HEART

Question 1

• Classical exertional pain, pressure or discomfort in the chest, shoulders, back, neck or arm (Angina Pectorsi)
• Acute Coronary Syndrome – including myocardial infarction (MI), non-ST elevation MI (non-STEMI) and ST elevation MI (STEMI)
• No CAD on angiogram – microvascular disease, especially in females
• Tearing or ripping chest pain radiating to the back or neck occurs with acute aortic dissection

Answer 1

chest pain

Question 2

• Unpleasant awareness of the heart beat
• If there are signs or symptoms of irregular heart action, obtain ECG
• May be atrial fibrillation (irregularly irregular)
• Clues in history:
  o transient skips, flip flops (premature contraction)
  o rapid beat with sudden onset/offset (paroxysmal supraventricular tachycardia)
  o rapid regular rate < 120 (sinus tachycardia)

Answer 2

Palpitations

Question 3

• Common patient concern
• Dyspnea: uncomfortable awareness of breathing that is inappropriate to level of exertion
  o Pulmonary embolism, spontaneous
  pneumothorax, anxiety
• Orthopnea: occurs when patient is supine and improves when patient sits up
• PND: episodes of sudden dyspnea and orthopnea that awaken patient from sleep: prompts patient to get up, stand up or go to window
  for air
  o Associated with wheezing or coughing
  o PND occurs in left ventricular heart failure and mitral stenosis

Answer 3

Shortness of Breath

Question 4

Accumulation of fluid in the extravascular interstitial fluid

• Causes: L/R ventricular dysfunction, pulmonary HTN or COPD
• Nutritional: hypoalbuminia
• Positional
• Dependent edema appears in lowest body parts
• Anasarca: severe generalized edema up to sacrum and abdomen

Answer 4

Swelling (Edema)

Question 5

• Transient loss of consciousness followed by recovery
• Most common cause is neurocardiogenic (neutrally mediated vasodepressor syncope or vasovagal syncope)
• Cardiac origin from arrhythmias

Answer 5

Fainting

Question 6

what is this heart condition:

Turbulent blood flow
Must time to cardiac cycle and note where best heard

types

Answer 6

murmurs

systolic and diastolic

Question 7

name this type of systolic murmur:

functional or nonfunctional?

o Due to:
▪ Blood flow across the semilunar (aortic and pulmonic) valves

o Begins after S1 and stop before S2
▪ Gap in sound just before S2

o Short murmurs that decrease in intensity with maneuvers that reduce left ventricular volume
▪ standing, sitting up, and straining during Valsalva maneuver

o Often heard in healthy patients and not pathological

o Listen for aortic stenosis and innocent flow murmurs

Answer 7

midsystolic murmur

functional

Question 8

name this type of systolic murmur:

functional or nonfunctional?

o Due to:
▪ Regurgitate flow across AV valves

o Begins with S1 and Stops with S2 (no gaps)

o May be mitral regurgitation

Answer 8

pansystolic murmur

holosystolic

Question 9

this type of systolic murmur?

starts at mid/late systole and persists to S2

Answer 9

Late systolic

Question 10

what type of murmur is this? systolic or diastolic? how is broken up?

represent valvular heart disease

Answer 10

diastolic

early, mid and late diastolic types

Question 11

what type of diastolic murmur is this?

• Due to:
o Regurgitate flow across incompetent semilunar valves (aortic regurgitation)

• Starts immediately after S2 (without discernable gap) and fades into silence before next S1

Answer 11

Early diastolic

Question 12

what type of diastolic murmur is this?

• Due to:
o Turbulent flow across AV valves (also happens in presystolic murmurs)

▪ Presystolic murmur of mitral stenosis in normal sinus rhythm
• Starts a short time after S2 and fades away before S1 or merges with late diastolic murmur

Answer 12

Mid-diastolic

Question 13

what type of diastolic murmur is this?

• Starts late in diastole and continues until S1

Answer 13

Late Diastolic

Question 14

name this murmur?

▪ Congenital patent ductus arteriosus and AV fistulas, common in dialysis patients,
produce continuous murmurs that are nonvalvular in origin

▪ Venous hums and pericardial friction rubs also have systolic and diastolic components

Answer 14

Continuous Murmurs

Question 15

name this continuous murmur?

• First rises and then falls in intensity

Answer 15

Crescendo-decrescendo murmur

Question 16

name this continuous murmur?

• Has same intensity throughout

Answer 16

Plateau Murmur

Question 17

name this continuous murmur?

• Grows louder

Answer 17

Crescendo murmur

Question 18

name this continuous murmur?

• Grows softer

Answer 18

Decrescendo murmur

Question 19

name this heart condition?

• Reflection of right atrial pressure
• Should be measured at 15-30 degrees
• No matter what angle it is the same
• Pressure greater than 3 cm above sternal angle is abnormal
• hallmark of heart failure

Answer 19

Jugular Venous Distension (JVD)

Question 20

this is the method used to screen for valvular heart disease and uses the bell, diaphragm of the instrument to listen to the heart?

Answer 20

auscultation

Question 21

name this part of the stethoscope used?

Better for picking up:
▪ high pitched sounds of S1 and S2
▪ murmurs of aortic and mitral regurgitation
▪ pericardial friction rubs

Answer 21

Use diaphragm

Question 22

name this part of the stethoscope used?

Better for picking up:
▪ Low pitched sounds of S3 and S4
▪ Murmurs of mitral stenosis

Answer 22

Use bell

Question 23

what are the positions used for auscultation?

Answer 23

o Left lateral decubitus
▪ Left sided S3 and S4

o Sit up, lean forward
▪ Completely exhale and stop breathing increases aortic murmurs