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105 Cards in this Set
- Front
- Back
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chest pain: precise local tenderness to touch, pressure and percussion
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superficial chest pain
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chest pain: intensified or related to thoracic movement
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pleuritic
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chest pain: sharp or stabbing pain that is localized precisely
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pleuritic
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chest pain: depe to sternum or vaguely placed within center of chest
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deep
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causes of superficial chest pain
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disorders of the skin, subcutaneous or nerves
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causes of pleuritic chest pain
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disorders of ribs, costal cartilage, intercostal structures or parietal pleura
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strangling chest pain that feels like heaviness or squeezing
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angina
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chest pain that is precipitated by activity, relieved by rest/nitroglycerin
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angina
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what diagnosis of chest pain is made by assessment of the patient's history?
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angina
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chest pain at rest, night or regular times of the day without exercise?
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variant angina
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chest pain that is caused by spasms of the coronary artery
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variant angina
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how do you make the diagnosis of MI?
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ECG and serum enzyme patterns
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how do you make the diagnosis of angina?
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it is a clinical diagnosis based on the patients history
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chest pain: deep continous chest discomfort that is made worse by moving
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pericarditis
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sudden onset of excruciating chest pain that has a tearing quality often felt on the back
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aortic dissection
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what is the most common cause of retrosternal discomfort?
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esophageal pain
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chest pain: burning quality that is induced by lifting, stooping, bending or lying down
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esophageal pain
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chest pain that is induced by offending food (italian sausage pizza with extra peppers) and reliefed by antacids, belching or nitroglycerin
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esophageal pain
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chest pain in younger individuals that is in the left pectoral region, associated with palpitations and fears of cardiac diseases in the patient
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anxiety
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chest pain: sharp or stabbing pain that is fleeting that is associated with stress
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anxiety
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can chest pain that is ischemic in origin be pointed to a specific area?
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no
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what is the most common cardiac symptom?
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dyspnea
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what is the mechanism of cardiac dyspnea?
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increased lung stiffness (decreased compliance) due to increased plmonary intersitial fluid. L CHF
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what is paroxysmal nocturnal dyspnea?
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sudden onset of dyspnea hours after assuming recumbent position that subsides after sitting up right
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sudden onset of dyspnea hours after assuming recumbent position that subsides after sitting up right
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paroxysmal nocturnal dyspnea
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sudden dyspnea that occurs right after lying down
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orthopnea
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what are the causes of PND?
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L ventricular dysfunction or CHF
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what are the causes of orthopnea?
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L CHF
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subjective awareness of cardiac activity - 'heart skips a beat'
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palpitations
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what information should be obtained from a patient with palpitations?
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sense of heart rate and rhythm (slow, fast, regular, irregular) and associated symptoms: anxiety, excitement, smoking, EtOH, meds, drugs; relieving factors
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sudden temporary loss of consciousness
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syncope
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define vascular syncope
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temporary loss of cerebral perfusion - common faint occurs with pt upright lack of perfusion caused by decreased TPR, no musclar activity, shock, dehydration etc
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what is the most common type of syncope?
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vascular
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define cardiac syncope
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decreased CO or can't increase CO enough to meet demands; due to dysrhythmias; not postural
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what type of syncope is associated with effort?
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cardiac - that is an ominous sign
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what is claudication
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aching, cramping or painful sensation in muscles of extremities associated with activity due to skeletal muscle ischemia (like angina)
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which type of edema is associated with cardiac issues?
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pitting edema
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what are 4 causes of edema?
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CHF, hepatic/renal disease, malnutrition/malabsorption, local venous/lyphatic disease
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what is the most likely cause of single extremity edema?
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local venous/lymphatic disease - increased local hydrostatic pressure
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what are 3 things that carotid pulses tell us?
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assess potential abnormalities or cerebral blood supply, it provides an index to timing of cardiac cycle events, wave forms aid in cardiac diagnosis
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what is the upstroke of the carotid pulses simultaneous with?
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the first heart sound
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what is the strenght of the carotid pulse dependent on?
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strength of the pulse is dependent on pulse pressure which is the difference between systolic and diastolic pressures
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what do the jugular pulse pressures allows to obtain information on?
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gives us information on preload and right ventricular function
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how do you distinguish the arterial from venous pulse in the neck?
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venous is more undulant and displays more than one impulse per cardiac cycle, it is affected more by respiration and by patient position and is generally not palpable
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which vein - internal or external jugular should be used to look at jugular pulse?
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internal - external has valves that alters pulse wave patterns
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what does venous pressure estimation give us information about?
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provides information about venous return to the right atrium
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what is the zero point when estimating venous pressure?
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right atrium is the true zero reference, the sternal angle of Louis is the clinical zero point
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what is normal venous pressure?
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7-9 cm
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what does low venous pressure suggest?
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reduced venous return (hypovolemia)
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what does high venous pressure suggest?
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volume overload or obstruction to venous emptying or impedance to atrial emptying
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what is the a wave of venous pulse?
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atrial systole right before S1 = produced by atrial contraction, coincident with atrial systole just before the carotid pulse
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should the a wave be larger or smaller than the v wave?
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larger
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what is the v wave of venous pulse?
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atrial filling = venous distension coincident with filling the atrium during systole just before the tricuspid opens
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what is a giant a wave?
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giant a waves suggest the right atrium is contracting against increased resistance or right atrial pressure is elevated (tricuspid stenosis, pulmonic stenosis, R ventricular hypertrophy, pulmonary hypertension)
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what is a large regurgitant v wave?
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regurge of blood from the right ventricle to the right atrium during systole - tricuspid valve incompetence
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what type of venous wave pulse would be seen with tricuspid stenosis?
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giant a wave
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what type of venous wave pulse would be seen with pulmonic stenosis?
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giant a wave
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what type of venous wave pulse would be seen with right ventricular hypertrophy?
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giant a wave
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what type of venous wave pulse would be seen with pulmonary hypertension?
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giant a wave
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what type of venous wave pulse would be seen with tricuspid vlave incompetence (regurge)?
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large regurgitant v wave
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what type of venous wave pulse would be seen with arrhythmias with loss of coordination between atria and ventricule systoles?
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cannon waves
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what is a cannon save?
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a large a wave due to atrial systole at the same time as ventricular systole (pressure against closed tricuspid valve), not regular like giant a waves but irregular due to dyssynchrony of atrial and ventricular systoles
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what is kussmaul sign?
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an inspriatory increase in venous pressur or filling (normally with inspiration there is a fall in pressure)
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kussmaul signs are clues to what 3 disease states?
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kussmaul signs are indicative of constrictive pericarditis, pericardial tamponade and severe heart failure
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what is the hepatojugular reflux?
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pressure on RUQ causes filling of nect viens when the patient is supine
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what does a depatojugular reflux indicate?
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reflux of venous blood from hepatic and mesenteric venous systems
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what is parvus et tardus?
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a low amplitude small volume, late upstroke carotid pulse associated with aortic stenosis
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what is parvus et tardus associated with?
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aortic stenosis
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what is bisferiens in regards to carotid pulse?
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a carotid pulse with two points seen in aortic regurg, hypertrophic and obstructive cardiomyopathy
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when is a carotid pulse that is bisferiens seens?
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in aortic regurg, hypertrophic and obstructive cardiomyopathy
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what is S1 associated with?
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mitral and tricuspid valves closure, apical impulse
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where is S1 loudest?
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at the apex
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what causes S2?
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aortic and pulmonary valves closing
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where is S2 loudest?
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at the base
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is S2 normally split?
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yes - the split is normally increased on inspiration
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what is S3 caused by?
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early diastole = ventricular failure
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where is S3 best heard?
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best heard with the bell at the apex
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what is S4 due to?
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late diastole - ventricular pressure or compliance problems, HTN, aortic stenosis, MI
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when are clicks heard?
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systole
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what is a mid systolic click caused by?
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mitral prolapse
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when are snaps heard?
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diastole
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what are snaps associated with?
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mitral stenosis
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what are the two types of systolic murmurs?
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regurgitant and ejection
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what is a systolic regurgitant murmur caused by?
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backward flow across the AV valve ro across the chamber
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murmur: plateau, holosystolic, blowing (high frequency)
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systolic regurgitation
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what is a systolic ejection murmur caused by?
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forward flow from one high pressure system to another
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murmur: systolic, crescendo-decresendo, diamond shpaed, harsh, intensity peaks at greatest flow
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systolic ejection murmur
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what are the 2 diastolic murmurs?
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early and late - always PATHOLOGICAL!
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what causes a early diastolic murmur?
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backflow from the great vessels to the ventricules
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how can early diastolic murmurs be heard best?
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with the patient seated and leaning forward - they are soft
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murmur: diastolic, decrescendo, high frequency (blowing)
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early diastolic murmur
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what causes late diastolic murmurs?
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flow from one low pressure area to another
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how can late diastolic murmurs be heard best?
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with the bell at the apex
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mumur: diastolic, rumbling (low frequency)
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late diastolic murmur
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what causes continous murmurs?
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PDA or AV fistula, they continue thorughout systole and diastole sometimes called 'machine murmurs'
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which murmurs are heard loudest at the apex?
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regurgitant murmurs (with S3) and late diastolic murmurs
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which murmurs are heard loudest at the base?
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ejection murmurs and early diastolic murmurs
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what ejection murmur at the base of the heart radiates to the carotids?
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aortic stenosis
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what murmur at the apex of the heart radiates to the axilla?
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mitral regurg
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sustained apical impulse, S4, paradoxically split S2 (only sometimes), ejection murmur at the base that radiates to the carotids?
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aortic stenosis
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lateral apical impulse, S3, holosystolic murmur at the apex that radiates to the axilla
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mitral regurg
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wide pulse pressure - bisferiens, lateral apical impulse, S3, diastolic decrescendo murmur at base
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aortic insufficiency
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increased jugular pressure, diastolic snap and diastolic rumbling at the apex
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mitral stenosis
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what is paradoxical S2 splitting?
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splitting decreases with inspriation
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what is fixed splitting of S2?
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wide split that is not affected by respiration - seen in atrial septial defects
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