Term
| most common cause of chest pain: |
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Definition
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Term
| Angina pectoris is chest pain resulting from __ without frank ___. |
|
Definition
- ischemia
- without frank infarction |
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Term
| Three clinical patterns of angina: |
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Definition
- Stable
- Unstable
- Prinzmetal |
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Term
| Stable angina is usually due to __ of a major __ __. |
|
Definition
| - stenosis of a major coronary vessel |
|
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Term
| Unstable angina is usually due to __ __ with variable __ __. |
|
Definition
- plaque disruption
- mural thrombi/blood clots |
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Term
| Prinzmetal angina is due to ___ . There is usually no __ __ . EKG shows __ __. It is more common in __. Symptoms usually occur in the __ __. __ are common. |
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Definition
- vasospasm
- NO precipitating factors
- ST elevation
- women
- early morning
- dysarrhythmias |
|
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Term
| Angina equivalents are symptoms caused by ___ __ but not exactly chest pain. |
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Definition
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Term
| Underlying causes of angina are usually consistent. Usually caused by activity and relieved by rest. Exertion of upper extremeties, thorax, and __ __ __ are common causes. Patients prefer to remain __ rather than __ __. |
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Definition
- walking up hill
- remain upright rather than lay down |
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Term
| The threshold for angina is often lower in the following circumstances: |
|
Definition
- in the morning
- after strong emotion
- with meals (usually large)
- exposure to cold |
|
|
Term
A 62 year old African American female with a history of HTN presents for routine follow-up. She states she has not been as active over the past 6 months but has noticed a slight “choking” sensation and nausea with exertion over the past 4 months. The symptoms do not occur at rest and usually get better with rest.
How many risk factors does she have, and what type of angina is this? |
|
Definition
- 3 risk factors (AA, age, and HTN)
- stable angina |
|
|
Term
Location and Radiation--
The distribution may vary widely but is commonly a well recognized pain
Typical presentation begins or localizes to retro-mid sternum
May begin as jaw pain, neck pain or back pain, abdominal pain
Usually not a “pin-point” localization of pain
May radiate to
Left shoulder
Left arm
Jaw
Less frequently right shoulder |
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Definition
|
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Term
| Pts with angina or MI usually can/cannot pin-point the location of pain ? |
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Definition
|
|
Term
Duration of Attacks
Usually short duration (3-30 mins)
Usually subsides completely without residual discomfort
Exertional angina promptly stops with rest, it usually lasts less than 3 minutes.
Angina associated with a heavy meal or stress/emotions often last 15-20 minutes.
Attacks lasting more than 30 minutes may suggest the development of unstable angina, myocardial infarction, or an alternative diagnosis. |
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Definition
|
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Term
Effect of nitroglycerin
Assists in diagnosis if NTG shortens an attack
Prophylactic NTG permits greater exertion or prevent angina entirely |
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Definition
|
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Term
|
Definition
Ischemic Heart Disease
Pericardium
Aorta
Valvular Heart Disease
Disease of the Bronchi
Parietal Pleural Pain
Esophagus/GI Tract/Biliary Tract
Musculoskeletal (costochondritis)
Anxiety
Thyroid Disease (palpitations)
Infectious Diseases |
|
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Term
| Dyspnea in heart disease is usually precipitated by exertion. It is usually caused by __ __ __ or __ __ resulting in __ __ __ __. It may also be caused by non-cardiac diseases like COPD, obesity, anxiety, and anemia. |
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Definition
- left ventricular dysfunction or valvular disease
- increased left heart pressure |
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Term
| Paroxysmal Nocturnal Dyspnea (PND) is dyspnea that occurs __ __ __ to __ __ after going to bed and is relieved by __ or __ __. This is more specific for __ __. |
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Definition
- abruptly 30 min to 2 hours
- standing or sitting up
- cardiac disease |
|
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Term
| palpitations, fatigue, cough, SOB, sweating, and nausea are all __ __. |
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Definition
|
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Term
| fatigue is commonly associated with __ and __. The longer the onset, the less likely it is unusual. |
|
Definition
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Term
|
Definition
Usually a Gradual Onset
Commonly occurs at night and with lying supine
May include Hemoptysis
Commonly associated with CHF, VHD, CAD |
|
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Term
| Cough is often associated with what 3 heart conditions? |
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Definition
|
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Term
| Leg symptoms of ischemia: |
|
Definition
Claudication (Leg Angina) - pain/discomfort in the legs but relieved with rest
Leg Cramps/Pain (especially with raising of the legs)
Changes in skin color, temperature, hair distribution, size of extremity
Slow healing wounds/lesions |
|
|
Term
|
Definition
Subcutaneous fluid collection in the lower extremities
Will also collect in sacral region of bedridden individuals
In cardiac disease it is usually the result of right heart failure,right heart valvular and pulmonary vascular disease, and pericardial disease.
Other causes include
peripheral venous insufficiency, venous obstruction, nephrotic syndrome, cirrhosis, premenstrual fluid retention, drugs (especially vasodilators such as beta-blockers, calcium channel blockers or salt-retaining medications such as nonsteroidal anti-inflammatory agents), or it may be idiopathic. |
|
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Term
| With cardiac disease, edema is usually due to __ __ __, __ __ __ disease, __ __ __, and __ __. |
|
Definition
- right heart failure
- right heart valvular disease
- pulmonary vascular disease
- pericardial disease |
|
|
Term
| Marfan Syndrome characteristics: |
|
Definition
- tall and slender
- disproportionately long limbs
- indented or protuding sternum (pectus excavatum)
- arched palate, overcrowded teeth, receding mandible
- curved spine (kyphosis)
- aortic regurgitation
- mitral regurgitation
- weakened aortic wall
- tears in inner and middle aortic layers |
|
|
Term
| Marfan Syndrome pts have abnormally __ __ __ leaflets leading to prolapse (in 75% of cases). These patients also have __ __ which causes heart murmurs, long-term damage, breathlessness, extreme exhaustion, and an irregular pulse. They also have __ regurgitation which leads to chest pain and heart failure. |
|
Definition
- large mitral valve leaflets
- Mitral Regurgitation
- Aortic Regurgitation |
|
|
Term
| Marfan Syndrome pts have a weakened __ layer of the __ wall causing the aortic valve leaflets to __ so an __ may form. |
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Definition
- middle
- aortic
- strecth
- aneurysm |
|
|
Term
| Down Syndrome characteristics: |
|
Definition
- Hypotonia
- Slanting eyes with epicanthal folds
- Hyperflexibility
- Short broad hands
- Broad feet with short toes
- Short, low set ears
- Flat nose bridge
- Small head
- Small oral cavity |
|
|
Term
| 50% of Down Syndrome patients have heart disease. |
|
Definition
Atrioventricular septal defect
VSD
Secundum ASD
PDA
Tetrology of Fallot
Mitral valve prolapse
AR, MR |
|
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Term
| Optic fundi characteristic signs of severe HTN and DM? |
|
Definition
- A-V nicking
- hemorrhages
- exudates
- papilloedema |
|
|
Term
| note that the internal jugular vein & carotid artery are (almost entirely) deep to the sternocleido-mastoid muscle |
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Definition
|
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Term
HOW DO YOU KNOW THE JUGULAR VENOUS PULSE FROM THE CAROTID ARTERY PULSE?
- Lay them at 45 degrees, press on their liver from outside > push down, slow steady press increase in pressure over 10 seconds, if it’s the carotid artery there would be no change, if it’s a vein and its destendable it will come up and expand. |
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Definition
|
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Term
| With jugular venous pulse, the a wave is a __ __ due to __ __. |
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Definition
| - positive deflection due to atrial contraction |
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Term
| With jugular venous pulse, the c wave is a ___ ___ due to the __ of the __ __ towards the atria at the beginning of __ __. |
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Definition
- positive deflection
- bulging of the tricuspid valve towards the atria
- beginning of ventricular contraction |
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Term
| With jugular venous pulse, the v wave is a __ __ due to __ of the right atrium against the __ __ __ during __ __. |
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Definition
- positive deflection
- filling of the right atrium
- closed tricuspid valve
- ventricular contraction |
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Term
| With jugular venous pulse, the y is a __ __ due to __ of the right atrium upon __ __. |
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Definition
- negative deflection
- emptying
- ventricular relaxation |
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Term
|
Definition
patient relaxed looking straight ahead
from in front of the patient look for the double impulse flicker of the jvp …
look between the 2 heads of SCM & along the anterior & posterior borders of SCM
note: double impulse in sinus rhythm, only single impulse in AF |
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Term
| JVP will be a double impulse with __ __, but only a single impulse with __ __. |
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Definition
- sinus rhythm
- atrial fibrillation |
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Term
| What parts of the jugular venous pulse would be missing in a person with a faulty tricuspid valve? |
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Definition
| - C and V would be missing |
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Term
| The double impulse flicker is associated with the _ and _ waves. |
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Definition
|
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Term
|
Definition
double impulse flicker timed with carotid pulse
occluded by soft pressure
vein fills from above
changes height with:
respiratory cycle
posture
hepato-jugular reflux |
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Term
| The jugular venous pulse will/will not change withe respirations, while the carotid pulse __ change with respirations. |
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Definition
- jugular venous pulse will change with respirations
- carotid pulse will NOT chance with respirations |
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Term
| Venous pulses change with respirations. Arterial pulses do NOT change with respirations. |
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Definition
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Term
| JVP is elevated if its greater than __. A normal JVP barely goes above the __ or not at all. If its pulsing up and down its abnormal. |
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Definition
|
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Term
| An elevated JVP is the classic sign of __ __ aka __ __ ___ __. |
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Definition
- venous hypertension
- right sided heart failure |
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Term
| Kussmaul sign is the paradoxical ___ of JVP with __ (instead of the expected __). This indicates impaired __ of the __ __. |
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Definition
- paradoxical increase of JVP with inspiration
- instead of the expected decrease
- impaired filling of the right ventricle |
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Term
|
Definition
- Constrictive pericarditis
- Restrictive cardiomyopathy
- Pericardial effusion
- Right sided heart failure |
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Term
| The carotid pulse is at the level of the __ __ at __. |
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Definition
|
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Term
| When we feel the carotid pulse, we are trying to assess the __ __ _ and __ __. |
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Definition
- left ventricular function
- aortic valve |
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Term
| Listen to the carotid artery with the __ to assess for __ from carotid artery __. |
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Definition
- diaphragm
- bruits
- stenosis |
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Term
| The radial pulse can be palpated between the ___ and __ __ __. |
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Definition
- brachioradialis
- flexor carpi radialis |
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Term
| The brachial artery pulse can be palpated just medial to the __ __. |
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Definition
|
|
Term
collapsing ‘water-hammer’ or bounding pulse of AI
pulsus alternans of left ventricular failure
other subtle signs |
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Definition
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Term
| Normally, blood pressure __ during inspiration and ___ during expiration. Pulsus paradoxus is an __ of this. |
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Definition
- decreases during inspiration
- increases during expiration
- exaggeration |
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Term
|
Definition
- Cardiac tamponade
- Pericarditis
- Chronic sleep apnea
- Croup
- Obstructive lung disease (COPD, asthma) |
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Term
| With pulsus paradoxus there is __ blood flow to the lungs, __ venous return to the right side of the heart, and __ blood flow to the left side of the heart. Consequently, there is reduced __ ___ and __ __ and __ pulse. |
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Definition
- increased blood flow to the lungs
- increased venous return to the right side of heart
- decreased blood flow to the left side of the heart
- reduced stroke volume and systolic pressure
- increased pulse |
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Term
| Tracheal deviation may indicate __ __. |
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Definition
|
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Term
| Possible causes of mediastinal shift and tracheal deviation? |
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Definition
- tension pneumothorax
- tumor (lung cancer)
- lymph node enlargement
- fibrotic lung changes |
|
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Term
| With pneumothorax, the mediastinal shift and tracheal deviation occurs to the __ side. |
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Definition
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Term
| The apex beat is the most __ and __ point that you can see or feel the pulsation of the heart during systole. |
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Definition
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Term
| Normal location for apex beat: |
|
Definition
- 5th intercostal space 1 cm medial to the midclavicular line
KNOW THIS |
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Term
| A displaced apical beat may indicate an __ __ __ heart or be a sign of __ __. |
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Definition
- enlarged dilated failing heart
- mediastinal shift |
|
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Term
| percussion of heart borders: |
|
Definition
not usually necessary!
however may help if apex beat impalpable or when pericardial fluid suspected |
|
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Term
| Early pulmonary edema may be suggested by __ __ __ __. |
|
Definition
| - fine late inspiratory crackles |
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Term
| In an immobile or elderly pt, it is normal to hear crackles that are cleared by coughing. |
|
Definition
|
|
Term
|
Definition
aortic arch
brachiocephalic a
L common carotid a
L subclavian a
R brachiocephalic v
L brachiocephalic v
superior vena cava
inferior vena cava |
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|
Term
| All 4 heart valves are situated under the __. |
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Definition
|
|
Term
| murmers originating from flow abnormalities in these valves are not usually best heard directly over them |
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Definition
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Term
| Murmurs are due to ___ blood flow within the __. |
|
Definition
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Term
|
Definition
Grade I :barely audible
Gr II : audible but quiet and soft
Gr III : moderated loud, without thrust or thrill
Gr IV : loud, with thrill
Gr V : louder with thrill, steth on chest wall
Gr VI : loud enough to be heard before steth on chest |
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|
Term
| Splinter hemorrhages of the nails may indicate __ __. |
|
Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
| Splinter hemorrhages, Ossler nodes, and Janeway lesions are all indicative of __ __. |
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Definition
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Term
| Clubbing is due to lack of __. |
|
Definition
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|
Term
| Acute Artery Occlusion: the 6 Ps: |
|
Definition
- Painful
- Pale
- Pulseless
- Paralyzed
- Parasthesia
- Perishingly cold |
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|
Term
| Often AAA is symptomless, however the following symptoms may occur: |
|
Definition
- pain or tenderness in lower back, abdomen, or side
- throbbing in the abdomen
- Rupture indications: light headedness, sweating, clammy skin, nausea |
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|
Term
Palpable mass
Not effective in obese patients and/or those with an AAA under 2 cm in diameter
Usual: abdominal ultrasound >80% accurate |
|
Definition
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|
Term
| The femoral pulse can be palpated midway between the __ __ and the __. It is a few cm below the __ __. |
|
Definition
- symphysis pubis and ASIS
- inguinal ligament |
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Term
| If you can't find the popliteal pulse, you can |
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Definition
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Term
| The posterior tibialis pulse is midway between the __ __ and the medial edge of the __ __. |
|
Definition
- medial malleolus
- Achilles tendon |
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Term
| The anterior tibial pulse is just above or below the __ __ between the two malleoli. |
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Definition
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Term
| The dorsalis pedis pulse is at the __ end groove between the first and second ___. |
|
Definition
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|
Term
|
Definition
2 mm = 1+
4 mm= 2+
6 mm= 3+
8 mm= 4+ |
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Term
Arterial, Venous, Lymphatic Systems
Occlusive Disease
Atherosclerotic (arterial)
Thromboembolic (venous)
Inflammatory Disease
Arthropathies
Vasculitis
Aneurysmal Changes |
|
Definition
|
|
Term
| Giant cell vasculitis aka temporal arteritis aka giant cell arteritis. |
|
Definition
|
|
Term
| Risk factors for peripheral vascular disease: |
|
Definition
Known CV Disease especially HTN and ASCVD and including Dysrhythmias
Family History of CV Disease Diabetes
Smoking
Sedentary Lifestyle
Dyslipidemias
HTN
Obesity
Trauma
Cancers
Pregnancy
Infections
BCP use
Recent Surgery |
|
|
Term
| Important aspects of history in cardiology: |
|
Definition
- chest pain
- back pain
- abdominal pain
- syncope
- dizziness |
|
|
Term
|
Definition
Ankle/Brachial Index
Doppler
Ultrasound
Plain Film Radiography
Contrast Imaging
CT/MRI Imaging |
|
|
Term
|
Definition
0 = absent
1= diminished
2= normal
3= bounding |
|
|
Term
| first tool to establish PAD dx: |
|
Definition
|
|
Term
|
Definition
Atherosclerosis
Vasculitis
Atheroembolic disease
Thrombotic disorders
Trauma
Radiation
Popliteal aneurysm
Thromboangiitis obliterans (Buerger’s disease)
Popliteal entrapment
Coarctation of aorta
Vascular tumor |
|
|
Term
| Ankle Brachial Index (ABI) is performed with the patient resting in the __ position. All pressures are measured with an __ __ and __ __ __. __ pressures are measured in the __ and __ __ arteries, followed by the __ and __ __ arteries. |
|
Definition
- supine
- arterial doppler
- blood pressure cuff
- Systolic pressures
- right and left brachial arteries
- right and left ankle arteries |
|
|
Term
|
Definition
Step 1: Apply the appropriately sized blood pressure cuff on the arm above the elbow (either arm).
Step 2: Apply Doppler gel to skin surface.
Step 3: Turn on the Doppler and place the probe in the area of the pulse at a 45-60° angle to the surface of the skin, pointing to the shoulder.
Step 4: Move the probe around until the clearest arterial signal is heard.
Step 5: Inflate the blood pressure cuff to approximately 20 mmHg above the point where systolic sounds are no longer heard.
Step 6: Gradually deflate until the arterial signal returns. Record the pressure reading.
Step 7: Repeat the procedure for the right and left posterior tibial and dorsalis pedis arteries. Place the probe on the pulse and angle the probe at 45o toward the knee.
Step 8: Record the systolic blood pressure of the contralateral arm. |
|
|
Term
| The ABI ratio is the ratio of the __ __ __ __ to the __ __ __ __ for each leg. |
|
Definition
| - highest ankle systolic pressure to the highest brachial systolic pressure |
|
|
Term
| ABI= (highest leg systolic pressure/highest brachial systolic pressure) |
|
Definition
|
|
Term
The ankle-brachial index is 95% sensitive and 99% specific for PAD
Establishes the PAD diagnosis
Identifies a population at high risk of CV ischemic events
The “population at risk” can be clinically and epidemiologically defined: |
|
Definition
|
|
Term
| patient comes in with claudication, what do you do? |
|
Definition
|
|
Term
| An ABI of __ and above is normal. |
|
Definition
|
|
Term
| An ABI of __ to __i s mild to moderate disease. |
|
Definition
|
|
