signs, symptoms, complications and risk factors for cardiac disease

what is a sign?

objective evidence of disease

• something that can be seen

what is a symptom?

subjective evidence of disease

• it is a feeling

headache : sign or symptom

symptom

cyanosis : sign or symptom

sign

SOB : sign or symptom

symptom

edema : sign or symptom

sign

what is angina?

chest pain caused by myocardial ischemia

stable vs unstable angina

stable

• chest pain controlled by nitroglycerin

• or by reducing/eliminating activity at the time of pain

unstable

• chest pain at rest

why is echo used for angina symptom?

to identify WMA

• reduced EF%,

• rule out ao stenosis, HCM, etc

why would a stress echo be used for angina?

induce symptoms and visualize changes on echo

what can be administered to treat angina?

propanolol (beta blocker)

nitroglycerin

SOB is associated with

valvular stenosis

pulmonary HTN

significant regurg

CHF

decreased EF%

what is dyspnea on exertion?

difficulty breathing with exercise

dyspnea on exertion is associated with

valvular stenosis

pulmonary HTN

significant regurg

CHF

decreased EF%

what is hemoptysis?

bloody sputum

hemoptysis is caused by

pulmonary edema

hemorrhage

hemoptysis is associated with

significant MS

significant acute MR

what is cyanosis?

bluish discoloration of skin and mucous membranes

cyanosis is associated with

pulmonary disease

eisenmenger syndrome

TOF

other r to l shunts

what can lead to clubbing of fingers and toes?

cyanosis

what is edema

accumulation of fluid in tissues/cells

what is pitting edema

ability to indent the skin and it takes time for the skin contour to return to normal

what can lead to edema?

LV/RV failure

systemic HTN

how is pitting edema measured?

scale of +1 - +4 with +4 being very slow normalization of skin contour

what is brawny edema

occurs when chronic tissue edema leads to tissue fibrosis (excessive buildup of fibrous connective tissue)

• edema and skin discoloration occurs without pitting

what kind of edema is commonly seen with left heart failure? right heart failure?

left : pulmonary edema

• weaked LV fails to pump oxygenated blood so blood backs up into LA and pulm veins

right : bilateral pedal edema

• RV fails to pump blood forward into the lungs and blood backs up into the systemic venous circuation

compare venous insufficiency swelling vs heart failure swelling

venous insufficiency : swelling in affected leg(s)

heart failure : swelling of legs AND feet

what is jugular vein distention

increased right heart pressure causes back log of blood into the vena cava and their tributaries

jugular vein distention can be due to

tricuspid stenosis

pulm htn

severe tricupid regurg

constrictive pericarditis

cardiac tamponade

what is pulsus paradoxus

>10mmHg drop in systolic BP with inspiration

pulsus paradoxus is associated with

cardiac tamponade (rapid fluid accumulation in pericardial sac)

constrictive pericarditis (pericardium becomes rigid, scarred and thick)

pulm embolism

COPD (lung disease)

what are palpitations?

when pt is aware that heart is beating

palpitations can be caused by

exercise

anxiety

caffeine

smoking

what is an arrhythmia?

abnormal heart rate or rhythm

what is syncope?

fainting/passing out

syncope can be caused by

hypotension

arrhythmia

myocardial infarction

subao stenosis

severe ao valvular stenosis

what is a murmur

audible sound associated with turbulent flow

what aids in murmur diagnosis

timing and duration of murmur

murmurs are associated with

valvular disease/defects

septal defects

what is a thrill?

palpable vibration and loud harsh murmurs

thrills are associated with

VSD

ao/pulm stenosis

fever/malaise is seen with

endocarditis (bacteria/fungi entering bloodstream causing heart lining/valves to be inflamed)

what is cachexia?

overall state of ill health (malnutrition and wasting) due to chronic heart disease

elevated serum levels of these three can indicate acute myocardial infarction

troponin

creatine kinase MB

lactic dehydrogenase (LDH)

** usually increased during and for 24-48 hours after an acute MI

abnormal carnitine levels result in

impaired muscle metabolism which can lead to dilated cardiomyopathy

what are signs of infection?

presence of staphyloccocus

fever on unknown origin

what causes the first heart sound (S1 lub)

mitral and tricuspid valve closing after atrial contraction

when does S1 occur on the EKG?

onset of QRS wave

what causes the second heart sound (S2 lub)

ao and pulm valve closing after ventricular contraction

when does S2 occur on the EKG?

end of T wave

which heart sound has a higher pitch?

s2

what closes first : mv or tv

mv

what closes first : ao or pulm

ao

what is s3? caused by?

abnormal heart sound : ventricular gallop

• caused by oscillation of blood back and forth between the walls of the ventricals due to the inflow of blood from the atria

when does s3 occur?

in diastole

• early diastole just after s2

s3 indicates

rapid ventricular filling due to

• pregnancy

• anemia

• CHF

• dilated cardiomyopathy

• severe valvular regurg

• l to r shunting

• high cardiac output

what is s4? caused by?

abnormal : presystolic gallop or atrial gallop

• caused by sound of blood being forced into a stiff/hypertrophic ventricle during atrial kick

when does s4 occur?

diastole

• late right before s1

s4 is seen with

htn

severe ao/pulm stenosis

cad

cardiomopathy

which abn heart sound is normal is children/YA?

s3

• after age 40 = abnormal & correlated with dysfunction or volume overload

when does the opening snap occur? associated with?

onset of diastole

mitral stenosis

what causes ejection click

abnormal tethering of cusps and it is the sounds they make when the valve tries to open under significant pressure

when does the ejection click occur?

right after S1 and occurs with ventricular contraction

when does the midsystolic click occur? associated wtih?

mid-late systole

associated with MVP (leaflets billow back into LA)

what is pericardial rub?

friction sounds caused by inflammation due to acute pericarditis

what is pericardial knock?

heart knocking against thickened rigid pericardial sac

pericardial knock is associated with

constrictive pericarditis

when is pericardial knock heard?

early diastole

• during filling blood passively rushes from atria into ventricles

• due to rigid pericardium the heart is restricted and unable to expand

• causes sudden stopping or braking of blood creating a loud knocking sound

compare functional vs pathologic murmur

functional : caused by rapid inflow across normal cardiac valve

pathologic : caused by turbulence of flow across disease cardiac valves

murmurs are characterized by

1. location (apex, sternal border, arch)

2. timing (systole, diastole, continuous)

3. intensity (grade 1-6, 1 barely audible; 6 very loud with palpable thrill)

4. pitch (low to high)

5. quality (harsh, rubbing, blowing, rumbling)

6. sound profile (crescendo, descrescendo, holosystolic)

in terms of heart sounds, when do systolic murmurs occur?

between s1 and s2

what are the systolic murmurs

mid systolic

late systolc

holosystolic

systolic ejection

describe what causes a midsystolic murmur

• ao or pulm stenosis

• increased flow through normal semiluar valves

• dilation of ao root

• dilation of pulm trunk

describe what causes a late systolic murmur

mitral valve prolapse

tricuspid valve prolapse

pap muscle dysfunction

describe what causes a holosystolic murmur

mitral and tricuspid regurg

vsd

when does the holosystolic murmur occur

immediately after s1 and continues to end systole

• occurs during isovolumic contraction period & when ao valve is opening

when does the systolic ejection murmur occur

when valve is opening BUT NOT during isovulimc contraction period

• slowly after s1 and increases in intensity relative to severity of valve obstruction

what causes systolic ejection murmur

semilunar valve stenosis (as,ps)

hypertrophic obstructive cardiomyopathy

when do diastolic murmurs occur

during interval between s2 of one cardiac cycle and s1 of another cardiac cycle

what are the diastolic murmurs

regurg diastolic murmurs

diastolic ejection murmur

late diastolic

austin flint

dock murmur

when do regurg diastolic murmurs occur?

early diastole; immediately after S2

what causes regurgitant diastolic murmurs

semilunar valve regurg

when do diastolic ejection murmurs occur?

when av valves are opening BUT NOT during isovolumic relaxation period

• mid diastolic murmur

what causes diastolic ejection murmurs

av valve stenosis

when does late diastolic mumur occur?

right before s1

how do large l to r shunt affect AV flow

increased av valve flow (PDA/ASD)

what is the austin flint murmur?

functional diastolic murmur caused by significant aortic regurg

• sound from vibratory motion of MV caused by aortic insufficiency jet

what is a dock murmur? associated with?

early diastolic murmur

associated with stenosis of LAD artery

what causes a continuous murmur

continuous flow through systole and diastole

continuous murmurs are seen in patients with

PDA

AV fistula (abn direct connection between artery and vein)

anomalous coronary origin

what is amyl nitrate?

vasodilator

• venous return increases and BP drops

which valvular abnormalities are holosystolic?

mr and tr

which valvular abnormalities are crescendo-descrescendo?

ao/pulm stenosis

mitral/tricuspid stenosis

which valvular abnormalities are descrescendo?

ao regurg

pulm regurg

what is aids and what is the most common cardiac complication?

virus that damages the immune syste and inhibits the body’s ability to fight infection/disease

• most common cardiac complication : pericardial effusion

what is acromegaly and what is it associated with?

when the pituitary gland produces too much growth hormone

associated with

• LV hypertrophy

• increased LV mass

• impaired relaxation

what finding are normal with aging?

• increased LV wall thickness and mass

• sigmoid ventricular septum

• increased LA size

• reduced cardiac output and stroke volume

• mitral annular calcification

• mitral valve leaflet thickening

• increased mitral A velocity (reduced E/A ratio)

• prolonged IVRT

• MR/TR

• increased ao root size

• ao valve calcification

alcohol abuse can cause

acute MI

reduced systolic ventricular function

dilated cardiomyopathy