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43 Cards in this Set
- Front
- Back
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Small, Weak Pulse
Characteristics |
Diminished pulse pressure
Weak and small on palpation Slow upstroke Prolonged systolic peak |
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Small, Weak Pulse
Causes |
Conditions causing a decreased stroke volume
heart failure hypovolemia severe aortic stenosis conditions causing increased peripheral resistance hypothermia severe congestive heart failure |
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Large, Bounding Pulse
Characteristics |
Increased pulse pressure
strong and bounding on palpation rapid rise and fall with a brief systolic peak |
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Large, Bounding Pulse
Causes |
Conditions causing an increased stroke volume or decreased peripheral resistance
fever anemia hyperthyroidism aortic regurgitation patent ductus arteriosus conditions resulting in increased stroke volume due to decreased heart rate bradycardia complete heart block conditions resulting in decreased compliance of the aortic walls aging artherosclerosis |
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Bisferiens Pulse
Characteristics |
Double systolic peak
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Bisferiens Pulse
Causes |
Pure aortic regurgitation
Combined aortic stenosis and regurgitation Hypertrophic cardiomyopathy |
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Pulsus Alternans
Characteristics |
Regular rhythm
chagnes in amplitude (or strength) from beat to beat (you may need a sphygmomanometer to detect the difference) |
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Pulsus Alternans
Causes |
left ventricular failure (usually accompanied by an S3 sound on the left)
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Bigeminal Pulse
Characteristics |
regular, irregular rhythm (one normal beat followed by a premature contraction)
alternates in amplitude (one strong pulse followed by a quick, weaker one) |
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Paradoxical Pulse
Characteristics |
Palpable decrease in pulse amplitude on quiet inspiration
pulse becomes stronger with expiration you may need a sphygmomanometer to detect the change (the systolic pressure will decrease by more than 10 mmHg during inspiration |
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Paradoxical Pulse
Causes |
Pericardial tamponade
Constrictive pericarditis Obstructive lung disease |
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Ventricular Impulses
Lift |
diffuse lifting left during systole at left sternal border
associated with right ventricular hypertrophy caused by pulmonic valve disease, pulmonic hypertension, and chronic lung disease may see retraction at apex from posterior rotation of left ventricle caused by oversized right ventricle |
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Ventricular Impulses
Thrill |
palpated over 2nd and 3rd intercostal space
may indicated severe aortic stenosis and systemic hypertension if palpated over 2nd and 3rd left intercostal spaces indicates pulmonic stenosis and pulmonic hypertension |
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Ventricular Impulses
Accentuated Apical Impulse |
sign of pressure overload
increased force and duration not usually displaced in left ventricular hypertrophy w/o dilation associated with aortic stenosis or systemic hypertension |
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Ventricular Impulses
Laterally Displaced Apical Impulse |
sign of volume overload
found over a wider area result of ventricular hypertrophy and dilatation associated with mitral regurg, aortic regurg, or left to right shunts |
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Abnormal Heart Rhythms
Premature Atrial or Junctional Contractions |
beats occur earlier than the next expected beat and are followed by a pause
rhythm resumes with next beat early beat has S1 of different intensity and a diminished S2 |
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Abnormal Heart Rhythms
Premature Ventricular Contractions |
beats occur earlier that the next expected beat and are followed by a pulse
rhythm resumes with next beat early beat has an S1 of different intensity and a diminished S2 |
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Abnormal Heart Rhythms
Sinus Arrhythmia |
dysrhythmia
heart rate speeds up and slows down in a cycle usually becomes faster with inhalation and slower with expiration S1 and S2 sound are usually normal S1 may vary with the heart rate |
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Abnormal Heart Rhythms
Afib and Atrial flutter w/ varying ventricular response |
dysrhythmia
ventricular contraction occurs irregularly short runs of the irregular rhythm may appear regularly S1 varies in intensity |
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Extra Heart Sounds During Systole
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high-frequency sounds heard just after S1 (ejection clicks)
produced by a functioning but diseased valve can occur early or mid-to-late systole best heard through diaphragm |
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Extra Heart Sounds During Systole
Aortic Ejection Click |
heard during early systole at the 2nd right intercostal space and apex
click occurs with opening of aortic valve and doesn't change with respiration |
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Pulmonic Ejection Click
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Best heard at the 2nd left intercostal space during early systole
click often becomes softer with inspiration |
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Midsystolic Click
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heard in middle or late systole
heard over mitral or apical area result of mitral valve leaflet prolapse during left ventricular emptying late systolic murmur typicall follows indicating mild mitral regurg |
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Extra Heart Sounds During Diastole
Opening Snap |
early diastole
heard with opening of stenotic or stiff mitral valve does not vary w/ respirations often mistaken for split S2 or S3 occurs earlier in diastole than S3 and has a higher pitch |
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Extra Heart Sounds During Diastole
S3 |
Ventricular Gallop
low frequency heard best with bell at apical area or lower right ventricular area w/ pt. in left lateral position accentuated during inspiration rhythm of "Ken-tuc-ky" result of vibrations caused by blood hitting ventricular wall during rapid filling normally found in young children, ppl w/ high CO, and in 3rd trimester rarely normal for ppl over 40 associated with decreased myocardial contractility, myocardial failure, congestive heart failure, and volume overload of ventricl from vascular disease |
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Extra Heart Sounds During Diastole
S4 |
Artial Gallop
low-frequency occurring at end of diastole when atria contract caused by vibrations from blood flowing rapidly into the ventricles after atrial contraction "Ten-nes-see" may increased with inspiration best heard with bell over apical area w/ pt. in supine or left lateral position never heard in absence of atrial contraction can be normal for athletes and some older pts. associated with coronary artery disease, hypotension, aortic and pulmonic stenosis, and acute myocardial infarction |
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Extra Heart Sounds During Diastole
Summation Gallop |
simultaneous occurrence of S3 and S4
caused by rapid heart rates in which diastolic filling is shortened associated with severe congestive heart disease |
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Extra Heart Sounds in Both Systole and Diastole
Pericardial Friction Rub |
heart best in left 3rd intercostal space
caused by inflammation of pericaridal sac high pitched, scratchy, scaping sound rub may increased with exhalation and when pt. leans forward use diaphragm, w/pt. leaning forward, exhale and hold breath usually heard 1st week after MI |
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Extra Heart Sounds in Both Systole and Diastole
Patent Ductus Arteriosus |
PDA
congenital anomaly leaves open channel between aorta and pulmonary artery found over 2nd left intercostal space and may radiate to left clavicle continuous murmur medium pitch harsh machinery sound loudest late in systole |
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Extra Heart Sound in Both Systole
Venous Hum |
Common in children
benign sound cause by turbulent blood in jugular vein heard about medial 3rd of clavicles (right) may radiate to 1st and 2nd intercostal spaces low pitch humming or roaring continuous murmur loudest in diastole obliterated with pressure on jugular vein |
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Midsystolic murmurs
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most common type
occur during ventricular ejection can be innocent, physiologic, or pathologic crescendo-decrescendo shape peak near midsystole and stope b4 S2 |
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Midsystolic murmurs
Innocent Murmur |
no physical abnormality
occur when ejection of blood in aorta is turbulent very common in children and young adults older ppl w/ CVD pt may have another murmur as well 2nd to 4th left ICS between LSB and apex little radiation grade 1 or 2 medium pitch variable quality usually disappear when pt sits |
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Midsystolic Murmurs
Physiologic Murmur |
caused by temporary increase in blood flow
occur with anemia, pregnancy, fever, and hyperthyroidsim 2nd to 4th ICS between LSB and apex little radiation grade 1 or 2 medium pitch harsh quality |
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Midsystolic Murmurs
Pulmonic stenosis |
pathologic
occurs from impeded blood flow across pulmonic valve and increased RV afterload commonly found in children atrial septal defect may mimic if severe, S2 is widely split and P2 is diminished early pulmonic ejection is common right-sided S4 present RV impulse often strongere and prolonged 2nd to 3rd ICS radiates toward left shoulder and neck soft to loud intensity medium pitch harsh quality loudest during inspiration |
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Midsystolic Murmurs
Aortic Stenosis |
impedes blood flow across valve and increase LV afterload
result from rheumatic disease or a degenerative process mimics include aortic sclerosis, bicuspid aortic valve, dilated aorta, aortic regurg if severe, A2 may be delayed resulting in an unsplit S2 or paradoxical split S2 S4 may occur due to decreased left ventricular compliance aortic ejection suggests congenital cause right 2nd ICS radiates from neck down to LSB to apex loud with thrill medium pitch harsh but musical at apex heard best with pt sitting and leaning forward loudest during expiration |
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Midsystolic Murmur
Hypertrophic Cardiomyopathy |
cause by rapid ejection of blood from LV during systole
massive hypertrophy of ventricle muscle coexisting obstruction to flow mital regurg may result pt may have S3 and S4 3rd and 4th left ICS decreases w/ squatting increases w/ straining down variable intensity medium pitch harsh quality |
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Pansystolic Murmurs
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occurs when blood flows from a chamber w/ high pressure to a chamber of low pressure through a orfice normally closed
pathologic begin with S1 and continue through systole to S2 |
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Pansystolic Murmurs
Mitral Regurg |
occurs when mitral valve fails to close fully in systole
result of blood flowing from LV back into LA volume overload occurs in LV causing dilation and hypertrophy S1 sound is decreased apical impulse is stronger and prolonged LV volume overload suspected if S3 heard Apex radiates to left axilla less often LSB soft to loud w/ apical thrill assoc. w/ loud medium to high pitch blowing quality heard best w/ pt in LL decubitus position doesn't become louder w/ inspiration |
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Pansystolic Murmurs
Tricuspic Regurg |
blood flowing from RV back to RA over a tricuspid valve not fully closed
RV failure is most common cause resulting from pulmonary hypertension or LV failure RV impulse is stronger and prolonged may be S3 along LLSB and jugular venous pressure is often elevated with visible v waves LLSB radiates to R of sternum, to xiphoid area, and to MCL, no radiation to axilla Variable intensity medium to high pitch blowing quality may increase slightly with inspiration |
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Pansystolic Murmurs
Ventricular Septal Defect |
congenital abnormality
blood flows from LV into RV through hole in septum causes loud murmur that obscures A2 sound 3rd, 4th, and 5th ICS wide radiation very loud intensity with thrill high pitch harsh quality increases with exercise |
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Diastolic murmurs
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indicative of heart disease
two types: early decrescendo (flow through incompetent SL valve (aortic is common) rumbling indicate valve stenosis (usually mitral) |
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Diastolic murmurs
Aortic Regurg |
occurs when leaflets of aortic valve fail to close completely
result of blood flowing from aorta back into LV results in LV volume overload ejection sound may be present severe regurg suspected if S3 and S4 present apical impulse becomes displaced downward and laterally with a widened diameter and increased duration pulse pressure increases, arterial pulses large and bounding 2nd to 4th ICS radiate to apex or LSB Grade 1 to 3 high pitch blowing, sometimes mistaken for breath sounds heard best with pt. sitting, leaning frwd have pt exhale then hold breath |
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Diastolic murmurs
Mitral Stenosis |
result of blood flow across disaeased mitral valve
thickened, stiff distorted leaflets result of rheumatic fever loud during mid-diastole as ventricle rapidly fills, then grows quiet, and become loud again immediately b4 systole as atria contract pt w/ Afib the second sound is absent because no atrial contraction Loud S1 palpable at apex often OS after S2 P2 becomes loud and the RV impulse becomes palpable if pulmonary hypertension develops apex little or no radiation grade 1 to 4 low pitch rumbling best heard with bell exactly on apex w/ pt in LLP mild exercise and listening during exhalation makes easier to hear |
