Term
| When the AV valve closes what sound do you hear? (S1, S2, S3 or S4). Is this systole or diastole |
|
Definition
| AV closure then systole of the ventricles occurs resulting in S1 and the QRS on ECG |
|
|
Term
| What valve is associated with S2 |
|
Definition
|
|
Term
| What valves are associated with S2 |
|
Definition
|
|
Term
| what causes a heart murmur |
|
Definition
| attributed to turbulent blood flow. Usually has a component of valve disease. |
|
|
Term
| what are the major factors that influence blood pressure |
|
Definition
1. Stroke volume
2. distensibility of the aorta and large arteries in the entire system
3. peripheral vascular resistance
4. volume of the vascular system (mostly arterial) |
|
|
Term
| What is the most classical true angina sign seen in patients |
|
Definition
| they clench their chest in pain |
|
|
Term
| palpitations may be common in what disease patients |
|
Definition
1. anxious
2. hyperthyroid |
|
|
Term
| palpitaitons may arise from what three physiologic changes? Are palpitations necessarily pathological? |
|
Definition
Palpitations in themselves are not always pathological or dangerous. They do indicate something else may be going on. Anxiety can illicit the feeling of palpitations. So its not always that bad.
Palpitations caused by:
1. irregular heart beats
2. increase forcefullness of contraction
3. fast acceleration or deceleration of Heart rate. |
|
|
Term
| You can have a ___ % weight gain in fluid before edema is evident |
|
Definition
| 10% weight gain of fluid third spaced prior to any noticeable edema |
|
|
Term
|
Definition
|
|
Term
Stage I HTN is?
Stage II HTN is? |
|
Definition
Stage I HTN: 140-159/90-99
Stage II HTN: >160/ >100 |
|
|
Term
| A patient has diabetes, COPD, Bipolar and RA and has a BP of 138/92 and should be diagnosied with what? |
|
Definition
| Stage I HTN (goal is BP < 130/80. |
|
|
Term
BP goal for people over 60 years of age?
BP goal for people <60 years |
|
Definition
>60 years: <150/90
<60 years: 140/90 |
|
|
Term
| all african americans with HTN should be placed on what drug |
|
Definition
|
|
Term
| What is metabolic syndrome. |
|
Definition
| Metabolic syndrome is a cluster of metabolic risk factors that when in combination with each other will exponentially increase a persons risks for cardiovascular problems, diabetes and CVD |
|
|
Term
| A patient needs 3 out of what 5x factors that contribute to metabolic syndrome |
|
Definition
Must have 3 out of the following
1. increase abdominal girth (overweight)
2. Elevated fasting blood glu or diabetes
3. Low HDL
4. Elevated Triglycerides or HLD
5. HTN (>130/85) |
|
|
Term
| Describe the internal jugular vein and its anatomy / location |
|
Definition
| Internal jugular is deep to the skin and not easy to directly see. It runs between the sternal and clavicular heads of the SCM. Have patient turn away from you to identify area of the IJ. |
|
|
Term
| How do you assess the JVP |
|
Definition
HOB 30 degrees
Turn head away from you
IDentify highest point of pulsation of Internal jugular
measure from sternal angle
Add 5 to vertical distance on ruler |
|
|
Term
| Does JVP accurately reflect LVEDP and low LV EF? |
|
Definition
|
|
Term
| normal carotid pulses should be characterized as |
|
Definition
| normal upstroke, which is brisk, smooth, and follows S1 and should do so almost immediately. IT should precede S2 (S2=aortic valve closing) |
|
|
Term
| A bounding carotid may indicate |
|
Definition
|
|
Term
|
Definition
| a variation in the magnitude of the pulse which indicates a variation in strong and weak contractions usually associated with severe left sided heart failure. |
|
|
Term
| Pulsus alternans is often accompanied with a ___ sound |
|
Definition
| left sided S3 Sound (S3 sound = - results from the impact of flowing blood during mid-diastole in a distended or incompliant ventricle. ) |
|
|
Term
| What is a thrill and what is a bruit? |
|
Definition
Thrill: feel it
Bruit: Hear It |
|
|
Term
| Does the degree of a bruit reflect how badly stenotic a carotid is? |
|
Definition
| NOOOOOOOOOOO. Just tells you to evaluate it further. |
|
|
Term
| What is a thrill and what is a bruit? |
|
Definition
Thrill: feel it
Bruit: Hear It |
|
|
Term
| Does the degree of a bruit reflect how badly stenotic a carotid is? |
|
Definition
| NOOOOOOOOOOO. Just tells you to evaluate it further. |
|
|
Term
| how do you locate the point of maximal impulse |
|
Definition
| a reference point on the precordium located around the 5th interspace 7-9 cm lateral to the midsternal line. Medial to the midcalvicular line. |
|
|
Term
| what is the clinical significance of PMI |
|
Definition
| If PMI is >2.5 cm then there is evidence of left ventricular hypertrophy |
|
|
Term
|
Definition
|
|
Term
| Best to feel for PMI by having patient do what |
|
Definition
| lay left lateral and exhale so that the lungs are not increased in diameter and its easier to palpate the apex of the heart. |
|
|
Term
| you can have increase amplitude with what conditions? (they would cause increase strength when you feel for PMI Point of maximal impulse) 4x |
|
Definition
1. hyperthryoid
2. anemic (heart must beat faster since less RBCs)
3. Mitral REgurg (not all the blood is getting pumped systemically so it beats stronger/faster to compensate)
4. Young adults (could be healthy) |
|
|
Term
| what is the duration of PMI |
|
Definition
| it should last through the first 2/3 of systole or less and never be biphasic |
|
|
Term
| sustained duration PMI is often associated with what causes |
|
Definition
|
|
Term
| diffuse amplitude PMI is often associated with what pathology |
|
Definition
| aortic or mitral regurgitation or cardiomyopathy |
|
|
Term
| When would PMI be slightly displaced to the left? What pathology can cause this |
|
Definition
1. aortic regurg
2. mitral regurg
3. cardiomyopathy |
|
|
Term
| hyperkinetic PMI is associated with what clinical pathology |
|
Definition
1. anxiety
2. hyperthyroid
3. severe anemia |
|
|
Term
| the heart sits in what interspaces on the left sternal border |
|
Definition
|
|
Term
| what is the difference in what the bell and diaphragm can detect in sounds |
|
Definition
Bell: more sensitive (smaller than diaphragm) so it can hear "smaller" low pitched sounds
Diaphragm: is better for high pitch sounds |
|
|
Term
| The aortic valve area is best auscultated where on the chest |
|
Definition
| 2nd interspace right sternal border |
|
|
Term
| pulmonic valve area is best heard in what area of the thorax |
|
Definition
| 2nd interspace left sternal border |
|
|
Term
| mitral valve area best heard over what area of the thorax |
|
Definition
| 5th interspace medial to left mid clavicular line |
|
|
Term
| tricupsid valve area best heard over what area of the thorax |
|
Definition
| 5th interspace left sternal border |
|
|
Term
| to accentuate possible S3 and S4, and mitral murmurs you should have the paitent in what position and where should you listen? What part of stethoscope do you use |
|
Definition
| Have patient in left lateral which pushes apex of the heart closer to thorax cage. Remember that the mitral and tricupsid valves are at the apex and will better be heard now. Use the bell of the stethoscope since S3, S4, mitral murmurs all are low pitch. |
|
|
Term
| S2 is better heard apex or base of the heart |
|
Definition
|
|
Term
| S1 is better heard at the apex or base |
|
Definition
|
|
Term
| To better accentuate aortic murmurs have pt in what position? Use what part of the stethoscope? |
|
Definition
| Have patient in sitting position, use the diaphragm since aortic sounds are high pitch. Have patient lean forward and exhale and hold their breath. Listen over the left sternal borders and apex. |
|
|
Term
| the most common cause of a systolic click is due to |
|
Definition
|
|
Term
| a S3 in adults > ___ years old is considered pathological |
|
Definition
|
|
Term
| what is the physiology of pathological S3 in adults over the age of 40 |
|
Definition
| During diastole and at the end of the rapid filling period there is an large high pressure generated from the ABRUPT DECELERATION OF INFLOWING BLOOD. Usually related to myocardial contractility decreases, heart failure or overload. |
|
|
Term
| Can a S4 sound be normal? |
|
Definition
| Yes but rarely, in some super athletes it can be normal. |
|
|
Term
| what heart sound is indicative of an underlying pathological problem |
|
Definition
|
|
Term
| feeling for a carotid while auscultating heart sounds is helpful in distinguishing differences between systole and diastole murmurs. Why |
|
Definition
| Physiologically the pulse you feel at the carotid will immediately follow S1. So this lets you know that whatever your hearing must be systolic if it happens in the timeframe of S1 --> S2 or when you feel a carotid pulse. But those murmurs must be immediately during the carotid upstroke. |
|
|
Term
| to distinguish between aortic stenosis and hypertrophic cardiomyopathy what would you do. |
|
Definition
| have patinet stand then squat. |
|
|
Term
| What pathology of a systolic heart murmu results in increase intensity from staniding valsalva maneuver during the strain phase |
|
Definition
| Hypertrophic cardiomyopathy |
|
|
Term
| most common kind of heart murmur is what category |
|
Definition
|
|
Term
| The majority of the anterior portion of the heart is made up of what ventricle |
|
Definition
|
|
Term
| right ventricular hypertrophy will cause the PMI to be relocated where |
|
Definition
| xiphoid or epigastric area |
|
|
Term
| relocation of the PMI towards the axillary indicates |
|
Definition
| left ventricular hypertrophy |
|
|
Term
| at what age does the presence of an S3 or S4 sounds become pathological and correlate with what two diseases |
|
Definition
| >40 years of age S3 and S4 = pathological and correlate with heart failure and acute MI |
|
|
Term
| S3 reflects? S4 reflects? |
|
Definition
S3: correponds to an aburpt deceleration of inflow across the mitral valve
S4: corresponds to increased left ventricular and diastolic stiffness which decreases compliance. |
|
|
Term
| when can pulmonic valve closure exceed aortic valve closure and result in a splitting of S2 heart sounds |
|
Definition
| During inspiration your diaphragm pushing down onto your abdomen and its venous blood supply causing an increase in preload to the right heart. AFter which right heart has more Stroke volume that lasts slightly longer than left ventricle and this means pulm valve stays open slightly longer than normal and you can hear a split sound |
|
|
Term
| splitting of S1 or S2 varies with respiration |
|
Definition
| ONLY SPLITTING OF S2 can occur with variations in respiration |
|
|
Term
| limb leads are in what plane, precordial leads are in what plane |
|
Definition
| Limb leads are in the frontal plane while precordial leads are the in transverse plane |
|
|
Term
| when positive and negative vectors blaance they form a straight line which is also known electrically as |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| describe some Sx of atypical women MI sx |
|
Definition
1. upper back pain
2. neck pain
3. jaw pain
4. SOB
5. Paroxysmal nocturanal dyspnea
6. nausea vomiting
7. Fatigue |
|
|
Term
|
Definition
| a type of dyspnea that occurs when the patient is lying down iand improves when the patients sits up. |
|
|
Term
| Are more cardiovascular events from stroke or heart disease for men and women |
|
Definition
women: stroke
men: heart disease
Those lead to cardiovascular related deatehs. |
|
|
Term
| Women have highest risk for cardiovascular death from storke. What risk factors do women have for stroke: |
|
Definition
1. pregnancy
2. hormone therapy
3. early menopause
4. preeclampsia
5. Afib |
|
|
Term
| If diabetes or kidney disease present then what is the BP goal |
|
Definition
|
|
Term
| diabetes doubles the risk of cardiovascular disease t/f |
|
Definition
|
|
Term
|
Definition
| fasting glucose >126 or HgA1C above 6.5% |
|
|
Term
| what is metabolic syndrome |
|
Definition
consists of a cluster of risk factors that create an increased risk of both CVD and diabetes. To diagnose need 3 or more of the five risk factors.
1. Waist circumference > 102 cm men or 88cm women
2. fasting glucose: >100
3. HDL <40 men <50 women
4. triglycerides > 150
blood bp > 130/85 |
|
|
Term
| One way to assess for stenosis or insufficency of the aortic valve is by feeling water artery |
|
Definition
assess the carotid artery and the upstroke which is associated with systole.
Bounding pulses: may be Aortic insuff
Carotid upstroke delay = Aortic stenosis |
|
|
Term
| what type of irregular pulse varies with respiration |
|
Definition
|
|
Term
| paradoxical pulse indicates what? How do you measure |
|
Definition
| measure with BP and korotkoff sounds. LIsten for loudest systolic and note measurement. Then listen for systolic which is more consistent throughout respirations. If the difference is ? 10 mmHg then it suggests pericardial tamponade, constrictive pericarditis or an obstructive airway disease. |
|
|
Term
| S2 is diminished in what disease S1 is diminished in what disease |
|
Definition
S2 is diminished in what disease: AS
S1 is diminished in what disease: 1st deg heart block. b/c AV valves begin to close due to the difference in pressure being higher in the ventricles compared to atrium. Normally the immediate contraciton of the ventricle should slam those AV shut thus contributing to a louder (normal) sounding S1. However if there is a 1st degree heart block then there is a delay getting the signal to the ventricles to contract. If you delay this then those AV valves are only closing based on the pressure difference without the added SLAMING from the ventricles contracting. |
|
|
Term
| IF PMI is greater than 3 sitting it indicates? IF PMI Is greatest lateral >3 it is more likely? |
|
Definition
Sitting > 3-4 = left ventricular overload
Lateral > 3 = LVH |
|
|
Term
| hyperkinetic PMI may indicate |
|
Definition
1. hyperthyroidism
2. severe anemia
3. pressure overload of LV
4. Volume overload of LV |
|
|
Term
| a sustained, low amplitude (hypokinetic) impulse on PMI is seen in |
|
Definition
|
|
Term
| a late systolic murmur is usually related to |
|
Definition
| mitral valve prolapse which also includes a systolic click. |
|
|
Term
| A continuous murmur may be from |
|
Definition
1. congenital ductus arteriosus
2. AV Fistulas
3. pericardial friction rubs |
|
|
Term
Whats the different between crescendo and decrescendo murmurs
What is crescendo-decrescendo murmur |
|
Definition
Crescendo: grows louder
Decrescendo: grows softer
Crescendo-decrescendo: rises in intensity then falls. |
|
|
Term
| A plateau murmur is most often related to a |
|
Definition
| a pansystolic murmur such as mitral regurgitation |
|
|
Term
| what grade of a murmur is associated with a palpable thrill |
|
Definition
|
|
Term
| what hemodynamically changes from sitting or standing positions |
|
Definition
Standing: Decrease return to heart, decrease LV volume so decrease SV, increase peripheral vascular resistance.
Squatting: increase LV volume, increase vascular pressuree/resistance, |
|
|
Term
| how do you distinguish aortic stenosis from LVH systolic murmurs |
|
Definition
| STanding the LVH murmur is louder b/c there is less volume available to the heart and more afterload so the heart has to work extra hard to push out what blood it has. If you have the patinet squat then the aortic stenosis will increase because the extra blood in the venntricles will need to be force across tight valves so the corresponding sound will be much louder. |
|
|
Term
| how many elastic membranes are on an artery |
|
Definition
| two elastic membranes which separate the three layers of the artery |
|
|
Term
| veins can hold a capacity of ____ of ciculating blood flow |
|
Definition
| 2/3 of circulating blood flow |
|
|
Term
| the arms are mostly drained of blood via |
|
Definition
| the axillary lymph tissue |
|
|
Term
|
Definition
| an infrarenal aortic diameter greater than >3.5 cm |
|
|
Term
| asymmetric blood pressures in both arms indicates |
|
Definition
| coarctation of the aorta and dissecting aortic aneurysm |
|
|
Term
| warmth and redness over the calf indicates |
|
Definition
|
|
Term
| chronic venous insufficiency has a ___ color that is patchy/thickened |
|
Definition
|
|
Term
| what disease causes spasms of the distal arteries and therefore decrease blood flow and all hte associated sx |
|
Definition
|
|
Term
| chronic venous engorgement secondary to venous occlusion or incompetency of venous valves is a disease known as |
|
Definition
| Chronic venous insufficiency |
|
|
