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