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PE Skills cardiovascular
cardiovascular
97
Anatomy
Graduate
10/23/2010

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Term
Angina:
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
movement or palpation
Term
some causes of chest pain:
Definition
- angina
- chest wall pain
- esophageal spasm
- pleurisy
- neurologic
Term
pleurisy hurts more with:
Definition
- breathing in
Term
orthopnea:
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
pectus excavatum:
Definition
chest caved in a little, moves heart more over to the side
Term
barrel chest:
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
2/3
upper arm
3/4
Term
pulse presure =
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
- retinal artery
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
murmur
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
S1
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
S1
Term
which heart sound does the pulse follow?
Definition
S1
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
M1 and T1
Term
DUB, or S2, is made of:
Definition
A2 and P2
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
S2
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
- diastolic
- low
Term
above 100 bmp:
Definition
tachycardia
Term
below 60 bpm:
Definition
bradycardia
Term
with aoritic regurgitation, the S2 is sound will be ____.
Definition
dampened
Term
time frame of ___ is less than ___.
Definition
lub L1 less than dub L2
Term
tricuspid regurg, and mitral regurg are systolic murmurs. Aortic and pulmonic regurgiation are diastolic murmurs.
Definition
Term
Bruits:
Definition
Term
Grading pulse:
Definition
+4= bounding
+3= full or increased
+2= expected or normal
+1= diminished or barely palpable
0= absent or not palpable
Term
Pulsus alternans:
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
Bigeminal pulse:
Definition
similar to alternans
smaller interval b/w big and little beat
IRREGULAR
Term
Pulsus paradoxus:
Definition
pulse wave decreases during inspiration
Term
Bounding pulse:
Definition
thyroid disease
hypertension
Term
water hammer pulse:
Definition
sharp amplitude followed by descent
Term
femoral pulse is where?
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
grading edema:
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
jugular veins
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
- right atrium
Term
CVP is high when pulse wave is more than 3 cm above the sternal angle
Definition
Term
Kussmaul's sign:
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
Hand vein technique:
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
tricuspid:
Definition
4th intercostal space
Term
mitral:
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
abnormal
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
- apex
- short
- low
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
apex
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
- higher
Term
Murmur characteristics:
Definition
- timing
- duration
- pitch
- location
- radiationG
Term
Grading a murmur:
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
- increases
Term
hyperdynamic state like hyperthyroidism will have increased blood so increased intensity of murmur.
Definition
Term
shapes of murmurs:
Definition
crescendo
decrescendo
crescendo-decresendo aka diamond shaped
pan or holo
combinations of the above
Term
Types of murmurs:
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
Innocent murmur:
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
innocent murmur
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
To-Fro murmur
Term
Bruit is turbulent blood flow in an artery. Venous hum is turbulent blood flow within a vein.
Definition
Term
Rub:
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
- high
- low
Term
Systolic click is a __ pitched sound in systole, can be early, mid or late. This is associated with a diseased ___ valve.
Definition
- mitral
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