Cardiovascular System - Lecture Notes (Anatomy, History, Exam, Documentation, Prevention (DPR)

Flashcards covering anatomy, history taking, physical examination, documentation, and prevention in the cardiovascular system lecture.

Which chamber forms most of the anterior (precordial) surface of the heart?

Right ventricle.

Where is the base of the heart located?

The superior aspect at the right and left 2nd interspaces next to the sternum.

Where is the apex and PMI located?

Apex at the 5th intercostal space, just medial to the left midclavicular line; PMI is the point of maximal impulse.

Which valves are the atrioventricular (AV) valves?

Tricuspid and mitral valves.

Which valves are the semilunar valves?

Pulmonic and aortic valves.

Heart sounds arise from what anatomical events?

Closing leaflets, adjacent structures, and blood flow.

What happens during systole?

Ventricular contraction; aortic valve opens; mitral valve closes; blood flows from the left ventricle to the aorta.

What happens during diastole?

Ventricular relaxation; blood flows from the atria to the ventricles; aortic valve closes; mitral valve opens.

List the peripheral arteries mentioned in the PVS exam.

Carotid, subclavian, brachial, aorta, radial, ulnar, femoral, popliteal, posterior tibial, dorsalis pedis.

What mnemonic is used for the History of Present Illness (HPI) in this course?

OPQRRSTAA (or an equivalent mnemonic).

What components are included under the HPI (as per notes)?

Chronological time; place of onset; duration; frequency; location; quality; quantity/severity; aggravating factors; alleviating factors; associated symptoms; self-treatment; recent evaluation; pertinent negatives.

Name common cardiac presenting symptoms.

Chest pain, palpitations, dyspnea, fainting (syncope); edema; wheezing, cough, or hemoptysis.

Give examples of typical chest pain symptoms due to cardiac etiology.

Left-sided chest pain with chest pressure/tightness, shortness of breath, radiation to the jaw, nausea/vomiting, diaphoresis.

What are atypical cardiac symptoms more common in women, the elderly, and diabetics?

Upper back pain, jaw pain, arm pain, shortness of breath, paroxysmal nocturnal dyspnea, nausea/vomiting, fatigue.

How are palpitations defined?

Unpleasant awareness of the heartbeat; sensations such as skipping, racing, fluttering, pounding, or stopping.

What can cause palpitations aside from primary heart conditions?

Non-cardiac conditions like anxiety or thyroid disease.

Define dyspnea, orthopnea, and paroxysmal nocturnal dyspnea (PND).

Dyspnea: uncomfortable awareness of breathing with exertion; orthopnea: dyspnea when lying down that improves when sitting up; PND: episodes of sudden dyspnea and orthopnea waking from sleep.

How is edema described in the cardiovascular history?

Accumulation of excess fluid in extravascular interstitial space; swelling in dependent regions (legs, hands, around eyes); interstitial tissue can absorb liters of fluid.

What past history components are important in cardiovascular assessment?

Past medical history (dyslipidemia, hypertension, diabetes, thyroid disease); past surgical history; medications and allergies; family history of cardiovascular disease; social history (smoking, alcohol, drugs, physical inactivity, unhealthy diet).

What is included in the Part 3 PVS exam?

JVP and carotid arteries; abdominal aorta; extremities: pulses; check for edema.

What is the normal position and location of PMI?

5th intercostal space, mid-clavicular line; normal diameter < 2.5 cm.

What are common abnormal PMI findings?

PMI displaced to the xiphoid/epigastric region (RVH); PMI >2.5 cm (LVH); PMI >10 cm lateral (LVH).

Where are the four cardiac valve areas auscultated?

Aortic area: 2nd right intercostal space; Pulmonic area: 2nd left intercostal space; Tricuspid area: 3rd/4th left intercostal space; Mitral area: 5th left intercostal space at the midclavicular line.

Which sounds are best heard with the diaphragm vs the bell?

Diaphragm: high-pitched sounds (S1, S2, murmurs of aortic and mitral regurgitation, pericardial rubs); Bell: low-pitched sounds (S3, S4, mitral stenosis).

What are S1 and S2?

S1: closure of the mitral/tricuspid valves; start of systole; S2: closure of the aortic/pulmonic valves; start of diastole.

Why might S2 be split, and when is this normal?

Split S2 results from asynchronous closure of the aortic and pulmonic valves; during inspiration it is often best heard at the left 2nd intercostal space; can be physiologically normal.

What is Split S1 and what can cause it?

Split S1 results from delay of tricuspid closure; related to certain conditions affecting tricuspid closure.

What is a cardiac murmur and how is it described?

Murmurs represent turbulent blood flow; described by location and timing (systolic vs diastolic).

What is a pericardial friction rub?

Rubbing of two surfaces of the pericardial sac.

What are S3 and S4 and what do they indicate?

S3 can be normal in children; in adults it may be a gallop indicating ventricular dysfunction; S4 indicates atrial contraction and can be a pathologic gallop.

What does Part 3 PVS exam include beyond listening to the heart?

JVP, carotid arteries, abdominal aorta, limb pulses, and edema assessment.

What are key guidelines for cardiovascular documentation?

Organize documentation; do not place subjective information in the wrong area; avoid using the word NORMAL; document all exams performed with objective details.

What prevention and counseling topics are highlighted after the cardiovascular exam?

Smoking cessation; DASH diet; physical activity (about 150 minutes/week); manage diabetes, hypertension, and hyperlipidemia; schedule follow-up.