroke of carotid pulse - mitral |
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What generates S2?
When does it occur? Which component occurs first? |
close of aortic/pulmonary valves
- after carotid pulse - aortic (LV activated first + higher systemic resistance) |
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What happens to A2 and P2 during inspiration?
S2 splitting? |
get further apart (RV filling^ = prolonged RV contraction = delays pulmonic valve closure)
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What affects intensity of S2?
Factors affecting... |
-leaflet mobility
- pumonary hypertension - systemic hypertension -afterload -systole duration -sequence of elec activation |
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What is a fixed split S2 pathognomonic of?
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atrial septal defect
balance b/w systemic venous return & shunted blood results in preserved RA filling & RV stroke volume A2 & P2 timing remain constant |
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When is S3 found?
What does it indicate? causes? (2) |
ventricular filling during DIASTOLE
congestive heart failure 1. decreased vent compliance (dialted cardiomyopathy) 2. ^ flow across AV valve (mitral regurg, aortic insufficiency, ventricular septal defect) |
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When is S4 heard?
What does it indicate? cause |
prior to ventricular activation, secondary to atrial contraction
ventricular hypertrophy decreased ventricular compliance (arterial hypertension, aortic stenosis, hypertrophy) |
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When are ejection sounds heard?
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early in ventricular systole secondary to blood flow across aortic or pulmonic valve
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What does an aortic ejection sound indicate?
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- biscupid aortic valve
- root disease - coarctation |
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What does a pulmonic ejection sound indicate?
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- valvular pulmonic stenosis
- pulm hypertension - dialted pulm artery |
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How do you classify cardiac murmurs?
(Levine and Harvey scale) |
1. timing
2. location 3. quality 4. intensity 5. pitch |
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Determination of the valve and condition requires what info? (5)
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1. clinical scenario/other exam findings
2. timing of murmur (systole/diastole) 3. location of murmur 4. quality of murmur 5. response to maneuvers (right-handed get louder w/ inspiration) |
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What is a murmur caused by aortic stenosis characterized by?
How is timing related to severity? |
harsh and diamond-shaped (crescendo-decrescendo)
- more severe, later the peak |
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What does a single S2 or paradoxical split S2 indicate?
What is is accompanied by? |
severe aortic stenosis
pulsus parvus |
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What is a paradoxical split of S2?
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P2 before A2
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What characterizes mitral regurgitation?
Begins with? Ends with? What is is frequently accompanied by? |
-soft
-blowing -high-pitched -holosystolic murmur (lasting an entire systole) - S1, A2 - S3 |
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Where does murmur direct when the cause is:
1) anterior leafleft 2) posterior leaflet |
1. axilla, thoracic spine
2. base of the heart |
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What characterizes mitral valve prolapse?
When is it more audible? How is it affected by body position? |
mid-systolic ejection click and late systolic murmur
when there is LESS blood in ventricle (more size-leaflet mismatch) extended when upright |
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What characterizes hypertropic cardiomyopathy?
What increases its intensity? |
systolic ejection murmur w/ increased intensity of S1 and preservation of S2
- maneuvers that ^ outflow obstruction |
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What characterizes aortic value regurgitation?
How is it best heard? |
- diastolic
- high pitched - blowing decrescendo murmur - follow normal S2 - patient sitting, leaning forward, at end of expiration |
