Heart section (General diagnosis)

What do jugular venous pulsations measure?

The pressure of the right side of the heart; can be more pronounced when congestive heart failure is present by applying pressure to the liver (hepatojugular reflex)

What is the definition of pulsus magnus?

“Bounding”; increased cardiac output, exercise, anxiety, fever, hyperthyroidism

What is the definition of pulsus parvus?

Weak or thready; decreased stroke volume, hypovolemia, aortic stenosis, CHF

What is the definition of pulsus alternans?

Alternates in amplitude; left ventricular failure

What is the definition of pulsus bisferiens?

Two strong systolic peaks separated by mild systolic dip (best felt at carotid artery); aortic regurgitation, aortic stenosis

What is the definition of pulsus paradoxus?

Decreased amplitude on inspiration, increased with expiration (>10 mmHg amplitude change); COPD, bronchial asthma, emphysema, pericardial effusion

What is the definition of water hammer pulse?

A jerky pulse that is rapidly increasing and then collapsing because of aortic insufficiency

What are thrills?

Vibration produced by turbulent blood flow within the heart (murmurs)

What is called when the ventricles contract?

Systole

What is called when the ventricles rest and are filling?

Diastole

What is S1?

Closure of AV (mitral and tricuspid valve) valves

What is S2?

Closure of semilunar (pulmonary and aortic) valves

What is S3 (ventricular gallop)?

Normal in children, young adults and athletes; >40 y.o. earliest sign of CHF

What is S4 (atrial gallop)?

Similar to S3 and is related to stiffness of the ventricular myocardium to rapid filling

Where do you auscultate for the aortic valve?

Right sternal border at the 2nd intercostal space; best auscultated with patient seated, leaning forward, and exhaling

Where do you auscultate for the pulmonic valve?

Left sternal border at the 2nd intercostal space

Where do you auscultate for the erb’s point?

Left sternal border at the 3rd intercostal space

Where do you auscultate for the tricuspid valve?

Left sternal border at the 4th or 5th intercostal space

Where do you auscultate for the mitral valve?

Mid-clavicular line at the 5th intercostal space; best auscultated in the left lateral decubitus position

What is stenosis?

Valve has trouble opening and the blood swirls through a narrow opening

What does a stenosis murmur sound like?

Low pitch and is best heard with the bell of the stethoscope

What is regurgitation?

Valve is insufficient and blood seeps or squirts back into the chamber

What does a regurgitation murmur sound like?

High pitch and is best heard with the diaphragm of the stethoscope

What is the mnemonic ARMS & PRTS for?

Mnemonic for heart murmurs which occur in diastole; the opposite occurs in systole

What is the mnemonic ARMS & PRTS stand for?

A: aortic P: pulmonic

R: regurgitation R: regurgitation

M: mitral T: tricuspid

S: stenosis S: stenosis

What is patent ductus arteriosus?

Failure of shunt to close between the aorta and left pulmonary artery; creates a continuous/machinery like murmur that can be heart in both phases of the heart cycle

What is tetralogy of fallot?

Dextraposition/overriding of the aorta, right ventricular hypertrophy, interventricular septal defect and pulmonic stenosis; creates a loud ejection murmur during systole and severe cyanosis

What is coarctation of the aorta?

Constriction of the descending aorta (usually distal to the left subclavian); causes higher blood pressure in the upper extremity by 20 mmHg (diagnostic) when compared to the lower extremity

What is subclavian steal syndrome?

Proximal stenosis of the subclavian artery; seen in younger females who faint (syncope/drop attacks) while exercising

What is the most common cause of left sided heart failure?

Hypertension (35-55 yoa); 2nd most common cause is aortic stenosis

What are early signs of left sided heart failure?

Pulmonary edema causing shortness of breath and orthopena; fluid collects first at the costophrenic angle

What is the most common cause of right sided heart failure?

Left sided heart failure

What is the most common cause of mitral stenosis?

Rheumatic fever (ASO-Titer)

What is cor pulmonale?

When the right side fails by itself; lung condition that causes right sided heart failure

What are symptoms of right sided heart failure?

Edema and fluid in the extremities, jugular venous distention, liver/spleen enlargement, hepatojugular reflex, ascites, caput medusa/spider angioma, pitting edema, stasis dermatitis, increased heart rate, S3 gallop, and decreased blood pressure

What is aortic dissection?

An interruption of the intima allowing blood into the vessel wall with immediate “tearing” pain; acute surgical emergency; associated with hypertension/arteriosclerosis (descending aorta) and Marfan’s syndrome (ascending aorta)

What is Marfan’s syndrome?

Inherited connective tissue disorder with ventricular weakening and enlargement; patient presents with tall, long fingers/limbs, lens subluxation, cardiovascular and lung problems

What is angina pectoris (coronary vasospasm)?

Comes on with exertion; relieved by vasodilators under tongue (usually nitroglycerin)

What is printzmetal angina?

Comes on with rest (atypical)

What is myocardial infarction?

Acute heart failure; comes on with rest; caused by atherosclerosis; CK-MB is elevated, increased LDH, and increased SGOT

What is an aneurysm?

Abnormal widening that involves all 3 layers; defect in elastic-media tissues

What is a normal “P” wave on an ECG?

Normal atrial depolarization

What is a normal “QRS” complex on an ECG?

Depolarization of the ventricles; repolarization of the atria hidden here

What is a normal “T” wave on an ECG?

Repolarization of the ventricles

What is a normal “U” wave on an ECG?

Repolarization of the papillary muscles

What does an increased PR interval mean?

Prolonged AV nodal delay (primary heart block)

What does it mean if there are two “P” waves before “QRS”?

Weinkbochs-block of bundle of HIS (secondary heart block)

What does it mean if there is no “QRS” pattern?

Complete heart block (no ventricular contraction); atrial repolarization is hidden under the QRS complex

What does it mean if the “ST” segment is enlarged or inverted?

MI (acute heart failure)

What is an echocardiogram/doppler used for?

To evaluate heart levels