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CV - Physical Exam Signs
Ddx for signs of CV problems
27
Medical
04/05/2008

Additional Medical Flashcards

 


 

Cards

Term

 

Different Blood Pressures

in Right & Left Arms 

 

(Difference > 10 mmHg)

Definition

Ddx:

1) Vascular abnormality - usually not a problem

2) Aortic dissection

 

Phys:

Aortic dissection - if the tear begins between the brachiocephalic trunk & the left subclavian artery or if a subclavian artery is occluded

Term

 

Different Blood Pressures

in the Arms vs. the Legs

 

(Difference > 10 mmHg)

Definition

Ddx:

1) Coarctation of the aorta - A discrete congenital narrowing of the aorta

 

Phys:

To be cont.

Term

 

Widened Pulse Pressure

 

(Difference btwn Systolic & Diastolic

>55-60 mmHg)

Definition

Ddx:

1) Aortic regurgitation

2) Other high CO states

3) Decreased LV compliance

4) Decreased afterload --> decreased diastolic BP

 

Phys:

To be cont.

Term

Narrow Pulse Pressure

 

(Difference btwn Systolic & Diastolic

< 20-25 mmHg)

Definition

Ddx:

 

Decreased CO, which can be caused by:

 

1) Aortic Stenosis

2) HOCM?

3) Mitral stenosis

4) Congestive Heart Failure

5) States of increased systemic resistance

 

Phys:

Narrow pulse pressure is caused by low CO, which can be due to:

- LV outflow obstruction (e.g. aortic stenosis, HOCM)

- Low LV volume (e.g. mitral stenosis)

- Low stroke volume (congestive heart failure)

- Increased systemic resistance (e.g. increased catchols, heart failure)

Term

 

Orthostatic Changes in Blood Pressure 

 

(Pressure >20 mmHg lower when standing)

Definition
Term

 

 

Bisferiens (Bifid) Pulse

Definition

A pulse with two positive waves during systole

    - The first wave rises rapidly & forcefully

    - The second wave is smaller & slower rising

 

Ddx:

1) Obstructive hypertrophic cardiomyopathy (HOCM)

2) Aortic regurgitation

3) States involving rapid ejection of increased SV out of the LV (fever, exercise, patent ductus arteriosus)

 

Phys:

Indicates LV ejection abnormalities... (to be cont.)

Term

 

 

Dicrotic Pulse

Definition

A pulse with two peaks, one in systole and one in diastole

 

Ddx:

1) Impaired LV function - low CO, low SV, high LV end-diastolic pressure, high systemic arterial resistance

 

Phys:

To be cont.

Term

 

 

Pulsus Alternans

Definition

A pulse that is alternately strong & weak in an every-other pattern

 

Ddx:

1) Severe impairment of LV function (an early sign of cardiac decompensation)

 

Phsy:

Impairment of electromechanical coupling in some cels during the weaker contraction... (to be cont.)

Term

 

 

 Pulsus Paradoxus

(Paradoxical pulse)

Definition

A marked decreased in pulse amplitude (or systolic BP) during inspiration

 

Ddx:

1) Cardiac tamponade

2) Constrictive pericarditis (pulsus paradoxus infreq. seen)

3) Superior vena cava obstruction

4) Asthma, obstructive airway disease

5) Pulmonary embolism

 

Phys:

To be cont.

Term

 

Radial-Femoral Lag

Definition

A delayed & weakened femoral pulse when compared with the radial pulse

 

Ddx:

1) Coarctation of the aorta

 

Phys:

To be cont.

Term

 

Apical-Radial Pulse Deficit

Definition

Not all apical beats are felt at the radial pulse

 

Ddx:

1) Atrial fibrillation

2) Other causes of low CO

 

Phys:

To be cont.

Term

 

Decreased Ankle-Brachial Index

(<0.95)

Definition

ABI = systolic BP at ankle / systolic BP at arm

 

<0.95 = vascular disease, <0.6 = intermittent claudication

 

Ddx:

1) Atheroscerotic peripheral artery disease

2) Giant cell arteritis

3) Aortic dissection

4) Arterial emboli

 

Phys:

to be cont.

Term

 

Absent Posterior Tibial Pulse

Definition

Ddx:

1) Peripheral vascular disease

Term

 

Absent Dorsalis Pedis Pulse

Definition

Ddx:

1) Peripheral vascular disease

2) Normal individual (congenitally absent in 10-12% of people)

 

Phys:

to be cont.

Term

 

Enlarged Aorta

( > 4cm)

Definition

Ddx:

1) Aortic aneurysm

 

Phys:

to be cont.

Term

 

Carotid Bruits

Definition

Low-pitched murmur over the carotid arteries

 

Ddx:

1) Atherosclerotic plaque

 

Phys:

Sound caused by turbulent flow, due to an obstruction

Term

 

Aortic Bruits

Definition

Low- pitched murmur over the aorta

 

Ddx:

1) Atherosclerotic plaque

2) Aortic aneurysm

 

Phys:

Sound caused by turbulent flow in the aorta

Term

 

 

Elevated Jugular Venous Pulse

Definition

Estimates CVP.

Normal CVP = 7 cm H2O

Normal JVP = 2 cm above sternal angle (angle of Louis)

Term

 

Abdomino-jugular (Hepato-jugular) Reflux

Definition
Term

 

"cv" Wave

on the JV Waveform

Definition

Ddx:

1) Tricuspid regurgitation

 

Phys:

To be cont.

Term

 

 

Venous Hums

over the Jugular Veins

Definition

Ddx:

1) Usually benign (esp. common in children)

2) Hyperdynamic state (e.g. anemia or thyrotoxicosis)

 

Phys:

Caused by blood flow through the internal jugular. Can be distinguished from other murmurs by the fact that it disappears when pressure is placed over the jugular.

 

 

Term

 

 

Right Ventricular Heave

(Parasternal Lift / Impulse)

Definition

Ddx: 

1)

2) Some motion is normal in children < 12

 

Phys:  

Caused by a dilated or hypertrophied right ventricle

Term

 

 

Enlarged Apical Impulse

Definition

Normally the size of a dime

 

Ddx:

1) Arterial hypertension

2) Aortic stenosis

3) Coarctation of the aorta

4) Hypertrophic cardiomyopathy (HCM or HOCM) 

 

 

Phys:

An enlarged apical impulse (like a sustained impulse)

indicates LV hypertrophy. Often this is a response to LV pressure overload.

 

1) Arterial HTN - Increased afterload causes pressure overload of LV

2) Aortic stenosis - Narrowed LV outflow tract (increased afterload) causes pressure overload of LV

3)  Aortic stenosis - Narrowed aorta causes increased afterload which causes pressure overload of LV

4) HCM - Genetically inherited condition of hypertrophy

Term

 

 

Sustained Apical Impulse

Definition

(Often accompanied by a presystolic impulse) 

 

Ddx:

1) Arterial hypertension

2) Aortic stenosis

3) Coarctation of the aorta

4) Hypertrophic cardiomyopathy (HCM or HOCM) 

 

 

Phys:

A sustained apical impulse (like an enlarged impulse) indicates LV hypertrophy. Often this is a response to LV pressure overload.

 

1) Arterial HTN - Increased afterload causes pressure overload of LV

2) Aortic stenosis - Narrowed LV outflow tract (increased afterload) causes pressure of overload of LV

3)  Aortic stenosis - Narrowed aorta causes increased afterload which causes pressure overload of LV

4) HCM - Genetically inherited condition of hypertrophy

Term

 

 

Presystolic Apical Impulse

Definition

A small impulse felt shortly before the normal systolic apical impulse. (Usually accompanied by a sustained apical impulse)

 

Ddx:

 

Phys:

The presystolic impulse is a palpable S4. It occurs when the atria contract into a stiffened LV.

 

 

Term

 

 

Laterally Displaced

Apical Impulse

Definition

Normally located in the mid-clavicular line at the 5th intercostal space

 

Ddx:

1) Mitral regurgitation

2) Aortic regurgitation

3) Patent ductus arteriosus (PDA)

4) Ventricular septal defect (VSD)??

5) Other high-volume states (e.g. thyrotoxicosis, anemia)

 

 

Phys:

A laterally displaced apical impulse indicates a dilated left ventricle. Dilation is due to LV volume-overload.

Term

 

Cardiac Thrill

Definition

A murmur that can be palpated.