Term
|
Definition
- due to lack of oxygenation to heart tissues
- dull, heavy, crushing
- predictable with exercise
- relieved with rest |
|
|
Term
| chest wall pain gets worse with: |
|
Definition
|
|
Term
| some causes of chest pain: |
|
Definition
- angina
- chest wall pain
- esophageal spasm
- pleurisy
- neurologic |
|
|
Term
| pleurisy hurts more with: |
|
Definition
|
|
Term
|
Definition
| difficulty breathing when lying flat |
|
|
Term
| Three positions for a heart exam: |
|
Definition
- sitting erect and leaning foward
- recumbent (laying supine)
- left lateral ducubitus position- laying on left side with left arm up around head, right arm on side, rolled slightly foward, very important for hearing mitral regurgitation |
|
|
Term
| left lateral decubitus position is important to hear: |
|
Definition
| - mitral valve regurgitation |
|
|
Term
|
Definition
| chest caved in a little, moves heart more over to the side |
|
|
Term
|
Definition
1:1 ratio
diminished heart sounds |
|
|
Term
| when measuring blood pressure, choose a cuff not more than ___ the length of the ___ ___. The bladder length needs to be ___ the circumference of the arm. |
|
Definition
|
|
Term
|
Definition
| systolic pressure- diastolic pressure |
|
|
Term
| Orthostatic vitals: blood pressure and pulse need to be taken while supine and when standing. Wait 1 minute b/w the measures. If bp falls more than 20 mm Hg, need to be concerned |
|
Definition
|
|
Term
| cyanosis is a sign of reduced ___. Palor is indicative of reduced ___. Erythema is indicative of ___ ___ poisoning. |
|
Definition
- oxygen
- circulation
- carbon monoxide |
|
|
Term
| Diabetics tend to lose their leg hair b/c of reduced circulation. |
|
Definition
|
|
Term
| which vessel do you see on a routine physical exam? |
|
Definition
|
|
Term
| in normal state, apical impulse is where? |
|
Definition
- 5th intercostal space at midclavicular line
- should be point of maximal impulse in normal state, may not be in diseased state |
|
|
Term
| The ___ pulse and ___ impulse should be happening at the same time. |
|
Definition
- carotid pulse
- apical impulse |
|
|
Term
| vibrations and thrills are sign of : |
|
Definition
|
|
Term
| percussion has little value with cardio exam. |
|
Definition
|
|
Term
| Listen to all heart sounds while patient is sitting and supine, only have to listen to mitral area in left lateral decubitus position. |
|
Definition
|
|
Term
| heart sound associated with contraction of ventricles? |
|
Definition
|
|
Term
| The S1 sound is associated with contraction of the ventricles and is caused by what valves closing? |
|
Definition
| - AV valves (mitral and tricuspid) |
|
|
Term
| which heart sound marks the beginning of systole? |
|
Definition
|
|
Term
| which heart sound does the pulse follow? |
|
Definition
|
|
Term
| lub-dub are medium to high pitched sounds |
|
Definition
|
|
Term
| 2nd heart sound marks the ___ ___ ___ and is caused by the closure of the __ and ___ valves. |
|
Definition
- end of systole
- aortic and pulmonic valves |
|
|
Term
| S1 is really two sounds really close together, the sound of the mitral valve and the tricuspid valve closing, so S1 is made of: |
|
Definition
|
|
Term
|
Definition
|
|
Term
| which sound is heard louder at the apex? |
|
Definition
| S1 (b/c sound reflects back from a closed valve) |
|
|
Term
| which sound is louder at the base? |
|
Definition
|
|
Term
| The 3rd heart sound is associated with __ ___, while the 4th heart sound is associated with __ ___. |
|
Definition
3rd= atrial emptying, beginning of ventricular filling
4th= atrial contraction/kick, end of ventricular filling |
|
|
Term
| the 3rd and 4th heart sounds are ___ sounds and are __ pitched. If these are heard, consider heart disease. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| with aoritic regurgitation, the S2 is sound will be ____. |
|
Definition
|
|
Term
| time frame of ___ is less than ___. |
|
Definition
|
|
Term
| tricuspid regurg, and mitral regurg are systolic murmurs. Aortic and pulmonic regurgiation are diastolic murmurs. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
+4= bounding
+3= full or increased
+2= expected or normal
+1= diminished or barely palpable
0= absent or not palpable |
|
|
Term
|
Definition
| - regular rhythm, but get one big one and then a little one, weakness of myocardial muscle could be serious heart disease but needs more tests |
|
|
Term
|
Definition
similar to alternans
smaller interval b/w big and little beat
IRREGULAR |
|
|
Term
|
Definition
| pulse wave decreases during inspiration |
|
|
Term
|
Definition
thyroid disease
hypertension |
|
|
Term
|
Definition
| sharp amplitude followed by descent |
|
|
Term
|
Definition
| at a point midway between the ASIS and symphis pubis, inferior to inguinal ligament |
|
|
Term
| signs of arterial insufficiency: |
|
Definition
Pulselessness
Pallor
Paresthesia
Paralysis
Pain
Painful ulceration
Hair loss |
|
|
Term
| signs are arterial disease: |
|
Definition
Pulselessness
Pallor
Paresthesia
Paralysis
Pain
Painful ulceration
Hair loss |
|
|
Term
| sign of venous insufficiency: |
|
Definition
- non painful ulcers
- vericosities
- hemosiderin staining
Venous stasis
Edema
Ulcers
Dermatitis
Hemosiderin staining |
|
|
Term
| other tests for cardiovascular disease: |
|
Definition
Edema
Clubbing
Jugular Venous Pressure (distention)
Abdominojugular Reflux
Homan’s Sign |
|
|
Term
|
Definition
|
|
Term
Pitting edema
“Plus one” (2 mm)
“Plus two” (4 mm)
“Plus three” (6 mm)
“Plus four” (8 mm) |
|
Definition
|
|
Term
| edema of legs can be secondary to heart failure |
|
Definition
|
|
Term
| which vein does not contain valves? |
|
Definition
|
|
Term
| Measuring jugular venous pressure (JVP) provides an indication of the pressure that is in the ___ ___, which can become abnormally elevated in certain disease states. |
|
Definition
|
|
Term
| CVP is high when pulse wave is more than 3 cm above the sternal angle |
|
Definition
|
|
Term
|
Definition
- mean jugular venous pressure increases during inspiration
- consider constrictive pericarditis |
|
|
Term
| Hepatojugular reflux sign: |
|
Definition
- better named abdominojugular reflux sign
- slow steady pressure to midabdomen for 15 seconds resulting in an increase in JVP greater than 3 cm water sustained for more than 15 seconds |
|
|
Term
| Homan's sign may indicate: |
|
Definition
deep vein thrombosis
- first support patients thigh and foot, then slightly bend knee and firmly and abrubptly dorsiflex ankle. Deep calf pain is a positive Homan's sign. |
|
|
Term
| jugular venous pressure measurement: |
|
Definition
| - with head of bed elevted at 45 degrees, or use hand vein technique with patient supine to estimate |
|
|
Term
|
Definition
Venous pressure may be estimated by examining the veins in the dorsum of the hand.
With a patient lying or sitting in a 30° elevation or greater, the arm is slowly and passively raised from a dependent position. When the venous pressure is normal, the veins collapse when the dorsum of the hand reaches the level of the angle of Louis.
A local venous obstruction or augmented peripheral venous constriction may diminish the accuracy of estimating CVP by this method. |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 5th intercostal space at midclavicular line |
|
|
Term
| first heart sound is ___ pitched, __ duration, ___ intensity, best heard at the ____. |
|
Definition
- high
- short
- normal
- apex |
|
|
Term
| Second heart sound is ___ pitched, ___ duration, ___ intensity, and best heard at the ___. |
|
Definition
- high
- short
- normal
- base |
|
|
Term
| Splitting of S1 is always ___. |
|
Definition
|
|
Term
| physiological splitting of S2: |
|
Definition
- normal
- occurs during inspiration due to pressure changes
- due to delayed closure of pulmonic valve after aortic valve
- best heard at 2nd-4th LICS |
|
|
Term
| Paradoxical splitting of S2: |
|
Definition
- always abnormal
- during expiration only
- could b due to conduction defects or pulmonary hypertension |
|
|
Term
| persistent splitting of S2: |
|
Definition
- splitting persists during inspiration and expiration
- persistent wide, fixed splitting is abnormal
- consider conduction defects |
|
|
Term
| S3 occurs just after S2, and its best heard at the ___. It is ___ duration, __pitched, with a dull thud-like quality. |
|
Definition
|
|
Term
| First rule is that S3 and S4 is abnormal until proven abnormal. |
|
Definition
|
|
Term
S3 gallop and EKG shows thickening of heart wall= left ventricular heart disease or early signs of congestive heart failure
If you hear S4- probably disease |
|
Definition
|
|
Term
| S4 occurs just before S1, heard best at the ____ . |
|
Definition
|
|
Term
S4 almost always associated with disease
Non-compliant ventricular wall
Consider HTN, CHF, CAD, other heart disease
Intensity varies according to etiology
Sometimes confused as a split S1 or an “opening snap”
Split S1 is higher-pitched than S4
Opening snap is higher-pitched than S4 |
|
Definition
|
|
Term
S3 and S4
A gallop is always considered abnormal
Evaluate the patient for heart disease |
|
Definition
|
|
Term
| characteristics of a murmur are affected by ___ and ___. High pitched murmurs are associated with ___ pressure. Low pitched murmurs are associated with ___ pressures. |
|
Definition
- volume and pressure
- higher
- lower |
|
|
Term
| Because the left side of the heart has more pressure, left sided murmurs are __ pitched. |
|
Definition
|
|
Term
|
Definition
- timing
- duration
- pitch
- location
- radiationG |
|
|
Term
|
Definition
Grade I - barely audible in a quiet room (“very faint”)
Grade II - heard with careful aid of the stethoscope
Grade III - heard easily and considered moderately loud
Grade IV - grade III, plus a palpable thrill
Grade V - loud and associated with easily palpable thrill
Grade VI - audible with stethoscope off chest, associated with a visible and palpable thrill |
|
|
Term
| Intensity of a murmur is influenced by: |
|
Definition
- pressure
- blood viscosity
- blood volume
- lesion
- obesity, chest shape |
|
|
Term
| As viscosity decreases, intensity of a murumur ____. |
|
Definition
|
|
Term
| hyperdynamic state like hyperthyroidism will have increased blood so increased intensity of murmur. |
|
Definition
|
|
Term
|
Definition
crescendo
decrescendo
crescendo-decresendo aka diamond shaped
pan or holo
combinations of the above |
|
|
Term
|
Definition
- ejection murmurs
- regurgitant murmurs
- continuous murmurs |
|
|
Term
| Ejection murmurs are associated with ___. Regurgitation murmurs can be ___ or ___. Continous murmurs are associated with ___ in the ___ ___ (atrialseptal defect or ventricular defect). |
|
Definition
- systole
- systole or diastole
- defects in heart wall |
|
|
Term
|
Definition
- pediatric patients, pts with thin chest, young athletic person, pregnancy due to increased blood flow, anemia due to decreased viscosity
- GRADE II OR LESS TO BE INNOCENT
- HEARD BEST AT LEFT STERNAL BORDER, MEDIUM PITCHED, SHORT DURATION, SOFT QUALITY
- S2 IS NORMAL
- MAY BE ENHANCED BY MANEUVERS THAT INCREASE BLOOD FLOW
- MAY DISAPPEAR WHILE THE PATIENT IS SITTING |
|
|
Term
| So a patient has a soft grade II murmur. You lay them down and lift up their legs and the murmur intensity increases. When they sit up the murmur goes away. What kind of murmur is this? |
|
Definition
|
|
Term
| Systolic ejection murmurs are also called ___ ____ murmurs. What are the three types of this murmur? |
|
Definition
- outflow obstruction
1. aortic stenosis
2. pulmonary stenosis
3. IHSS (Idiopathic Hypertrophic Subaortic Stenosis) |
|
|
Term
| With IHSS, there is too much muscle under the aortic valve, so blood leaving the ventricle will cause turbulence> murmur |
|
Definition
|
|
Term
| With IHSS, the bundle of His is also involved so that conduction is harmed, this is what causes sudden death on football field |
|
Definition
|
|
Term
| Standing and squatting is useful in diagnosing IHSS b/c this should increase blood to heart,and if IHSS the murmur gets softer when this happens and gets louder when the patient is standing. It is opposite for an innocent murmur. |
|
Definition
|
|
Term
| Regurgitant murmurs aka ___ murmurs. |
|
Definition
- backflow
Mitral regurgitation
Aortic regurgitation
Pulmonic regurgitation
Tricuspid regurgitation |
|
|
Term
| Type of regurgitant murmur where you have aortic stenosis with regurgitation: |
|
Definition
|
|
Term
| Bruit is turbulent blood flow in an artery. Venous hum is turbulent blood flow within a vein. |
|
Definition
|
|
Term
|
Definition
Associated with movement of heart within the inflamed pericardial sac
A rub may occur in any or all phases of the heart cycle
A rub may disappear as effusion develops
Think Pericarditis! |
|
|
Term
| Opening snap is __ pitched and means the ___ valve is diseased. It can be confused as a __ __ or as ___. |
|
Definition
- high
- aortic
- split S1
- S4 |
|
|
Term
| You can tell and opening snap is not S4, b/c an opening snap is __ pitched and S4 is ___ pitched. |
|
Definition
|
|
Term
| Systolic click is a __ pitched sound in systole, can be early, mid or late. This is associated with a diseased ___ valve. |
|
Definition
|
|
