Notes in cardio exam

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Published	09/08/2024	{{c1::Levine's}} sign is a clenched fist held over the chest to describe ischemic chest pain. As the referred pain associated with ischemia radiat…
Published	09/08/2024	{{c1::women}}, patients with {{c3::diabetes}}, and the {{c2::elderly}} commonly present differently than the “classic” picture when they are having an…
Published	09/08/2024	{{c1::LEFT}} sided heart failure causes {{c2::RESPIRATORY}} symptoms
Published	09/08/2024	{{c1::Left}} sided heart failure causes decreased {{c2::cardiac output}} and pulmonary {{c3::congestion}}. Common symptoms are: cough, Dyspnea, SOB, O…
Published	09/08/2024	{{c1::RIGHT}} sided heart failure causes {{c2::SYSTEMIC}} symptoms
Published	09/08/2024	right sided heart failure causes {{c1::congestion}} of {{c2::peripheral tissues }}. Common symptoms are: Edema, weight gain, JVD, ascites, l…
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Published	09/08/2024	cardiovascular physical exam includes: {{c1::vitals}}{{c1::inspection}}{{c1::palpation}}{{c1::auscultation}}and {{c1::VJP}}
Published	09/08/2024	Blood pressure={{c1::cardiac output}} x {{c1::systemic vascular resistance}}
Published	09/08/2024	Cardiac output={{c1::heart rate}} x {{c1::stroke volume}}
Published	09/08/2024	Vitals and anthropometrics of the cardio exam:•Heart rate ▫Fast? Slow? Normal? Inappropriately normal? ▫{{c5::Cardiac output}}=heart rate x stroke vol…
Published	09/08/2024	inspect for {{c1::lifts}} during the cardio PE
Published	09/08/2024	palpate for {{c1::heaves}}/{{c1::thrills}} and the {{c1::PMI}} during the cardio exam
Published	09/08/2024	a PMI is the {{c1::point of maximal impulse }}
Published	09/08/2024	a lift is when you {{c1::SEE}} the chest wall {{c2::impulse}} rise and fall with beating of heart
Published	09/08/2024	a {{c1::thrill}} is a palpable heart murmur, usually over the region where the murmur is heard best
Published	09/08/2024	a parasternal {{c1::heave}} is a heaving motion felt over the left parasternal area while palpating with the heel of the right hand
Published	09/08/2024	a heave suggests {{c1::right ventricular hypertrophy}}
Published	09/08/2024	a heave is detected by placing the heel of the hand over the {{c1::left parasternal}} region ({{c2::3rd}} & {{c2::4th I}}CS). Heel of the hand is …
Published	09/08/2024	a {{c1::heave}} may be normal in children or small/thin adults but if present throughout {{c2::systole}}, then likely pathologic
Published	09/08/2024	a parasternal heave is caused by {{c1::right sided enlargement}} or {{c1::severe left atrial enlargement }}
Published	09/08/2024	{{c1::thrills}} are palpable {{c2::murmurs}} caused by vibrations from very turbulent blood flow
Published	09/08/2024	to palpate a thrill, press {{c1::MCP}}s of hand firmly on chest to feel for buzzing or vibratory sensation. Must palpate each area that will be {…
Published	09/08/2024	if a thrill is felt, must {{c2::auscultate}} that area. This indicates a more signficant {{c1::murmur}}
Published	09/08/2024	PMI or apical impulse may be seen or felt. It is a brief early {{c1::pulsation}} caused by contraction of LV apex. During contraction, the a…
Published	09/08/2024	for PMI, examine the patient {{c1::supine}} or in {{c1::LLD}} position. In a healthy heart the {{c2::left ventricle}} impulse is the same as PMI.…
Published	09/08/2024	Anything that {{c1::increases}} the chest wall tissue may make it more difficult to locate the PMI
Published	09/08/2024	Right ventricular impulse normally not palpable beyond {{c1::infancy}} but some pathologic states may have a right sided PMI (PS, pulm HTN, ASD, hyper…
Published	09/08/2024	a normal PMI is located vertically between the {{c1::4th}} and {{c1::5th}} interspace, {{c2::midclavicular}} line ({{c2::MCL}})
Published	09/08/2024	a normal PMI is less than {{c1::2 - 2.5}} cm (quarter size)
Published	09/08/2024	a normal amplitude of the PMI is anything from {{c1::discrete}} to {{c1::brisk}} and {{c2::tapping}} is normal. It can increase in youn…
Published	09/08/2024	a PMI is should normally occur during {{c2::early}} portion of {{c1::systole}}.
Published	09/08/2024	you should {{c1::listen}} while you feel for a PMI
Published	09/08/2024	should feel the PMI through the {{c1::first}} heart sound but not the {{c1::second }}
Published	09/08/2024	when assessing the PMI, you should start with your {{c1::whole hand}}, then finer assessment with your {{c2::fingertips}} and then with {{c3::one fing…
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Published	09/08/2024	a PMI may be upward and lateral during {{c1::pregnancy }}
Published	09/08/2024	a PMI may be laterally displaced due to {{c1::heart failure}} or {{c1::cardiomyopathy/cardiomegaly}}
Published	09/08/2024	an increased {{c1::amplitude}} of a PMI may be due to (5) {{c2::hyper}}thyroid, {{c2::anemia}}, {{c2::aortic}} stenosis, {{c2::mitral}} regurgitation,…
Published	09/08/2024	an {{c2::increased}} amplitude AND {{c2::sustained}} PMI may be due to {{c1::left ventricular hypertrophy}}
Published	09/08/2024	a {{c1::sustained LOW}} amplitude/{{c1::non-palpable}} PMI may be due to dilated cardiomyopathy, pericardial effusion
Published	09/08/2024	if a PMI is nonpalpable, it may be due to obesity. Try {{c1::percussion}}. Start left of cardiac border in 3rd, 4th, 5th ICS. Go from resonance t…
Published	09/08/2024	Amplitude in regards to PMI means {{c1::hard bounding}} beat, or very {{c2::soft}} beat.
Published	09/08/2024	Increased amplitude happens when the heart has to work very {{c1::hard}} to beat or is beating very {{c2::quickly}} or has a {{c3::thickened}} wall, o…
Published	09/08/2024	Low amplitude with dilated cardiomyopathy is due to the {{c1::THIN}} wall to give an impulse.
Published	09/08/2024	the {{c2::bell}}/ {{c2::light}} pressure are used for {{c1::low}} frequency sounds
Published	09/08/2024	the {{c1::diaphragm}}/{{c1::deep}} pressure is used for {{c2::high}} frequency sounds
Published	09/08/2024	when auscultating:•Start at {{c1::Base}} or {{c1::Apex}} •“{{c2::Inch}}” stethoscope around the heart borders •Pause on all 4 valves PLUS {{c3::Erbs p…
Published	09/08/2024	as pressure rises in the ventricles, {{c1::mitral}} then {{c1::tricuspid}} valve close. This generates {{c2::first}} heart sound (S{{c2::1}}); ventric…
Published	09/08/2024	S1 is usually discerned as a {{c1::single}} audible sound. The {{c2::mitral}} valve closure is the loudest component
Published	09/08/2024	S1 is {{c1::systole}}, period of ventricular contraction
Published	09/08/2024	S1 is normally {{c1::louder}} at the apex and {{c1::softer}} at the base
Published	09/08/2024	S1 is {{c1::louder}} with: increased heart rate, high cardiac output states (exercise, anemia)
Published	09/08/2024	S1 is {{c1::softer}} with: {{c2::1o}} heart block,  {{c2::mitral}} calcification, poor  {{c2::left}} ventricular contraction
Published	09/08/2024	S1 {{c1::Splitting}}: This can occur at left sternal border, but don’t confuse for an S4. Hear best at LLSB with diaphragm
Published	09/08/2024	“{{c1::Split}}” S1:  Audibly discern closure of mitral then tricuspid valve (20-30 milliseconds) apart
Published	09/08/2024	As pressures in the ventricles fall the {{c1::Aortic }} then {{c1::Pulmonic}} close. This generates {{c2::second}} heart sound (S{…
Published	09/08/2024	{{c1::S2}} is diastole: period of ventricular relaxation
Published	09/08/2024	S2 is heard {{c2::LOUDER}} at the {{c1::BASE}}. It is {{c2::softer}} at the {{c1::apex}}
Published	09/08/2024	Physiological S2 splitting is NORMAL on {{c1::INSPIRATION}}. A2 normal timing, P2 is delayed
Published	09/08/2024	{{c1::Expiratory}} splitting is abnormal (paradoxical) during S2
Published	09/08/2024	{{c1::FIXED}} Split S2 is abnormal
Published	09/08/2024	{{c1::A}}2 (A2/P2?) is usually LOUDER
Published	09/08/2024	A loud {{c1::P}}2 suggests pulmonary hypertension
Published	09/08/2024	•Laying on the LLD brings the {{c1::left ventricle}} closer to the chest wall
Published	09/08/2024	•Sitting and leaning forward (hold breath after expiration) can increase likelihood of hearing an {{c1::aortic}} murmur
Published	09/08/2024	{{c1::S3}} indicates{{c2:: early}} diastole, early inflow hitting a greater than normal volume of residual blood in the left ventricle
Published	09/08/2024	{{c1::S4}} indicates{{c2:: late}} diastole, fluid from atrial kick hitting against a stiff left ventricle
Published	09/08/2024	S{{c1::3}} ddx: {{c2::Heart failure}}, {{c2::volume}} overload, {{c2::mitral/tricuspid }}regurgitation, decreased myocardial {{c2::cont…
Published	09/08/2024	S{{c1::4}} ddx: {{c2::Myocardial ischemia}}, {{c2::hypertensive heart}} disease, {{c2::aortic}} stenosis, {{c2::cardiomyopathy}}
Published	09/08/2024	S3 is {{c4::dull}} and {{c4::low}} in pitch, an S3 is usually heard best with the {{c1::bell}} of the stethoscope placed at the {{c2::apex}} while the…
Published	09/08/2024	S4 is the {{c1::atrial}} contraction, or kick, where the final 20% of the {{c1::atrial}} output is delivered to the ventricles. It can also signify a …
Published	09/08/2024	{{c2::Friction rub}} caused by the heart rubbing against an inflamed {{c1::pericardial sac }}
Published	09/08/2024	A friction rub is usually continuous and heard diffusely over the chest. Sometimes better heard when the patient leans {{c1::forward}} or with {{…
Published	09/08/2024	A loud P2 suggests {{c1::pulmonary hypertension}}
Published	09/08/2024	jugular venous pressure reflects pressure in the {{c1::right atrium }}
Published	09/08/2024	Changes in {{c1::JVP}} gives clues to {{c2::volume}} status, {{c2::ventricular}} function, {{c2::arrhythmias}}, valve {{c2::patency}}
Published	09/08/2024	right atrial pressures are indicative of {{c2::central venous pressure (CVP)}} which is a major determinant of filling pressures and therefore the pre…
Published	09/08/2024	{{c1::Preload}} of the right ventricle regulates {{c2::stroke volume}} through the Frank-Starling mechanism.
Published	09/08/2024	Frank Starling: {{c1::cardiac output}} increases or decreases in response to changes in {{c2::heart rate}} or {{c2::stroke volume}}
Published	09/08/2024	JVP is assessed with pulsations of the {{c1::right internal jugular vein }} which lies deep to the SCM
Published	09/08/2024	IJP is rarely {{c1::palpable}} while the carotid always is
Published	09/08/2024	{{c1::IJP}} is soft, biphasic, undulating and the {{c1::carotid}} is a singal forceful thrust
Published	09/08/2024	IJP is eliminated by {{c1::light}} pressure on veins above the {{c1::sternal}} end of the clavicle
Published	09/08/2024	IJP height changes with {{c1::position }}
Published	09/08/2024	IJP height falls with {{c1::inspiration}}
Published	09/08/2024	{{c1::Carotid}} not affected by pressure, position or inspiration
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Published	09/08/2024	Physiology behind why is going on during these “oscillations” Changing {{c1::pressure}} in the atrium= 2 peaks and 2 troughs 1. Atrial contraction - …
Published	09/08/2024	JVP must be done with the head of the bed at {{c1::30-45}} degrees
Published	09/08/2024	a decreased JVP could be a sign of {{c1::blood loss}} or {{c1::dehydration}}
Published	09/08/2024	an increased JVP could be due to {{c1::heart failure}}, {{c1::pulmonary hypertension}}, {{c1::tricuspid valve disease}}, {{c1::pericardial tamponade}}
Published	09/08/2024	JVP has a high specificity in {{c1::heart failure}} and {{c1::cardiac tamponade }}
Published	09/08/2024	Kussmaul's sign is a sign of an {{c1::elavated JVP }}.
Published	09/08/2024	{{c1::Kussmaul sign}} is a distention of the jugular veins during {{c2::inspiration}} due to the negative intrathoracic press…
Published	09/08/2024	{{c1::abdominojugular reflux}} is:  jugular venous {{c2::congestion}} induced by exerting manual pressure over the patient's …
Published	09/08/2024	a positive abdominjugular reflux test is an increase of JVP of {{c1::>3}}cm (from baseline) sustained for {{c1::> 15}} sec
Published	09/08/2024	ask the patient if they can {{c1::tap}} out their heart beat
Published	09/08/2024	MUST consider {{c1::HOCM}} in an adolescent patient with {{c2::sudden onset SOB}} with {{c3::exertion}}.
Published	09/08/2024	sharp pain may be a {{c1::pulmonary embolism}}
Published	09/08/2024	{{c1::crushing}} pain more likely with MI
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