Cardiovascular

Front 1

How do patients present with bacterial endocarditis

Back 1

Fever, chills, and malaise that is associated with the new murmur and abrupt onset of CHF. Skin findings are found mostly in the fingers, hands, and toes. These are hemorrhages or splinter hemorrhages on the nail bed, petechiae on the palate, painful violet colored nodes on the fingers or feet.

Front 2

Where is the apical impulse located

Back 2

Fifth intercostal space by the midclavicular line on the left side of the chest.

Front 3

When would you see displacement of the point of maximum impulse

Back 3

Severe left ventricular hypertrophy and cardiomyopathy, pregnancy in the third trimester.

Front 4

Pathway of deoxygenated blood

Back 4

Enters the heart through the superior vena cava and inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, the Lungs, Alveoli.

Here it picks up oxygen and releases carbon dioxide.

Front 5

Pathway of oxygenated blood

Back 5

Exits the lungs through the pulmonary veins and enters the heart. Left atrium, mitral valve, left ventricle, aortic valve, aorta, general circulation.

Front 6

Systole and diastole using the pneumonic motivated apples

Back 6

Mitral valve, tricuspid valve, atrioventricular valves, Aortic valve, Pulmonic valve, semi lunar valves.

Front 7

Heart sound: S1 systole

Back 7

This is the lub sound. Closure of the mitral and tricuspid valve. Atrioventricular valve's.

Front 8

aortic area

Back 8

Second intercostal space to the right side of the upper border of the sternum. Also described as the second intercostal space by the right side of the sternum at the base of the heart.

Front 9

Heart murmur mnemonic for systolic murmur

Back 9

MR. ASH

These murmurs are also described as occurring during S1 or as holosystolic, pansystolic, early systolic, late systolic, or mid systolic murmur's. These murmurs are louder than diastolic murmur's and can radiate to the neck or axilla.

Front 10

Mitral regurgitation

Back 10

A pansystolic or holosystolic murmur. Best hurt at the apex of the heart or apical area. Radiates to the axilla. Loud blowing and high-pitched murmur.

Front 11

aortic stenosis

Back 11

A Midsystollic ejection murmur. Best heard at the second intercostal space at the right side of the sternum. Radiates to the neck. A harsh noisy murmur.

Front 12

Diastolic murmur mnemonic

Back 12

MS. AR

Diastole is also known as The S2 heart sounds, early diastole, late diastole, or mid diastole. Diastolic murmur's are always indicative of heart disease.

Front 13

Mitral stenosis

Back 13

A low pitched diastolic rumbling murmur. Heard best at the apex of the heart or the apical area. Also called an opening snap.

Front 14

aortic regurgitation

Back 14

A high pitched diastolic murmur. That's right at the second intercostal space at the right side of the sternum. High-pitched blowing murmur.

Front 15

Heart sounds: S2 diastole

Back 15

The dub sound. Closure of the aortic and Pulmonic valves. Semi lunar valves.

Front 16

S3 heart sound

Back 16

Pathognomic for CHF.

Occurs during early diastole also called the ventricular Gallup or he S3 Gallup. Sounds like Kentucky. Always considered abnormal if it occurs after the age of 35.

Front 17

S4 heart sound

Back 17

Caused by increased resistance due to a stiff left ventricle, usually indicates left ventricular hypertrophy, considered a normal finding in some elderly.

S4 occurs during late diastole also called and atrial Gallup or atrial kick. Best heard at the apex or apical area (mitral area) using the bell of the stethoscope.

Front 18

The bell of a stethoscope can be used for which tones

Back 18

Low tone such as the extra heart sounds S3 or S4 or mitral stenosis

Front 19

The diaphragm of the stethoscope is best used for

Back 19

Mid to high-pitched tone such as long sounds, mitral regurgitation, and Aortic stenosis.

Front 20

Where is a benign split S2 best heard

Back 20

Over the Pulmonic area or second intercostal space left of the sternum. This is due to the splitting of the aortic and pulmonary components. It's a normal finding it appears during inspiration and disappears and expiration.

Front 21

Timing of systolic murmur

Back 21

Use the MR. As pneumonic

Front 22

Diastolic murmur

Back 22

Use the MS. AR pneumonic

Front 23

Where is the mitral area

Back 23

The apex or apical area of the heart. Fifth left intercostal space about 8 to 9 cm from the midsternal line and slightly medial to the midclavicular line. PMI or the apical pulse is located in this area.

Front 24

How do you evaluate pulsus paradoxus

Back 24

It is measured by using blood-pressure cuff and a stethoscope. The apical pulse can still be heard even though The radial pulse is no longer palpable.

Front 25

What is the treatment plan for raynauds phenomenon

Back 25

Avoid touching cold objects, cold weather, avoid stimulants, smoking cessation, nifedipine or amlodipine.

Front 26

Mitral valve prolapse

Back 26

The classic finding is an S3 click followed by a systolic murmur.

Front 27

How do you treat triglycerides

Back 27

Use niacin first

Front 28

Metabolic syndrome

Back 28

Metabolic disorder with a cluster of symptoms. These patients are at a higher risk for diabetes and cardiovascular disease.

At least three characteristics must be present to diagnose metabolic syndrome. Abdominal obesity, hypertension, and hyperlipidemia.

Front 29

What are some examples of target organ damage

Back 29

Microvascular damage to eyes: silver and or copperware arterials, AV junction nicking, flame shaped hemorrhages, papilledema.

Kidneys: microalbuminuria and protein urea, elevated serum creatinine and abnormal GFR, peripheral or generalized edema, macrovascular damage.

Heart: S3, S4, carotid bruit, CAD and acute MI, decreased or absent peripheral pulses.

Brain: TIAs with damage and hemorrhagic strokes.

Front 30

What are the three major groups that cause secondary hypertension

Back 30

Renal, endocrine, and other causes such as obstructive sleep apnea.

Front 31

What are some side effects of loop diuretics

Back 31

Electrolyte imbalance, hypokalemia, hyponatremia and hypomagnesemia

Front 32

What are some side effects of aldosterone receptor antagonist diuretics?

Back 32

Gynecomastia, hyperkalemia, G.I. Examples of these medications are spironolactone.

Front 33

What are some Side Effects of calcium channel blocker

Back 33

Headaches, ankle edema, heart block or bradycardia, reflect hernia. These medications are the PINES family or verapamil/diltiazem

Front 34

Alpha-1 blocker/antagonist

Back 34

Also known as alpha adregenic blockers. Suffix of Zosyn. Vasodilator. Side effects are dizziness and hypotension so give at bedtime and a very low dose.

Examples: Hytrin and Flomax.

Front 35

How do you treat isolated systolic hypertension in the elderly

Back 35

thiazide diuretics used first, add a calcium channel blocker and or an ace inhibitor or ARB.

Front 36

What symptoms do you see with left ventricular failure

Back 36

Crackles, Bibasilar rails, cough, dyspnea, decreased breath sounds, Dullness to percussion. Nighttime dyspnea, orthopnea, cough at night, and wheezing.

Front 37

Right ventricular failure

Back 37

Jugular venous distention, and large spleen, enlarged liver, nausea, abdominal pain, lower extremity edema with cool skin.

Front 38

Isolated systolic hypertension increases the risk for

Back 38

Myocardial infarction and stroke