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Med Surg: Cardio I - PPT 2
Fall Semester - 2010 (Common Cardiac S&Sx)
105
Medical
Graduate
10/30/2010

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Cards

Term
What are the cardinal sx of presentation of heart conditions? (5)
Definition
Chest pain
Dyspnea
Palpitations
Syncope
Fatigue
Term
Where is the pain of angina located? Does it radiate to any location?
Definition
Retrosternal Region; Radiates to or occasionally isolated to neck, jaw, shoulder, arms (usually left) or epigastrum.
Term
Where is the pain of MI located? Does it radiate to any location?
Definition
Retrosternal Region; Radiates to or occasionally isolated to neck, jaw, shoulder, arms (usually left) or epigastrum.
Term
Where is the pain of Pericarditis located? Does it radiate to any location?
Definition
Left of the sternum; may radiate to neck or left shoulder (often more localized than pain of myocardial ischemia)
Term
Where is the pain of Aortic dissection located? Does it radiate to any location?
Definition
Anterior chest; may radiate to back, iterscapular region
Term
How is the pain of Angina described? (Quality) How long does it last? (Duration)
Definition
Pressure, Squeezing, tightness, heaviness, burning, indigestion
Lasts < 2 - 10min
Term
How is the pain of MI described? (Quality) How long does it last? (Duration)
Definition
SEVERE!!! Pressure, Squeezing, tightness, heaviness, burning, indigestion
Lasts variable lengths but usually > 30 min
Term
How is the pain of Pericarditis described? (Quality) How long does it last? (Duration)
Definition
Sharp, stabbing, knife-like
Lasts many hours to days, may wax and wane
Term
How is the pain of Aortic dissection described? (Quality) How long does it last? (Duration)
Definition
Excruciating, tearing, knifelike
Sudden onset, Unrelenting
Term
What is the pain of angina aggravated by? (Provocative)
Definition
Exertion
Cold Weather
Emotional Stress
May occur early in the morning with no provocation
Term
What is the pain of angina alleviated by? (Palliative)
Definition
Rest
Nitroglycerin
Term
What is the pain of MI aggravated by? (Provocative)
Definition
SEVERE PAIN associated with MI (already bad, can't get worse)
Term
What is the pain of MI alleviated by? (Palliative)
Definition
Cannot be relieved by rest or Nitroglycerin (differentiates MI from Angina)
Term
What is the pain of Pericarditis aggravated by? (Provocative)
Definition
deep breathing
rotating chest
laying supine
Term
What is the pain of pericarditis relieved by? (Palliative)
Definition
sitting up and leaning forward
Term
What are some predisposing factors of Aortic dissection?
Definition
HTN, Marfan syndrome
Term
What will you hear on auscultation during angina pain?
Definition
S3, S4
murmur of papillary dysfunction
Term
What are some associated sx of a MI? (5)
Definition
Dyspnea
Nausea
Vomiting
Weakness
Diaphoresis
Term
What will you hear on auscultation with pericarditis?
Definition
Pericardial friction rub
Term
What findings may appear on PE with aortic dissection?
Definition
murmur of aortic insufficiency
pulse or BP asymmetry
Term
Where is the pain of a PE located?
Definition
Substernal or over region of pulmonary infarction
Term
How is the pain of a PE described? (Quality)
Definition
Pleuritic (with pulmonary infarction)
Angina-like
Term
How long does the pain of a PE last?
Definition
Sudden Onset
Lasts Minutes to hours
Term
What is the pain of a PE aggravated by?
Definition
Deep breathing
Term
What are the associated sx of a PE?
Definition
Dyspnea
Tachypnea
Tachycardia
Hypotension
Hemoptysis (with Pulmonary infarction)
Term
Where is the pain associated with pulmonary hypertension located?
Definition
Substernal
Term
How is the pain associated with Pulmonary HTN described? (Quality)
Definition
Pressure
Oppressive
Term
What is the pain of Pulmonary HTN aggravated by? (Provocative)
Definition
Aggravated by effort
Term
How can the pain of costochondritis be reproduced?
Definition
reproduced with palpation
Term
Where is the pain of a spontaneous pneumothorax located?
Definition
Unilateral
Term
How is the pain of a spontaneous pneumothorax described? (Quality)
Definition
sharp (well localized)
Term
How long does the pain of a Spontaneous Pneumothorax last?
Definition
Sudden onset
Last Many Hours
Term
What is the pain of a spontaneous pneumothorax aggravated by?
Definition
breathing
Term
Where is the pain of a peptic ulcer located?
Definition
Epigastric
Substernal
Term
How is the pain associated with a peptic ulcer described? (quality)
Definition
Visceral
Burning
Aching
Term
What is the pain associated with a peptic ulcer relieved by?
Definition
Food
Antacid
Term
Where is the pain associated with anxiety states located?
Definition
Often localized over precordium; though the location often moves from place to place
Term
What are the BIG SIX risk factors of heart dx?
Definition
Smoking/Tobacco Use
FHx
Age
Hyperlipidemia
Diabetes
HTN (bigger risk for stroke)
Term
How can you lower homocysteine levels? (risk factor for heart dx)
Definition
lowered by taking folic acids
Term
What is the normal BP range?
Definition
<120/80
Term
What is the range of prehypertension?
Definition
Systolic - 120 to 139
Diastolic - 80 to 89
Term
What is the range of Stage 1 HTN?
Definition
Systolic - 140 to 159
Diastolic - 90 to 99
Term
What is the range of Stage 2 HTN?
Definition
>160
>100
Term
What heart condition do diabetes pts have an increased risk of?
Definition
Silent Ischemia, Silent MI
Term
Term that means - an abnormally uncomfortable awareness of breathing?
Definition
Dyspnea
Term
Term that means - Dyspnea upon assuming the supine posture?
Definition
Orthopnea
Term
Term that means - dyspnea occurs only in a lateral decubitus position, most often in patients with heart disease?
Definition
Trepopnea
Term
Term that means - is dyspnea that occurs only in the upright position?
Definition
Platypnea
Term
What are palpitations often a manifestation of?
Definition
Psychiatric Conditions such as depression and panic disorders
Term
With palpitations what arrhythmia has an abrupt onset and termination after several minutes?
Definition
sustained ventricular or supraventricular tachyarrhythmia
Term
Which type of arrhythmia has palpitations described as a gradual onset and termination of a pounding heart beat?
Definition
sinus tachycardia
Term
What are some drugs that can precipitate arrhythmias that can cause palpitations?
Definition
tobacco
caffeine
alcohol
epinephrine
ephedrine
aminophylline
atropine
Term
What noncardiac conditions can cause arrhythmias that can cause palpitations?
Definition
Thyrotoxicosis
Hypoglycemia
Pheochromocytoma
Fever
Term
Term that means - Sudden, transient loss of consciousness?
Definition
Syncope
Term
Term that means - feeling of impending syncope?
Definition
Presyncope
Term
What must the mean arterial pressure be to sustain conciousness?
Definition
60 mmHg
Term
Which class of cardiac illness is described as patients with no limitation of activities; they suffer no symptoms from ordinary activities?
Definition
Class 1
Term
Which class of cardiac illness is patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion?
Definition
Class 2
Term
Which class of cardiac illness is patients with marked limitation of activity; they are comfortable only at rest?
Definition
Class 3
Term
Which class of cardiac illness is patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest?
Definition
Class 4
Term
What type of edema is associated with lymphedema?
Definition
non-pitting
Term
What is pitting edema formed from?
Definition
oncotic or protein
Term
What is the term that describes the chest wall caving in?
Definition
Pectis Excavatum
Term
What is the definition of clubbing?
Definition
Lose the nail-bed angle (Clubbing is a late manifestation)
Term
On PE what are the signs of R sided heart failure?
Definition
JVP height elevated (above 0-3)
Liver Engorgement (Liver Span >6 - 12 along MCL)
Hepato-jugular reflex is elevated (First-sign of R sided HF)
Ascites (noticed very end stage)
Pitting Edema
Term
With jugular venous pulsation what does the A wave correspond to?
Definition
atrial contraction
Term
With jugular venous pulsation what does the C wave correspond to?
Definition
Atrial Kick
Term
With jugular venous pulsation what does the V wave correspond to?
Definition
Ventricular contraction
Term
With jugular venous pulsation what does the x and y decent correspond to?
Definition
filling of the heart before and after ventricular filling
Term
What is arterial pulse a signal of?
Definition
Ventricular contraction
Term
Which type of pulse is described as a small delayed arterial pulse? What condition is it a characteristic of?
Definition
Pulsus Parvus; severe valvular aortic stenosis
Term
Which type of pulse is described as low in amplitude and volume with a delayed peak? What condition is this pulse a characteristic of?
Definition
Pulsus parvus et tardus; Aortic Stenosis or shock
Term
What type of pulse is described as jerky, with full expansion followed by a sudden collapse? What condition is this type of pulse a characteristic of?
Definition
Waterhammer or Corrigan's Pulse; Aortic valve regurgitation
Term
Which pulse is described as characterized by an increase in the velocity of the upstroke and amplitude?
Definition
Hyperkinetic Pulse
Term
Which type of pulse is described as a faint, slow pulse?
Definition
Hypokinetic Pulse
Term
What conditions are hyperkinetic pulses associated with?
Definition
anxiety, exercise, fever, thyrotoxicosis, hypertension, aortic regurgitation, arterio-venous fistula, and patent ductus arteriosus
Term
Which type of pulse is described as diminished unilaterally or bilaterally, often with systolic bruit? What condition is this pulse associated with?
Definition
Pulse Differens; Extracranial carotid stenosis due to atherosclerosis
Term
Which type of pulse is described as an exaggeration of normal variation of the pulse which weakens during inspiration? What conditions is this type of pulse associated with?
Definition
Pulsus Paradoxus; Cardiac tamponade, Pericarditis, COPD, Asthma
Term
Which type of pulse is described as double-peaked with rapid rise (or double peaked with normal or delayed rise)? What conditions is this pulse associated with?
Definition
Biferiens Pulse; Hypertrophic Cardiomyopathy or Combined aortic regurgitation and stenosis
Term
Which type of pulse is described as a beat-to-beat variation in the amplitude of the pressure pulse? What condition is this pulse associated with?
Definition
Pulsus Alterans; depression in left ventricular systolic function
Term
Where is the PMI palpated?
Definition
5th Intercostal space along the MCL
Term
What term is described as a sustained, systolic outward movement of the precordium? What condition is this a sign of?
Definition
Lift/Heave; indicative of cardiomegaly or heart failure
Term
What term is described as a vibration (like a cat purring) felt when a cardiac murmur is grade IV-VI / VI?
Definition
Thrill
Term
Which valves are responsible for S1 heart sound?
Definition
mitral/tricuspid
Term
Which valves are responsible for S2 heart sound?
Definition
aortic/pulmonic
Term
What type of gallop is S3?
Definition
Ventricular gallop (3 = three syllables = sys to le)
Term
What type of gallop is S4?
Definition
Atrial gallop
Term
Which valve makes an opening-snap sound?
Definition
Mitral
Term
With what condition are friction rubs heard?
Definition
Pericardial effusion
Term
Which type of murmurs are nearly all pathologic?
Definition
diastolic murmurs
Term
Which type of murmurs are nearly all benign?
Definition
systolic murmurs
Term
Is mitral regurgitation a systolic or diastolic murmur?
Definition
systolic
Term
Is tricuspid regurgitation a systolic or diastolic murmur?
Definition
systolic
Term
Is Ventricular Septal Defect a systolic or diastolic murmur?
Definition
systolic
Term
Is aortic stenosis a systolic or diastolic murmur?
Definition
systolic
Term
Is pulmonic stenosis a systolic or diastolic murmur?
Definition
systolic
Term
Is aortic regurgitation a systolic or diastolic murmur?
Definition
diastolic
Term
Is pulmonic regurgitation a systolic or diastolic murmur?
Definition
diastolic
Term
Is mitral valve stenosis a systolic or diastolic murmur?
Definition
diastolic
Term
Is tricuspid valve stenosis a systolic or diastolic murmur?
Definition
diastolic
Term
With inspiration what happens to blood flow into the heart? How does this affect murmurs?
Definition
More blood flows into the right side of the heart; More blood flow causes a split of S2,because the pulmonary valve is delayed in closing. All right sided murmurs become louder with inspiration
Term
Which murmurs are accentuated by standing?
Definition
hypertrophic cardiomyopathy and mitral valve prolapse (both left sided dealing with systole)
Term
What effect does the valsalva maneuver have on blood flow in the heart?
Definition
Diminishes RV and LV filling
Term
What effect does the valsalva maneuver have on murmurs?
Definition
Since it diminishes flow, it diminishes most murmurs, except for hypertrophic cardiomyopathy and mitral valve prolapse
Term
What does squatting do to most murmurs?
Definition
Increases venous return and arterial resistance which causes an increase in most murmurs (except hypertrophic cardiomyopathy and mitral valve prolapse)
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