What are the categories of dizziness?
- vertigo
- dysequilibrium
- presyncope
- lightheadedness
are most palpitations harmful?
no, most of them are benign
- common in pregnancy, caused by stress, induced by alcohol
What are the red flags in conduction with palpitations?
- more than 6 episodes per minute (red flag) or last for hours (yellow flag)
- SOB
- Chest pain
- Dizziness
- Lightheadedness
- Sudden cardiac death in family member
- Personal history of heart disease
What is the pneumonic for Well’s criteria of PE?
Don’t Die, Tell The Team To Calculate Criteria
- DVT symptoms (3 points)
- Diagnosis most likely (3 points)
- Tachycardia (1.5 points)
- Three days of immobilization or surgery in past 30 days (1.5 points)
- Thromboembolism in the past (1.5 points)
- Coughing (hemoptysis) (1 point)
- Cancer (1 point)
What is the Wells risk score interpretation of PE?
> 6 points = high risk (78.4%)
2-6 points = moderate risk (27.8%)
<2 points = low risk (3.4%)
What are the wells clinical prediction rule for DVT?
- Active cancer (tx w/in 6 months, or palliation)
- Paralysis, paresis, or immobilization of LE
- bedridden for more than 3 days b of surgery (w/in 4 weeks)
- Localized tenderness along distribution deep veins
- Entire leg swollen
- Unilateral calf swelling of >3cm
- Unilateral pitting edema
- Collateral superficial veins
- Alt diagnosis as likely or more likely than DVT (-2 points)
- all other criteria worth 1 pt
What is the Wells risk score interpretation of DVT?
> or = 3 = high risk (75%)
1-2 = moderate risk (17%)
<1 = low risk (3%)
What blood-tight partition divides the left heart from the right heart?
inter ventricular septum
Which portion of the electrocardiogram (ECG) represents a small deflection sometimes seen just after the T wave, representing the final phase of ventricular repolarization?
U wave
Does heart size increase or decrease with age?
Decrease
Name the five traditionally designated auscultatory areas and their corresponding intercostal space
- Aortic valve area – 2nd R intercostal space
- Pulmonic area – 2nd L intercostal space
- Second pulmonic area – 3rd L intercostal space
- Tricuspid area – 4th L intercostal space
- Mitral area – 5th L intercostal space, midclavicular line
Splitting of S2is greatest during which part of respiration?
inhalation
Describe a pericardial friction rub.
- One systolic sound and two diastolic sound (one diastolic sound in early diastole and one at end diastole)
- High pitched grating, rasping, or creaking sound heard over the heart due to rubbing of the inflamed pericardial surfaces as the heart contracts and relaxes
Name the 7 causes of murmurs that aren’t the result of valvular defects
- High output demands that increase speed of blood flow (fever, thyrotoxicosis, anemia, pregnancy)
- Structural defects, either congenital or acquired, that allow blood to flow through inappropriate pathways (atrial or septal defects)
- Diminished strength of myocardial contraction
- Altered blood flow in the major vessels near the heart
- Transmitted murmurs resulting from valvular aortic stenosis, ruptured chordae tendinae of mitral valve or severe aortic regurgitation
- Vigorous left ventricular ejection (more common in children)
- Persistence of fetal circulation
In sick sinus syndrome, sinoatrial dysfunction occurs secondary to which disorders?
Hypertension, arteriosclerotic heart disease, or rheumatic heart, or without known cause
Which four cardiac defects make up the tetralogy of Fallot?
- Ventricular septal defect
- Pulmonic stenosis
- Dextroposition of the aorta
- Right ventricular hypertrophy
An apical PMI palpated beyond the left fifth intercostal space may indicate?
L ventricular hypertrophy
You are listening to a patient’s heart sounds in the aortic and pulmonic areas. The sound becomes asynchronous during inspiration. What is the prevalent heart sound to this area is most likely due to?
- S2 split due to decreased intrathoracic pressure during breathing, causing pressure increase on venous return into the ventricles
- Increased venous return causes increased blood volume in right ventricle compared to the left, so it takes more time for the blood to get through
- Aortic valve closes before the pulmonic valve
What are normal cardiac changes that occur during pregnancy?
- Heart position changes – apical impuls is upward and more lateral by 1-1.5cm
- More audible splitting of S1, S2 and S3 may be heard after 20 weeks
- Systolic ejection may be heard over the pulmonic area in 90% of pregnant women
- Murmur is intensified during inspiration or expiration but should not be louder than grade 2
What are the parts of the EKG and what do they represent?
P - Spread of a stimulus through Atria (Atrial depolarization)
PR interval - time from initial stimulus of atria to initial stimulus of ventricles (.12-.2s)
QRS - the spread of a stimulant through the ventricles (Ventricular depolarization)
ST seg and T - the return of stimulated ventricular muscle to a resting state (Ventricular repolarization)
U - small deflection sometimes after T
QT interval - the time elapsed from the onset of ventricular depolarization until the completion of ventricular depolarization, with the interval varying with the cardiac rate
- tough, double-walled sac encasing and protecting heart
- thin outermost muscle layer covering heart, inner layer of pericardium
- thick, muscular middle layer responsible for pumping
- innermost layer, lining chambers and covering valves
- Pericardium
- Epicardium
- Myocardium
- Endocardium
What changes in the heart occur at birth?
- Ductus arteriosus and interatrial foramen ovale close
- Right ventricle assumes pulmonary circulation
- Left ventricle assumes systemic circulation
What changes occur in the hearts of older adults?
- Heart size decreases.
- Left ventricular wall thickens.
- Valves fibrose and calcify.
- Endocardium thickens.
- Myocardium becomes less elastic.
- ECG tracing changes.
What causes an S3 heart sound?
ventricular filling (fluid overload)
