Term
| Preload is what and inc/dec in what? |
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Definition
volume of blood in ventricles (RV) at end of diastole (end diastolic pressure), stretch before contraction
inc in hypervolemia, regurgitation of cardiac valves, HF, exercising, inspiration
dec w Exhalation, hemorrhage, decreased LV output, pooling blood in capillary beds or veins |
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Term
| afterload is what and inc in waht |
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Definition
resistance left ventricle must overcome to circulate blood, pressure overload
inc in hypertesnion, vasoconstriction
inc afterload = inc cardiac workload |
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Term
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Definition
| +ve or -ve contractility, SV + CO, dobutamine and dopamine |
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Term
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Definition
| rate control (for contractility) |
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Term
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Definition
| SVR. dec afterload, inc CO, nitroprusside and nitrates |
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Term
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Definition
| SVR. inc afterload, dec CO, epinephrine and norepinephrine |
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Term
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Definition
• S1 (lub)
– Loudest and longest of heart sounds
– Closure of mitral and tricuspid valves during start of ventricular systole
• S2 (dub)
– Closure of the aortic and pulmonic valves, loudest at base
– Heard best in pulmonic area
• S3—followsrapidfillingventricleinearlydiastole • S4—whenatriacontractrightbeforeS1 |
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Term
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Definition
• Narrowing of valve opening
• Creates turbulent blood flow
• Murmur heard when valve is open and blood is flowing through |
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Term
| Valve Insufficiency (aka Regurgitation) |
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Definition
• Valve remains slightly open after closure
• Creates back flow of blood
• Murmur heard when the insufficient valve closes |
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Term
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Definition
• Thickening of the valve without stenosis
• On echo:
– Leaflet thickening, stiffness, and/or calcification
• Aortic valve sclerosis is common in the elderly
– May hear systolic murmur
– May progress to aortic stenosis
– Marker for increased CV risk |
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Term
| right sided heart failure findings |
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Definition
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Term
| left sided heart failure findings |
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Definition
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Term
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Definition
| Palpable movements of localized areas of the precordium due to increased intensity of the sustained systolic contraction |
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Term
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Definition
| A palpable murmur. Best felt through bone, use ulnar surface of your hand or the ball of your hand |
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Term
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Definition
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Term
| wide splitting of s2 causes |
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Definition
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Term
| Fixed split S2 heard during expiration and inspiration cause |
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Definition
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Term
| Paradoxical split S2 heard during expiration only cause |
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Definition
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Term
| S3 gallop commonly associated with |
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Definition
| mitral regurgitation, VSD, elevated left atrial and left ventricular pressures, post MI, and dilated cardiomyopathy. An S3 is most commonly associated with left ventricular failure and is caused by blood from the left atrium slamming into an already overfilled ventricle during early diastolic filling. |
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Term
| S4 gallop (aka “atrial gallop”) is commonly associated with |
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Definition
left ventricular hypertrophy and diastolic CHF, and it is almost always abnormal.
• The S4 is a sound created by blood actively trying to enter a stiff, non-compliant left ventricle during atrial contraction, late diastole. It’s most frequently associated with left ventricular hypertrophy that is the result of long- standing hypertension. |
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Term
| The presence of both an S3 and S4 simultaneously is referred to as |
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Definition
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Term
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Definition
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Term
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Definition
• A pericardial friction rub is a scratching, crackling, and typically fleeting, high-pitched extra heart sound heard in patients with inflammation of the two pericardial layers. Many pericardial friction rubs have three short components, each associated with cardiac movement: (1) atrial systole, (2) ventricular systole, and (3) ventricular diastole. Usually the first two components are present. All three make diagnosis easy, while only one (usually the systolic) makes it easy to be confused with a murmur.
• Caused by inflammation of the pericardial sac (pericarditis, cardiac tamponade), scratching, grating, or squeaky quality
• LSB
• High pitch
• Best to use diaphragm |
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Term
| opening snap of mitral stenosis |
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Definition
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Term
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Definition
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Term
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Definition
grade 1= barely audible
grade 2= soft, variable, innocent usually
grade 3= easy to hear, intermediate, no thrill
grade 4- loud, audible to anybody, thrill
grade 5= sounds like a train, very significant, thrill
grade 6= scarcely required a stethoscope, thrill |
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Term
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Definition
systolic murmer
-aortic stenosis
-aortic valve sclerosis
-flow murmer (physiologic) |
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Term
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Definition
systolic ejection murmer
-flow murmer
-pulmonic stenosis |
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Term
| left sternal border murmers |
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Definition
diastolic murmur
-aortic regurgitation
-pulmonic regurgitaton
systolic murmur
-hypertrophic cardiomyopathy |
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Term
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Definition
diastolic murmur
-atrial septal defect
-tricuspid stenosis
holosystolic murmur
-tricuspid regurgitation
-ventricular septal defect |
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Term
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Definition
holosystolic murmur
-mitral regurgitation
diastolic murmur
-mitral stenosis
systolic murmur
-mitral valve prolapse |
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Term
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Definition
Aortic stenosis (AS)
Pulmonic stenosis (PS)
Mitral regurgitation (MR) Tricuspid regurgitation (TR) Mitral valve prolapse (MVP) Atrial septal defect (ASD) Ventricular septal defect (VSD) Hypertrophic cardiomyopathy |
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Term
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Definition
| Aortic regurgitation (AR) Pulmonic regurgitation (PR) Mitral stenosis (MS) Tricuspid stenosis (TS) Austin-Flint murmurs |
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Term
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Definition
| Patent ductus arteriosus (PDA) Combination murmurs |
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Term
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Definition
| also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality |
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Definition
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Definition
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Definition
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Definition
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Definition
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Definition
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Term
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Definition
– 0=absent
– 1+=diminished
– 2+=normal
– 3+=increased
– 4+=bounding |
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Term
| Inequalityinthe amplitude of the peripheral pulses may result from: |
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Definition
– Obstructive arterial diseases, most commonly atherosclerosis
– Aortic dissection
– Aortic aneurysm
– Takayasu disease
– Coarctation of the aorta
– Supravalvular aortic stenosis |
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Term
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Definition
| • Pulsus alternans is characterized by alternating amplitude of the arterial pulse. It is most commonly a sign of heart failure due to left ventricular systolic dysfunction. It can occur rarely with diastolic heart failure, cardiac tamponade, or with marked tachypnea when the respiratory rate is one-half of the heart rate. |
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Term
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Definition
• Characterized by two systolic peaks of the aortic pulse during left ventricular ejection separated by a mid-systolic dip
• Palpable usually indicates hemodynamically significant aortic regurgitation
• Less common causes: hypertrophic cardiomyopathy, large PDA, AV fistula, significant MVP, or hyperdynamic circulatory state |
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Term
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Definition
• Thisischaracterizedby an interruption (transient drop
in amplitude) in the upstroke.
• Ananacroticradialpulse, along with a slow rising low amplitude delayed peaking carotid pulse, indicates hemodynamically significant aortic stenosis. |
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Term
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Definition
• Thisischaracterizedby a greater than 20 mmHg decrease in systolic arterial pressure during inspiration.
• Palpablepulsus paradoxus most commonly indicates impending tamponade.
• Other causes are COPD and hypovolemic shock. |
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Term
| Lymphadenopathy vs. Lymphadenitis |
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Definition
• Lymphadenopathy is palpable enlargement (> 1 cm) of ≥ 1 lymph node; it is categorized as:
– Localized: When present in only one body area
– Generalized: When present in ≥ two body areas
• Lymphadenitis is lymphadenopathy with pain and/or signs of inflammation (redness, tenderness)
• Causes: infection, malignancy, connective tissue disorders, TB, mono, viruses |
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Term
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Definition
• 1+ = trace pitting
• 2+ = mild-moderate
• 3+ = significant (moderate-severe)
• 4+ = marked (severe) |
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Term
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Definition
| massive and generalized edema |
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Term
Superficial Phlebitis
vs. Superficial Thrombophlebitis |
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Definition
• Superficial phlebitis: Presence of pain and inflammation involving a vein in the absence of thrombus
• Clinical diagnosis
• Pain, tenderness, induration, and erythema along the course of a superficial vein
• Due to inflammation, which may be accompanied by thrombosis, and less commonly, infection of the vein
• If thrombus is apparent as a thickened cord or subsequently identified with imaging studies (often the case), the terms superficial thrombophlebitis or superficial vein thrombosis are preferred |
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Term
| Superficial Vein Thrombosis |
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Definition
| • The recognition that thrombosis of the axial veins (great saphenous vein, small saphenous vein) can lead to thromboembolism, particularly when the more proximal vein is affected, has led to the use of the term “superficial vein thrombosis” (SVT) in the medical literature to connote a similar level of seriousness that is attached to the term “deep vein thrombosis.” |
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Term
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Definition
• Cellulitismanifestsasan area of skin erythema, edema, and warmth; it develops as a result of bacterial entry via breaches
in the skin barrier.
• A skin abscess is a collection
of pus within the dermis or subcutaneous space. |
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Term
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Definition
• Thrombus is a solid mass of platelets and/or fibrin (and other components of blood) that forms locally in a vessel. Thrombi form when the clotting mechanism
is activated.
• This is supposed to happen when you are injured.
• However, it can also occur at the site of an ulcerated atherosclerotic plaque or wherever the endothelial cells lining the inner surface of an artery have been damaged.
• An embolus is anything that travels through the blood vessels until it reaches a vessel that is too small to let it pass. When this happens, the blood flow is stopped by the embolus. |
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Term
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Definition
venous thrombus that traverse a cardiac defect to access the arterial circulation that can also cause acute limb ischemia affecting the upper or lower extremity
– May present with acute ischemia of an extremity, symptoms of deep vein thrombosis, or pulmonary embolism, and they typically have little evidence of cardiac or peripheral
artery disease |
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Term
| Arterial Thrombosis and Acute Limb Ischemia |
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Definition
• Arterial thrombosis most likely to occur at the site of an
atherosclerotic plaque. Thrombosis can also occur in arterial aneurysms and at sites of prior revascularization (stents, bypass grafts).
• Acute limb ischemia is a sudden decrease in limb perfusion that may threaten limb viability and is usually due to acute arterial occlusion, which may be due to emboli from a proximal source, acute thrombosis of a previously patent, often atherosclerotic artery, or related to arterial trauma. Embolism accounts for the majority of cases of acute extremity ischemia. |
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Term
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Definition
| • Theclassicphysicalsigns of acute limb ischemia are the six P’s (pain, pulselessness, pallor, paresthesia, paralysis, and poikilothermic). Subjective sensory deficits are signs of early nerve dysfunction, and major sensory or motor loss is indicative of advanced ischemia. |
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Term
| Intermittent Claudication |
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Definition
• Peripheral artery disease (PAD), specifically atherosclerotic disease leading to peripheral artery obstruction, may be silent or present with a variety of symptoms and signs indicative of extremity ischemia.
• The clinical manifestations of arterial insufficiency (regardless of etiology) are due to a lack of blood flow to the musculature relative to its metabolism, which results in pain in the affected muscle groups.
• The presence of an extremity ulcer is one of the more obvious clinical signs that can be due to ischemia, but there are other manifestations, such as claudication and rest pain. |
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Term
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Definition
– Age≥70years
– Age50to69yearswithahistoryof smoking or diabetes
– Age40to49withdiabetesandat least one other risk factor
for atherosclerosis
– Legsymptomssuggestiveof
claudication with exertion, or ischemic pain at rest
– Abnormallowerextremitypulseexamination
– Known atheroscleros is at other sites (coronary, carotid, renal artery disease) |
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Term
| Peripheral Artery Disease |
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Definition
• Often no complaints are presented.
• If the supply of blood fails to satisfy ongoing metabolic requirements as a consequence of arterial narrowing, symptoms will occur.
• Severity depends upon the degree of arterial narrowing, number of arteries affected, and the activity level of the patient.
• PAD symptoms include pain of one or more lower extremity muscle groups related to activity (intermittent claudication), atypical pain, pain at rest, or with non- healing wounds, ulceration, or gangrene. |
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Term
| Peripheral Venous Disease |
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Definition
• Chronicvenousdisease/insufficiencyrefers to a wide spectrum of morphologic (venous dilation) and/or functional abnormalities (venous reflux) of long duration.
• Vein-relatedproblemsmayormaynotbe symptomatic and include a wide range of clinical signs that vary from minimal superficial venous dilation to chronic skin changes with ulceration. |
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Term
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Definition
• Inadequate muscle pump function, incompetent venous valves (reflux), and venous thrombosis or obstruction are causes of elevated venous pressure (venous hypertension), which initiates a sequence of anatomic, physiologic, and histologic changes leading to vein dilation, skin changes,
or skin ulceration.
• Venous ulcers are typically colonized with gram-negative bacteria.
• They may cause sepsis. |
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Term
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Definition
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Term
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Definition
• Ifyoususpectarterial insufficiency in the radial or ulnar arteries
• Determinespatencyofthe radial and ulnar arteries
• Canbeusedtoassesswhether arterial insufficiency exists in the upper extremity
• UsefulforABG,bloodgasdraw
• The radial artery is first occluded by the examiner applying firm pressure over it. If it is not pale, you have not compressed the arteries sufficiently.
• The patient is asked to clench the fist tightly.
• The patient is then asked to open the fist.
• Color of the palm is observed.
• The test is repeated with the occlusion of the ulnar artery.
• Pallor of the palm during compression of one artery indicates occlusion of the other (the palm flushes within
3–5 seconds). |
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Term
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Definition
| • The resting ankle-brachial systolic pressure index (ABI) is a simple test that can be performed at the bedside, and should be measured in patients with one or more findings consistent with PAD on the review of symptoms or other findings on physical exam. The ABI is the ratio of the ankle systolic blood pressure divided by the brachial systolic pressure detected with a Doppler probe. In patients with no or mild to moderate symptoms, ABI of <0.90 has a high degree of sensitivity and specificity.\ The normal ABI is >0.91 to as high as 1.3. |
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Term
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Definition
• Calf swelling is present in most patients with femoral or popliteal venous involvement.
• Thigh swelling occurs with iliofemoral thrombosis.
• Slow dorsiflexion of the ankle with the patient’s knee in flexion may produce pain in the calf or ankle.
• Pain elicited by this technique is referred to as Homan’s Sign.
• Another technique to access for DVT is calf tenderness. With your fingertips, compress the calf muscles against the tibia and note TTP and palpable cords. |
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Term
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Definition
DARTH VADER
• D: Death
• A: Arrhythmia
• R: Rupture (free ventricular wall, septum, or papillary muscles)
• T: Tamponade
• H: Heart failure
• V: Valve disease
• A: Aneurysm of ventricle
• D: Dressler’s syndrome
• E: Embolism
• R: Recurrence/mitral regurgitation |
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Term
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Definition
• A separation of the layers of the aortic wall due to an intimal tear
• Typical presentation with acute chest and back pain that is severe, sharp, and may have a ripping or tearing quality. Pain can radiate anywhere in the
chest or into the abdomen or back
• May be acute or chronic
• Symptoms: syncope, heart failure, stroke, HTN-Type B dissection
• Signs: pulse deficit, diastolic murmur, stroke, hypotension
• Widened mediastinum on CXR
• Echo, d-dimer, etc. |
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Term
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Definition
• Stress (takotsubo) cardiomyopathy often occurs in the setting of physical
or emotional stress
or critical illness.
• Symptoms, including substernal chest pain, are similar to that of acute myocardial infarction.
• EKG, cardiac biomarkers, BNP, radionuclide imaging confirm diagnosis. |
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Term
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Definition
| • Insomecases,thepatient cannot qualify the nature of the discomfort but places their clenched fist in the center of the chest, which is known as the “Levine sign. |
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