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PA Cardio

endocardium thin inner layer that covers the inside surfaces of hearts chambers, valves, and muscles
myocardium thick middle layer of heart muscle, responsible for most of heart's pumping action
epicardium thin, glossy membrane that covers the outer surface of the heart
pericardium protective sac encasing the heart
SA node pacemaker, 60-100 bpm
AV node 40-60 bpm
purkinje fibers 20-40 bpm
Chest pain with breathing is indicative of: pleural rub
chest pain with exertion is indicative of: angina
orthopnea dyspnea upon laying down; common in heart failure- lungs fill with fluid when lay down
one ankle swollen- indicative of: DVT
both ankles swollen indicative of: heart failure
ankle swelling and dyspnea in evening is indicative of: congestive heart failure
pitting edema is indicative of... heart failure
non pitting edema is indicative of... lymphedema
skipping beats (irregularly) is symptoms of... atrial fibrillation
palpitations followed by fainting is indicative of... ventricular tachycardia
palpitations relieved by cough or cold water are indicative of... supraventricular tachycardia
syncope during micturition vasovagal response
neurological dizziness- symptoms if still dizzy when laying down and aggravated by head movements
claudication exertional pain, normally in ankle, calf, or buttock
fever is indicative of... infective endocarditis
infective endocarditis synthetic valves, untreated strep, IV drug users. - Valve replacement patients need prophylactics before dentist`
modifiable risk factors for CV disease obesity, high cholesterol, smoker, hypertensive, drinking, IV drugs, etc
nonmodifiable risk factors for CVD ever had heart diseases, diabetes, family hx of CAD, CVA, DM, high cholesterol
bell low pitched sounds
diaphragm high pitched sounds
pectus excavatum hollowed chest; sternum not aligned and doesnt grow correctly, gives sunken appearance
pectus carinatum pigeon chest; sternum and ribs protrude
kyphosis over curving of thoracic vertebrae; hunchback
scoliosis spine curved from side to side (lateral curvature)
Point of Maximal Impulse 5th intercostal, 1 cm left of midclavicular line, below nipple
cardiomegaly increased heart/ventricular size or thickness (hypertrophy). Common cause of inferior or lateral displacement of the apex
Thrill palpation of a murmur or ventricular septal defect (flow going back and forth, vibration)
lift/heave apical impulse is more vigorous
1+ pitting edema slight pitting, 2mm, disappears
2+ pitting edema somewhat deeper pitting, 4 mm, disappears in 10-15 sec
3+ pitting edema deep pit/ 6 mm, may last >1 min; dependent extremity swollen
4+ pitting edema very deep pit/ 8 mm, lasts 2-5 min, dependent extremity grossly distorted
pulse locations/names carotid, radial, brachial, femoral, popliteal, dorsalis pedis, posterior tibial
pulse grade 0 not palpable
pulse grade 1 diminished
pulse grade 2 expected
pulse grade 3 full, increased
pulse grade 4 bounding
pulsus paradoxus on clinical examination, one can detect beats on auscultation during inspiration that cannot be palpated at the radial pulse. Results from decrease of blood pressure, which leads to the radial pulse not being palpable
Aortic Valve location right mid sternal border, 2nd right intercostal space
Pulmonic Valve location left mid sternal border, 2nd left intercostal space
Tricuspid Valve location left lower sternal border, 4th left intercostal space
Mitral Valve location Apex, midclavicular line, 5th intercostal space
S1 lubb; mitral/tricuspid valves closing (beginning of systole), loudest at apex and LLSB. Often a single sound even though mitral slightly precedes tricuspid
S2 dubb; pulmonic and aortic closure (end of systole), loudest at base (LMSB/2LICS), higher pitched than S1, better heard with diaphragm
S2 split occurs with inspiration, not patholgical. Aortic valves closes before pulmonic valve
S3 third heart sound. Normally, diastole is silent, but S3 causes vibration. Occurs when ventricles are resistant to filling during early filling stage. Occurs immediately after S2 when AV valves open and atrial blood first pours into ventricles`
S4 fouth heart sound; occurs at the end of diastole, when ventricle is resistant to filling. Atria contract and push blood into a noncompliant ventricle. Creates vibration right before S1
murmur turbulence in the heart or blood stream, can be benign or pathologic
diastolic murmur occurs when heart muscle relaxes between beats
systolic murmur occurs when the heart muscle contracts
Intensity of murmur loudness, graded on scale from 1-6
murmur grade 1 only audible on listening carefully for some time
murmur grade 2 murmur is faint, but immediately audible on placing the stethoscope on the chest
murmur grade 3 loud murmur readily audible, but with no palpable thrill (moderately loud, prominent)
murmur grade 4 a loud murmur with a palpable thrill
murmur grade 5 loud murmur with a palpable thrill. so loud that it is audible with only the rim of the stethoscope touching the chest
murmur grade 6 loud murmur with palpable thrill. The murmur is audible with the stethoscope not touching the chest, but lifted just off it
stenosis constriction/narrowing of heart valve opening or surface
regurgitation incomplete closure of valve leaflets = backflow of blood
auscultation of carotid listen for bruits with bell
innocent murmurs often in children- also called flow, benign, norml, nonpathological, functional, inorganic, physiologic
pediatrics- cardiac exam congenital defects. sinus arrythmias expected, variable heart rates
geriatrics- cardiac exam atypical presentations, more likely to have heart failure, calcification causes carotid bruits, histological vessel changes (dilation, tortuosity, decreased elasticity/vasomotor tone), ectopic EKG changes
pregnancy- cardiac exam increasing tachycardia, apical pulse more upward and lateral, systolic ejection murmurs, S3 sound, compression of vena cava (hypotension), increased dependent edema and variscosities, hemorrhoids
Created by: alexadianna
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