Term
| what are the the words often used to describe chest pain? |
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Definition
| tightness, gripping, burning, vice-like, pressure, indigestion, and "elephant sitting on my chest" |
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Term
| where might the chest discomfort radiate? |
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Definition
| sub-xiphoid radiates to -> neck, lower jaw, either arm (usually L), into the back |
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Term
| what times would you ask the pt when they experience the chest discomfort? |
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Definition
| exertion, anxiety, cold weather, postprandial, sex |
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Term
| what is the classic female chest pain presentation? |
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Definition
| anxiety, depression, insomnia, SOB, fatigue, restlessness (older women with DM are perfect targets for atypical presentations) |
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Term
| what is the classic male chest pain presentation? |
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Definition
| chest discomfort, SOB, (pts w/DM w/neuropatht may not be able to "feel pain") |
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Term
| what is angina pectoris? when does it occur? |
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Definition
| recurring chest pain/discomfort that happens when the heart is not receiving enough blood - occurs during exertion activities, anxiety/stress, environmental (cold weather/high alt) |
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Term
| what is the effect of angina pectoris? how is it relieved? |
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Definition
| increased HR, systolic BP and myocardial O2 demand. it can be relieved by rest w/in minutes (lasting no longer than 20 min) |
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Term
| what are the three types of CAD? |
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Definition
| fixed obstructive, variant/prinzmetal, and mixed |
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Term
| what is fixed obstructive CAD? |
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Definition
| this is the classic way for angina to present - involves one or more of the major coronary arteries being 70% or more occluded - causing discomfort upon exertion |
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Term
| what is variant/prinzmetal CAD? |
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Definition
| pure spasm of coronary artery disease, rare - makes up 1%. happens during early waking hours w/minimal activity |
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Term
| what is mixed disease CAD? |
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Definition
| obstruction w/at least 50% occlusion w/spasms at the site of the obstruction - quite lethal |
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Term
| other that ischemia, what are other possible causes of angina pectoris? |
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Definition
| severe systolic HTN (LVH) and valvular heart disease (aortic stenosis, idiopathic hypertrophic subaortic stenosis, increased volumes), and congenital abnormalities |
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Term
| who gets angina pectoris? |
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Definition
| young males and elderly males/females |
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Term
| what are "anginal equivalents" that may not be angina, but correlated with CAD? |
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Definition
| fatigue, shortness of breath (usually with obese, females, and DM), females: fatigue, depression, dyspnea |
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Term
| what are good questions to ask in terms of the shortness of breath issue? |
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Definition
| do you have orthopnea? (SOB withn lying flat) - pts will add pillows to compensate. do you have proximal nocturnal dyspnea (wake up short of breath - due to left ventricular dysfunction or ischemic heart disease, HTN), and do you have swelling/edema in the legs (reflects R side of the heart, manifested by lack of lung circulation). do you have palpitations (awareness of heart beat - significant if the pt co-presents with light headedness/dizziness/passing out) |
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Term
| what are the major risk factors for CAD? |
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Definition
| smoking, HTN, DM, high cholesterol |
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Term
| what are the minor risk factors for CAD? |
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Definition
| obesity, family hx (father died of MI @ 40-50, mother at 50-60), gout, increased CRP, triglyceridemia, sedentary lifestyle, type A personality |
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Term
| what is a good question to ask pts about pain in the legs related to PAD? |
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Definition
| when you walk up a hill, do your calves hurt? |
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Term
| what is the most common cause of ED? |
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Definition
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Term
| is sharp radiating pain CAD? |
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Definition
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Term
| when taking an ABI, what should be higher? |
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Definition
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Term
| what does it mean if you see cholesterol deposits in pts eyes? |
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Definition
| they have those deposits everywhere |
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Term
| what veins are checked for distension? |
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Definition
| the internal is more accurate, but the external can be used for heavier pts |
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Term
| what is the normal neck distension for pts? where is this taken? what does this, if distended indicate? |
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Definition
| 5 cm. it is taken 1/2 way up the neck - if distented - this indicates a R sided heart dysfunction |
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Term
| if a pt presents with SOB and lower extremity edema, but no neck vein distension is this a R sided heart problem? |
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Definition
| no - likely a pelvic obstruction |
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Term
| what is the hepatojugular reflux test? |
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Definition
| apply subhepatic pressure for 10-60 sec, have the pt breathe slowly though their mouth - if you see the neck veins fill from the bottom up and remain up - this is consistent with R ventricular dysfunction |
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Term
| what is the kussmaul sign? |
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Definition
| neck vein distention with inspiration and expiration - sign of pericardial effusions |
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Term
| what is the difference between angina pectoris and an MI? |
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Definition
| TIME - angina discomfort that is not relieved by nitroglycerine is either unstable angina or an MI |
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Term
| what is normal pulse pressure? |
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Definition
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Term
| what does the A wave correspond with? what sound? where is it heard best? |
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Definition
| atrial contraction, the 4th heart sound, heard best in the L lateral position (listen w/bell - low pitched) |
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Term
| what are "regular" a waves caused by? |
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Definition
| pulmonic stenosis, aortic stenosis, tricuspid stenosis, mitral stenosis, HTN, IHSS (idiopathic hypertrophic subaortic stenosis), ischemic heart disease, and aging |
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Term
| what are "large" a waves caused by? |
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Definition
| atrial flutter (2 atrial contractions to every ventricular contraction) and paroxysmal tachycardia (2 P waves for each QRS) |
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Term
| what are "cannon" a waves caused by? |
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Definition
| 3rd degree heart block - atria and ventricles not contracting together |
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Term
| what is the C wave caused by? |
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Definition
| isovolumetric contraction |
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Term
| what is the X descent caused by? |
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Definition
| early and rapid atrial filling (agate pericardial tamponade) - consistent with *acute pericardial effusions |
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Term
| what is the V wave caused by? |
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Definition
| right ventricular volume overload, tricuspid regurgitation |
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Term
| what is the Y descent caused by? |
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Definition
| late atrial filling associated with *chronic pericardial effusion seen with SLE, chronic renal failure, and metastatic disease |
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Term
| if the carotid upstroke is rapid upstroke, rapid decline; what may this be indicative of? |
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Definition
| aortic regurgitation (pt may present with SON, hx of rheumatic fever) |
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Term
| if the carotid upstroke is slow upstroke, slow decline; what may this be indicative of? |
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Definition
| bilateral carotid bruits, aortic stenosis - generally seen in pts 70-80 yrs old |
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Term
| if the carotid upstroke is rapid upstroke, slow/delayed decline; what may this be indicative of? |
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Definition
| IHSS (idiopathic hypertrophic subaortic stenosis) - may be be young person with family hx of sudden death, who had syncope during time of stress |
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Term
| if the carotid upstroke is slow upstroke, normal decline; what may this be indicative of? |
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Definition
| person w/a stroke (facial droop, etc - can have a unilateral beat) |
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Term
| where is the apex of the heart? how big should it be? |
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Definition
| 4-5th intercostal space in the midclavicular line - should only be no bigger than a 1/2 dollar |
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Term
| where is S1 heard? S3? S4? |
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Definition
| all in the apex of the heart |
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Term
| how are S1, 3, and 4 sounds separated if they all are heard in the apex of the heart? |
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Definition
| S1 is enhanced by inspiration. S3 is best heard in the L lateral recumbent position (big heart - floppy ventricle). S4 correlates with atrial sounds (small heart - barely palpable). |
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Term
| what part of the heart is under the sternum? should you be able to feel it? |
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Definition
| the R ventricle - should not be palpable |
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Term
| what is under the 3rd intercostal space and midclavicular line? should you be able to feel it? |
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Definition
| the L atrium - should not be able to feel; indicative of mitral stenosis/regurgitation |
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Term
| what happens with the S2 sound? |
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Definition
| the aortic and pulmonic valves close (aortic first) |
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Term
| what is paradoxical splitting of S2? what is it caused by? |
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Definition
| this means the aortic/pulmonic valves are together for inspiration, but apart for expiration. it can be caused by pulmonary HTN, LBBB, and transvenouse pacemaker |
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Term
| what is fixed splitting of S2? what is it caused by? |
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Definition
| the aortic and pulmomic valves don't move together for inspiration or expiration. it can be caused by atrial septal defects |
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Term
| what is wide splitting of S2? what is it caused by? |
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Definition
| big volumes that delay closure - loud S2 sounds - caused by aortic regurgitation, patent ductus arteriosis |
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Term
| how many significant murmurs are there? how are they divided? |
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Definition
| 10; divided in to 5 early to late, 2 mid to late and 3 late |
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Term
| what are the 5 early to mid systolic murmurs? |
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Definition
| pulm stenosis, tricuspid regurg, atrial septal defect, IHSS, acute mitral regurg |
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Term
| what are the 2 mid to late systolic murmurs? |
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Definition
| aortic stenosis, mitral valve prolapse |
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Term
| what are the 3 late holosystolic murmurs? |
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Definition
| mitral regurg, tricuspid regurg, ventricular septal defects |
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