Term
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Definition
Aortic regurgitation
Early diastolic decresendo |
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Term
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Definition
S3 sounds
Mnemonic: SLOSH’-ing-in
S1 - - - S2 - S3
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Term
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Definition
S4
Mnemonic: A-STIFF WALL = S4-S1 ... S2 |
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Term
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Definition
| S2 split (physiologically normal if during inhalation, paradoxical if during exhalation) |
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Term
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Definition
Late aortic stenosis
Late systolic murmur |
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Term
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Definition
Mitral stenosis (diastolic murmur)
More common in female, associated with rheumatic disorder. Best heard at the apex with little radiation.
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Term
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Definition
| Mitral regurgitation (systolic murmur) |
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Term
| What are possible causes for paradoxical reversal of the S2 split? |
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Definition
- Left bundle block = delays activation of left ventricle, and, consequently, aortic closing
- Aortic stenosis = delays aortic closing
- Hypertrophy of cardiac muscle
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Term
| Patient complains of mild to moderate pressing/squeezing in retrosternally, radiating to shoulders, arms, neck, lower jaw and upper abdomen. Pain is 1-3 minutes, on occasion 10-20. What is this condition called? Underlying cause? Aggravating factors? |
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Definition
- Angina pectoris
- Temporary myocardial ischemia, usually secondary to coronary stenosis
- Exertion (in cold), meal, emotional stress
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Term
| Patient complains of moderate pressing/squeezing in retrosternally, radiating to shoulders, arms, neck, lower jaw and upper abdomen. Pain is over 20 minutes in duration. What is this condition called? Underlying cause? |
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Definition
| Myocardial infarction; prolonged myocardial ischemia (similar to angina, but longer duration) |
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Term
| Patient presents with a persistent, severe pain that he describes as "knifelike". Pain is precordial, radiating to tip of shoulder and neck. What is this condition called? Underlying cause? Aggravating and relieving factors? |
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Definition
- Pericarditis
- Irritation of parietal pleua adjacent to pericardium
- Breathing, changing position, coughing, lying down
- Sitting forward
Note: when mechanism is unclear, pain is retrosternal, crushing |
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Term
| Patient describes a ripping/tearing pain in his anterior chest, radiating to his neck, back and abdomen. Pain is excrutiating, arriving suddenly and persisting for hours. Patient has history of hypertension. What is the most likely underlying condition? The pathophysiology? Associated symptoms? |
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Definition
- Dissecting aortic aneurysm
- Splitting within the layers of the aortic wall, allowing passage of blood to dissect channel.
- Syncope, hemiplegia, paraplegia
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Term
| Patient comes in complaining of right chest pain thats relieved by lying on right side. Pain occurs with coughing, and is described as a mild burning. What is the most likely cause? |
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Definition
| Tracheobronchitis (inflammation of trachea and large bronchi) |
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Term
| What cardiac disease can cause dyspnea? What are symptoms that increase specificity? |
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Definition
Left-sided heart failure leading to increased pulmonary capillary bed pressure, decreased compliance, and, potentially, acute pulmonary edema.
Specifically, aggravated by lying down (orthopnea) and wakens patient at night (paroxysmal nocturnal dyspnea). Relieved by rest and sitting up. |
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Term
| What are four questions a physician can ask to generate a differential diagnosis spurred by various symptoms (chest pain, dyspnea, fatigue, edema, etc) |
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Definition
CAAR
- Chronology - how long does the pain persist? How often does it occur?
- Associated symptoms - SOB, cough, diaphoresis (sweating), neausea, vomiting
- Aggrevating factors - eating, exercise, stress, posture
- Relieving Factors – rest, food, antacids, posture, nitroglycerin
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Term
| What is considered a high jugular venous pressure? How is it measured? What does this indicate? |
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Definition
- >4 cm above sternal angle, or >9 cm above right atrium
- With patient in 30 degree incline, measure highest oscillation point (meniscus) of right jugular; bring to higher incline if pressure is low and vice versa
- High pressure = right heart failure, low pressure = left heart failure
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Term
| How does jugular venous pulsation relate to the cardiac cycle? |
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Definition
Four events (atrial contraction, atrial relaxation, atrial filling, atrial empyting) correspond to "A" distension, "X" collapse, "V" distension, "Y" collapse.
[image]
See also: YouTube video |
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Term
| What are some possible abnormalities that can present in the carotid pulse? |
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Definition
- Pulsus tardus - slow upstroke of pulse pressure
- Pulsus parvus - low amplitude of pulse pressure
Note: aortic stenosis can cause both of these. |
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Term
| How does the carotid pulse relate to the cardiac cycle? |
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Definition
Upstroke (sudden) = aortic opening (correlates with S1)
Downstroke (smooth) = ventricular relaxation |
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Term
| In what circumstances is a "split" heart sound normal? |
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Definition
S2 during inhalation
Increased capacitance in pulmonary vascular bed prolongs ejection of blood from right ventricle. This delays closing of pulmonic valve.
Note: pulmonic valve closing is generally quieter than aortic valve. |
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Term
| You listen to a patients chest at the left 5th intercostal space, midclavicular. You hear a harsh, holosystolic murmur. S1 sounds are slightly diminished, with a regular beat occuring after S2. What is the most likely pathology? Which area of the heart are you listening to? What causes the diastolic sound? |
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Definition
- Mitral regurgitation- valve fails to close in systole, causing systolic regurgitation of blood from LV --> LA
- Apex
- S3 caused by volume overload on left ventricle
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Term
| You listen to a patients chest at the left 5th intercostal space, midclavicular. You hear a low-pitched rumble during diastolsis, preced by an opening "snap." S1 is accentuated. What is the most likely cause? Which area of the heart are you listening to? |
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Definition
- Mitral stenosis - thickening of mitral valve leaflets, preventing complete opening. Two component: middiastolsis and pressystolsis.
- Apex
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Term
| You listen to a patients chest at the 2nd-4th interspace, close to the right sternal border. You here a high pitched diastolic murmur, and ask the patient to sit leaning forwards. What is the most likely pathology? What would be an indication of severe pathology? What are some associated findings? |
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Definition
- Aortic regurgitation- leaflets of aortic valve fail to close completely during diastole, leading to back flow and volume overload on left ventricle.
- S3 or S4 (ventricular overload and increased resistance to ventricular filling, respectively)
- Increase pulse pressure, large and bounding arterial pulse, lateral and downward displacement, widened diameter
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Term
| You listen to the patient's right, 2nd intercostal space, noticing a systolic murmur that increases in volume, climaxing midsystole, before quieting. There's an S2 split during exhalation. You ask the patient to sit and lean forward. What is the most likely pathology? What causes the parodoxical split? What would you see if you looked at the carotid pulse? |
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Definition
- Aortic stenosis (congenital, rheumatic, degenerative)
- Premature closure of the aortic valve
- Delayed upstroke and decreased amplitude
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Term
| When listening to the left intercostal spaces (2nd-4th), you notice a soft pitched, midsystolic murmur. There is no ejection sounds, paradoxical splitting, or diastolic murmur. What is the most likely cause? |
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Definition
| Turbulent blood flow, most likely generated by ventricular ejection of blood into the aorta. (Innocent murmur) |
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Term
| How can you distinguish arterial from venous diseases? |
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Definition
- Arterial = lessened blood flow causing cool limbs, less hair, reduced/absent pulses, painful ulcers, gangrene
- Venous = varicose veins, dilation or peripheral edema, hyperpigmentation, painless ulcers
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Term
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Definition
Aortic regurgitation
Early diastolic decresendo |
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Term
| Distinguish true claudication from pseudoclaudication |
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Definition
- True claudication = Exertional aching pain, cramping tightness fatigue. Occurs in muscle groups (not joints). Due to peripheral vascular disease from atherosclerosis
- Pseudoclaudication = changes over time that may occur at rest; palpable distal pulses. Most commonly caused by lower back problems
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Term
| Distinguish chronic peripheral arterial disease from acute |
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Definition
- Chronic: legs are cool with less hair growth, pale nail beds, painful ulcers. Peripheral pulses are diminished
- Acute: due to platelet plug or thrombus. Less blood flow, pallor absent pulses, pain, paresthesias, loss of function
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Term
| What is the grading system fro peripheral pulses? |
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Definition
- 0 = absent
- 1+ = barely palpable
- 2+ = normal
- 3+ = enlarged
- 4+ = aneurysmal
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