CS- S1B2
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| Class I | No limitation in physical activity; slight fatigue
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| Class II | Slight impairement of physical activity
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| Class III | Marked limitation of physical activity; comfortable at rest, but less than ordinary activity causes symptoms
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| Class IV | Symptoms may be present even at rest; unable to engage in any physical activity w/out discomfort
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| Most common symptoms of heart disease | Dyspnea, chest pain, palpitations, syncope, fatigue, diaphoresis, cachectic appearance
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| Dyspnea | Difficulty breathing; pp by exertion, result from left atrial+pulmonary venous pressure or hypoxia; worsening of left atrial hypertension=pulmonary edema;quantified by amount of activity that precipates it
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| Orthopnea | Dysnea that occurs in recumbency; result from increase from central venous pressure
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| Paroxysmal nocturnal dyspnea (PND) | SOB that occurs abruptly;30-2h after going to bed&is released by sitting or standing up
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| Ischemia | inadequate circulation of blood to the myocardium;usu as result of coronary a. disease d/t stenosis;sensation of discomfort;last 5-20min;tightness, pressure
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| Angina Pectoris | Coronary a. go to different parts of the heart;precordial chest pain,usu pp by stress or exertion, relieved rapidly by rest or nitrate drugs(nito=veno dilator)obstruct of coronary vess(atherosclerotic heart disease if no obstruc: L ventricular hypertrophy
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| Pain of Myocardial Infarction | if pain last longer than 20 mins then MIA
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| MI | Sudden insufficiency of arterial blood supply to the heart muscle as result of occlusion of coronary a; anxiety/sense of uneasiness;retrosternal,L precordial, protracted ischemic symptoms
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| Ischemic Pain | pp by exertion;usu relieved by rest, not related to position or respiration;if can reproduce pain by palpating then NOT heart pb; also seen with hypertrophy of either ventricles, aortic disease
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| Atypical Chest Pain | Myocarditis, cardiomyopathy, Primary pulmonary hypertension, Mitral valve prolapse
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| Palpitations | Awareness of the heartbeat;manifestation of cardiac abnormalities that increase stroke volume; cardiac dysrhytmias, PVC,SVT(supraventricular)or atrial ventricular tachycardia (VT)
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| PVC | premature ventricular contraction
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| Syncope | Loss of consciousness, faint
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| Cadiogenic syncope | at AV=no heartbeat;usu fr sinus node block AV conduction or ventricular febrillation(heart quivering, no organized activity);few prodromal sympt;cardiomyopathy;no premonitory sx: not postural hypotension
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| Neurocardiogenic syncope=vasovagal syncope | inappropriate increase in vagal efferent activity, follow brief period of duaphoresis, abrupt in onset like arrythmia-induced syncope
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| Diaphoresis | hypotension or hyperadrenergic state; seen in PERICARDIAL TAMPONADE
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| Cachectic appearance | chronic low cardiac output states
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| Central Cyanosis | d/t aterial desaturation, low output state
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| Peripheral Cyanosis | Reflects impaired tissue delivery of adequately saturated blood;poycythemia,peripheral vasoconstriction
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| Systolic pressures below 90 or more than 140 | need follow-up
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| Tachypnea | nonspecific=respiration rate more than 16/min;consider pulmonary disease+heart failure
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| Diminished peripheral pulses | result from arteriosclerotic peripheral heart disease; accompanied by localized bruits
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| Carotid pulse | valuable to assess L ventricular dunction
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| Delayed upstroke | aortic stenosis
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| Bisferiens quality | 2 palpable peaks, hypertrophic obstructive cardiomyopathy, mixed aortic regurgitation & stenosis
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| Pulsus alternans | a,plitude of pulses alternated every other beat during sinus rhythm; occurs when cardiac contractility is very depressed or w/ large PERICARDIAL EFFUSIONS
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| Pulsus paradoxus | a decrease in systolic blood pressure during inspiration more than normal 10mm Hg, valuable sign of chronic obstructive pulmonary disease (COPD)
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| Jugular Venous Pulsations | Insight into right atrial pressure;if more than 3cm above Angle of Louis: increased CVP; if rise more than 1cm w/ sustained R upper abdominal quadrant pressure (hepatojugular reflex)=increased central blood volume
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| Crackles | heard at lung bases; sign of congestive heart failure(CHF)
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| Wheezing and Rhonchi | suggest obstructive pulmonary disease but may occur in L heart failure (cardiac asthma)
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| Pleural Efllusions | w/ bibasilar percussion, dullness, and reduced breath sounds = commin in CHF
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| Edema in heart disease | results from elebated right atrial pressures
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| Pulse oximetry | shown thru capillaries, more it absorbs shows oxygen concentration in blood, red light
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| S1 | Mitral & Tricuspid valves
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| S2 | Pulmonary & Aortic valves
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| 3rd heart sound | mid-diastolic sounds
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| 4th heart sound | atrial gallop- abnormal
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| S3 | during rapid filling phase of ventricle, after closure of aortic and pulmonary valves;may be normal in children, pregnant; heart failure(ventricle dysfxn),mitral and tricuspid regurgitation(increase flow during rapid filling phase of ventricles)
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| S4 | Triple cadence to heart sounds at rate of 100/min; valve snaps back; indicative of serious disease; stiff or non-compliant ventricle
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| Clicks | high-pitched sounds. Ejection sounds
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| Murmurs | valvular disease; pansystolic when merge w/ 1st heart sound and persist thru all systole
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| Ejection murmurs | when they begin after the 1st heart sound and end before the 2nd
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| Innocent murmurs | often vary w/ inspiration, diminish in upright position; most often heard in thin individuals-esp. women
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| Thrills | palpable vibrations associated with murmurs
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