Week 4 Medical Terminology

point of maximal impulse

strongest impulse noticed during palpation of the precordium, which is usually the left ­ventricular apical impulse;

however, in the setting of pulmonary hypertension or right ventricular hypertrophy, the point of maximal impulse may be located over the right ventricle in the left parasternal area

dextrocardia

abnormal condition in which the apex of the heart is located in the right hemithorax, due to abnormal folding of the heart tube during embryologic development; may be associated with the anatomic reversal of the atria and the abdominal viscera (dextrocardia with situs inversus)

heart murmur

heart sound heard during systole or diastole that represents turbulent blood flow, usually due to blood rapidly moving from a high pressure to a lower pressure chamber; common examples include: (1) pulmonary flow murmurs during high cardiac output states such as pregnancy, adolescence, anemia, or thyrotoxicosis; (2) stenotic aortic valve or pulmonic valve (systolic murmurs); (3) regurgitant mitral or tricuspid valve (systolic murmurs); (4) stenotic mitral or tricuspid valves (diastolic murmurs); or (5) regurgitant aortic or pulmonic valves (diastolic murmurs); (6) congenital murmurs, such as that of a ventricular septal defect (harsh, holosystolic murmur) or a patent ductus arteriosus (continuous murmur)

orthopnea

shortness of breath while lying flat that most commonly develops in patients with left ventricular failure and results from the redistribution of pulmonary edema to the most dependent portion of the lung; most easily assessed by querying how many pillows a patient uses to sleep

palpitations

abnormal sensation of feeling one’s own heart beat; may be rapid, slow, regular, or irregular and is a common symptom of many arrhythmias as well as anxiety associated with those arrhythmias

sycnope

sudden onset of loss of consciousness due to lack of adequate perfusion to the brain; when resulting from innate cardiac pathology, such as a fatal or near-fatal arrhythmia, syncope is often associated with injury to the face, dentition, major joint dislocation, or fractures

bruit

abnormal high-pitched sound resulting from turbulent blood flow, usually heard during systole during the auscultation of an artery; commonly heard in patients with a dialysis arteriovenous fistula or an atherosclerotic plaque resulting in severe arterial narrowing

thrill

abnormal vibratory impulse palpated over areas of turbulent blood flow, most commonly observed in patients with a dialysis arteriovenous fistula, a stenotic aortic valve, or a ventricular septal defect

pulsus alternans

abnormal pulse characterized by an alternating “strong” and “weak” pulse quality found in patients with significant left ventricular dysfunction thought to originate due to abnormal contractility in the failing heart; may be detected by palpation, while auscultating the blood pressure, or by Doppler echocardiography

pulsus paradoxus

abnormal pulse characterized by exaggerated swings in systolic pressure due to increased ventricular interdependence, usually found in cardiac tamponade or severe asthma exacerbations; normally, systolic pressure decreases by 2 to 4 mm Hg, but, in pulsus paradoxus, systolic pressure decreases by >10 to 12 mm Hg with inspiration, as the filling of the right ventricle impedes filling of the left ventricle

heave

abnormally strong precordial impulse lasting the entire duration (or slightly less) of systole, discovered during palpation of the precordium; if found in the left parasternal area, it usually represents right ventricular hypertrophy or pulmonary hypertension, and if found in the midclavicular to anteroaxillary area, it usually represents a left ventricular aneurysm

hypertrophic obstructive cardiomyopathy

common genetic cardiomyopathy associated with a harsh systolic murmur created by turbulent blood flow through the left ventricular (LV) outflow tract during systole; characteristic murmur is made louder with LV volume depletion (standing after squatting or after ingesting a large fatty meal) and is made softer with increased LV volume or with increased afterload (isometric handgrip)

valsalva manuever

provocative examination maneuver wherein a patient performs a forced exhalation with a closed glottis; significantly reduces venous return to the heart, which has diagnostic utility in heart failure, hypertrophic obstructive cardiomyopathy, and pulmonary hypertension

lymphedema

nonpitting edema caused by lymphatic obstruction that usually occurs after radiation therapy, lymph node dissection, or rare parasitic infections

edema

clinically relevant interstitial fluid that develops as a result of increased venous pressure, decreased capillary osmotic pressure, or decreased lymphatic drainage effusion pathologic joint fluid that may be visible or palpable

poikilothermia

decrease in temperature of one extremity as compared symmetrically with the other extremity that signifies arterial obstruction; when occurring acutely, it suggests an occlusive arterial thrombus

allen test

physical examination maneuver performed to assess the integrity of the circulation of the palmar arterial arches done by compressing the ulnar and radial arteries simultaneously for at least 5 seconds, followed by the sequential release of compression of each artery while observing the hand for arterial filling

cyanosis

bluish discoloration of the skin that can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment

stridor

continuous, musical, high-pitched sound heard over the upper airways or at a distance without a stethoscope; results from airflow across a narrowed upper respiratory tract

accessory muscle use

using muscles that assist, but do not play a primary role, in tidal breathing; sign of respiratory distress

barrel chest

increased anterior–posterior diameter of the chest wall resembling the shape of a barrel, most often associated with lung hyperinflation due to emphysema

tactile fremitus

palpable vibratory transmission felt on the chest wall during speaking; intensity changes depending on the characteristics of the airways and lung parenchyma

bronchial breath sound

soft, nonmusical sound heard on both phases of the respiratory cycle that mimics tracheal

sound; indicates airway patency surrounded by consolidated lung tissue (e.g., pneumonia) or fibrosis

vesicular (normal) breath sound

soft, nonmusical sound heard best on inspiration and early expiration across all lung fields; considered a normal breath sound

crackles

discontinuous, nonmusical, short, explosive lung sounds that arise from small distal airways popping open during inspiration; fine crackles are softer, higher pitched, and more frequent per breath than coarse crackles

rhonchi

considered a variant of wheeze arising from the same mechanism but lower in pitch, similar to snoring; may be heard on inspiration, expiration, or both; may be affected by cough, implicating secretions in the mechanism (unlike wheeze)

wheeze

continuous, musical, high-pitched lung sounds heard on inspiration, expiration, or both; arise from rapid and turbulent airflow across airways narrowed almost to the point of closure

pleural friction rubs

discontinuous, nonmusical, low-frequency, grating sound heard during inspiration and expiration (biphasic) often best heard in the axilla and bases of the lungs; arises from inflammation and roughening of the visceral pleura as it slides against the parietal pleura (e.g., pleuritis, malignancy)

transmitted voice sounds

sounds generated in the larynx heard when auscultating the thorax; resonance changes depending on characteristics of the airways and/or parenchyma

egophony

sign in which spoken “ee” is heard as “ay” when auscultating an area of consolidation (e.g., pneumonia)

bronchophony

sign in which spoken words are louder over an area of consolidated lung

whispered pectoriloquy

sign in which whispered words are heard louder and clearer over an area of consolidated lung