Term
| What are s3 and s4 heart sounds? |
|
Definition
| filling sounds. S3 indicates passive filling pathology and is heard in early diastole and S4 is active filling pathology and is heard in late diastole |
|
|
Term
| what are characteristics of atrophic skin changes? What causes it? |
|
Definition
| thinning, dry, cally, loss of hair, loss of sweat and sebaceous glands. Caused by ischemia to the skin |
|
|
Term
|
Definition
| classic symptomis goes to be worse onexertion, diphoresis (head andneck( and clod or food allergies. |
|
|
Term
| Historical findings in pt with unstable angina |
|
Definition
differentiated from stable angina by occurence withough physical exertion. can develop from stable angina.
unstable angina is UNPREDICTABLE. |
|
|
Term
| Variant/Mixed Angina hx findings |
|
Definition
| similar pain to other anginas w/ variable threshold of initiation, occurs at rest or exertion and NOT PREGRESSIVE IN SEVERITY |
|
|
Term
| Name 5 risk factors for coronary ischemia? |
|
Definition
| HTN, DM, Hyperlipidemia, smoking, family hx, male sex, postmenopausal women. |
|
|
Term
what is arcus senilis?
What is it a sign of? |
|
Definition
| cloudy ring around the iris in the eye. sign of atherosclerosis and hyperlipidemia |
|
|
Term
| What common conditions show AV nicking? |
|
Definition
|
|
Term
| a bruit heard over a vessel indicates what? |
|
Definition
|
|
Term
a murmur hear of the mitral valve most likely indicates what?
What causes it? |
|
Definition
| mitral valve insufficiency and regurgitation of blood back into the atrium. Often due to weak pappilary muscles from coronary ischemia |
|
|
Term
| what heart sounds will be heard if a pt is suffering from coronary ischemia? |
|
Definition
| s3 and s4, systolic murmur over mitral valve, rubs, and clicks |
|
|
Term
| ECG findings in a coronary ischemia pt? |
|
Definition
may be normal.
may have ST elevation or depresion |
|
|
Term
| CXR findings in coronary ischemia pt? |
|
Definition
| elarged cardiac shadow and calcification of the aortic arch |
|
|
Term
| what diagnostic tests can you order to confirm coronary ischemia? |
|
Definition
| stress test, nuclear stress test w/ imaging, fast CT, cariac catheterization |
|
|
Term
| how do you differentiate between angina and pericarditis? |
|
Definition
| pain is relieved if pt sits forward and is generally constant w/o relief in pericarditis. |
|
|
Term
| Pericarditis location of pain? associated diseases? pt symptoms? exacerbating factors? |
|
Definition
substernal pain
associated w/ viral infections or chronic inflammatory disease such as RA. Pt suffers tachycardia and dyspnea.
Not exaggerated w/ exertion |
|
|
Term
| Physical findings in pericarditis |
|
Definition
pericardial friction rub (diagnostic)
Pericardial knock
No atherosclerosis
Neck vein distention w/ tamponade |
|
|
Term
| What is cardiac tamponade? |
|
Definition
| fluid filling the pericardial sac |
|
|
Term
| lab findings in pericarditis? |
|
Definition
increase RBC sedimentation rate (inflammation marker)
Positive inflammation markers
ECG: diffuse ST elevation |
|
|
Term
| what test do you use to confirm pericarditis? |
|
Definition
echocardiography - ultrasound\
cardiac catheterization for pressure determination
Pericardial biopsy |
|
|
Term
Common pt history for mitral valve prolapse?
How do you distinguish MVP from other chest pathologies? |
|
Definition
substernal pain w or w/o radiation
Dyspnea at rest or exertion
Palpitations and near syncope or syncope
Most common in young thin females***
Family history of MVP** |
|
|
Term
| physical findings in MVP? |
|
Definition
mid-systolic click (S1-click-S2)
Resting tachycardia
pectus excavatum |
|
|
Term
| What tests would you order to confirm MVP? |
|
Definition
echocardiography
Holter monitor for arrhythmias |
|
|
Term
|
Definition
sudden UNILATERAL CHEST PAIN NON-SUBSTERNAL
severe dyspnea (worse that the pain. Not the case in angina)
worse w/ inspiration |
|
|
Term
| how do you test for a PE? |
|
Definition
ABG shows hypoxia and hypercarbia
ECG normal
CXR normal usually
VQ scanning***
pulmonary arteriography |
|
|
Term
| what differentiated esophageal spasm from angina? |
|
Definition
| onset after eating, not related to physical activity, and related to postural position |
|
|
Term
| what tests would you order to diagnose esophageal spasm? |
|
Definition
upper GI barium swallow
Esophageal manometry (tube down your throat, swallow, measure pressure) |
|
|
Term
| differentiating factor that distinguishes musculoskeletal pain from other chest pains? |
|
Definition
| usually worse with motion or position and palpation |
|
|
Term
syndrome X features?
finding that indicates it is syndrome X? |
|
Definition
looks exactly like coronary ischemia even with associated ECG findings. However, no physical findings with stress test or catheterization.
**pts are usually younger than typical heart pts** |
|
|
Term
| how do you differentiate pericarditis from pleurisy? |
|
Definition
| pleurisy is worse with respiration while pericarditis does not change |
|
|
Term
| history findings of pleurisy? |
|
Definition
sharp stabbing pain in lateral chest
worse with inspiration/cough
associated w/ viral infection
no pain radiation
movement worsens pain
lasts for days |
|
|
Term
| physical findings with pleurisy? |
|
Definition
| pleural friction rub, focal rales, shallow splinting respirations |
|
|
Term
| common history of aortic dissection pt? |
|
Definition
sudden SEVERE tearing chest and back pain
diaphoresis
hx of atherosclerosis or HTN |
|
|
Term
| physical findings in aortic dissection pt? |
|
Definition
different BP in legs and arms
HTN
cardiac murmur or aortic insuffeciency
Lungs clear |
|
|
Term
| what tests confirm arotic dissection? |
|
Definition
trans-esophageal echocardiography
aortogroaphy
cxr |
|
|
Term
| hx found in pt with aortic stenosis? |
|
Definition
looks exactly like angina
pain w/ exertion
dyspnea w/ exertion
lightheadedness w/ exertion
slowly progressive over years |
|
|
Term
| physical findings in pt with aortic stenosis? |
|
Definition
differentiated w/ systolic ejection murmur at aortic listening post
S4 sounds
enlarged PMI w/ heaves, lifts
reduce carotic upstroke
soft aortic closure sound |
|
|
Term
| how do you test for aortic stenosis? |
|
Definition
echocardiography
ECH show LV hypertrophy
CXR shows enlarged heart
cardiac catheterization |
|
|
