All abnormalities ch 22

normal chest configuration

AP to Transverse - 1:2 ratio

barrel chest

thorax is round shaped. ratio is 1:1

seen in aging adults, copd, and chronic asthma

Funnel Chest (Pectus Excavatum)

depression in lower sternum

can cause murmurs or compress heart and vessels

Pigeon Chest (Pectus Carinatum)

sternum protrudes forward

congenital

increased ap diameter

Scoliosis

abnormal lateral curvature of the spine

s shape

kyphosis

hunchback

athletes that use their arms in overhead positions

including swimmers

forward translated head and internally rotated shoulders

pluses bisferiens

Each pulse has 2 strong systolic peaks, with a dip in between

Bigeminal pulse

2 rapid beats followed by a long interval

paradoxical pulse

Large difference in pulse pressure between inhalation and exhalation.

Lift (Heart)

sustained thrust during systole

thrill (heart)

vibratory sensation felt on the skin overlying an area of turbulence and indicates a loud heart murmur usually caused by an incompetent heart valve

Accentuated Apical Impulse

A sign of pressure overload

Increased force and duration

Laterally Displaced Apical Impulse

A sign of volume overload

Premature Atrial Contraction (PAC)

irregular heart rhythm characterized by atrial contractions occurring before the expected time

premature ventricular contraction (PVC)

a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker)

Sinus Arrhythmia

A sinus rhythm in which the rate varies with respiration, causing an irregular rhythm.

a fib

Atrial fibrillation (irregular heartbeat)

Atrial Flutter

irregular beating of the atria

often described as "a-flutter with 2 to 1 block or 3 to 1 block"

Aortic ejection click

heard at the 2nd right interspace and apex. intensity does not change with respiration

Pulmonic ejection click

Best heard at the second left ICS during early systole, the pulmonic ejection click often becomes softer with inspiration.

midsystolic click

mitral valve prolapse

can be heard over the mitral valve

late systolic murmur

Opening snap

A sharp, high-pitched click heard in early diastole related to opening of the abnormal valve in cases of mitral stenosis

S3 heart sound

in early diastole during rapid ventricular

filling phase.

Associated with increased filling pressures (e.g., mitral regurgitation, HF) and more common in dilated ventricles

normal in children and pregnant women

S4 heart sound

coincides with atrial contraction in late diastole and "a" wave in jugular venous pressure curve

due to increased resistance to ventricular filling following vigorous atrial contraction

summation gallop

abnormal mid-diastolic heart sound heard when both the pathologic S3 and S4 are present

pericardial friction rub

scraping or grating noise heard on auscultation of the heart; suggestive of pericarditis

patent ductus arteriosus

passageway between the aorta and the pulmonary artery remains open after birth

venous hum

A continuous murmur heard on auscultation over the major veins at the base of the neck or around the umbilicus

not normally heard

heard best with the diaphragm of the stethoscope

mid systolic murmur

begins after S1 and stops before S2

innocent murmur

no valvular or other pathologic cause, generally soft

vibratory or musical quality

Heard, at 2nd/3rd left ICS and disappears w/ sitting

physiological murmur

caused by temporary increase in blood flow

can occur in anemia, pregnancy, fever, and hyperthyroidism

murmur of pulmonic stenosis

Loud harsh systolic murmur that radiates to the left shoulder and increases with inspiration

In mild-moderate stenosis a loud ejection click precedes the murmur -> decreases with inspiration

murmur of aortic stenosis

Systolic crescendo/decrescendo murmur that radiates to the neck; ↑ with ↑ preload (Valsalva maneuver).

murmur of hypertrophic cardiomyopathy

only systolic murmur that increases during "strain phase" of valsalva maneuver due to increased outflow tract obstruction

Murmur—mitral regurgitation.

A HOLOSYSTOLIC MURMUR that RADIATES to the AXILLA; ↑ with ↑ afterload (HANDGRIP MANEUVER)

Murmur of Tricuspid Regurgitation

Pansystolic murmur

Increases in intensity with inspiration

ventricular septal defect

large hole between two ventricles lets venous blood pass from the right to the left ventricle and out to the aorta without oxygenation

murmur of aortic regurgitation

Occurring when the leaflets of the aortic valve fail to close completely

the murmur of aortic regurgitation is the result of blood flowing from the aorta back into the left ventricle.

necrotic great toe with blisters on toes and foot

Arterial ulcer. Great toe is necrotic with blisters on the toes and foot seen in arterial insufficiency.

Raynaud disease, Raynaud syndrome

cyanosis of the fingers or toes due to vascular constriction, usually caused by cold temperatures or emotional stress

arterial insufficiency

inadequate blood flow through the arteries

venous insufficiency

an abnormal circulatory condition characterized by decreased return of venous blood from the legs to the trunk of the body

neuropathic ulcer

secondary complication usually associated with a combination of ischemia and neuropathy.

most often associated with diabetes.

frequently found on foot

wound has good granulation tissue and little or no drainage.

superficial thrombophlebitis

inflammation of a vein near the surface due to the presence of a blood clot

lymphedema

swelling due to an abnormal accumulation of lymph fluid within the tissues

varicose veins

abnormally swollen, twisted veins with defective valves; most often seen in the legs

edema associated with lymphedema

Caused by abnormal or blocked lymph vessels

Nonpitting

Usually bilateral; may be unilateral

No skin ulceration or pigmentation

edema associated with chronic venous insufficiency

Caused by obstruction or insufficiency of deep veins

Usually unilateral; may be bilateral

Skin ulceration and pigmentation may be present