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38 Cards in this Set
- Front
- Back
How do patients present with bacterial endocarditis |
Fever, chills, and malaise that is associated with the new murmur and abrupt onset of CHF. Skin findings are found mostly in the fingers, hands, and toes. These are hemorrhages or splinter hemorrhages on the nail bed, petechiae on the palate, painful violet colored nodes on the fingers or feet. |
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Where is the apical impulse located |
Fifth intercostal space by the midclavicular line on the left side of the chest. |
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When would you see displacement of the point of maximum impulse |
Severe left ventricular hypertrophy and cardiomyopathy, pregnancy in the third trimester. |
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Pathway of deoxygenated blood |
Enters the heart through the superior vena cava and inferior vena cava, right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, the Lungs, Alveoli. Here it picks up oxygen and releases carbon dioxide. |
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Pathway of oxygenated blood |
Exits the lungs through the pulmonary veins and enters the heart. Left atrium, mitral valve, left ventricle, aortic valve, aorta, general circulation. |
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Systole and diastole using the pneumonic motivated apples |
Mitral valve, tricuspid valve, atrioventricular valves, Aortic valve, Pulmonic valve, semi lunar valves. |
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Heart sound: S1 systole |
This is the lub sound. Closure of the mitral and tricuspid valve. Atrioventricular valve's. |
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aortic area |
Second intercostal space to the right side of the upper border of the sternum. Also described as the second intercostal space by the right side of the sternum at the base of the heart. |
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Heart murmur mnemonic for systolic murmur |
MR. ASH These murmurs are also described as occurring during S1 or as holosystolic, pansystolic, early systolic, late systolic, or mid systolic murmur's. These murmurs are louder than diastolic murmur's and can radiate to the neck or axilla. |
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Mitral regurgitation |
A pansystolic or holosystolic murmur. Best hurt at the apex of the heart or apical area. Radiates to the axilla. Loud blowing and high-pitched murmur. |
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aortic stenosis |
A Midsystollic ejection murmur. Best heard at the second intercostal space at the right side of the sternum. Radiates to the neck. A harsh noisy murmur. |
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Diastolic murmur mnemonic |
MS. AR Diastole is also known as The S2 heart sounds, early diastole, late diastole, or mid diastole. Diastolic murmur's are always indicative of heart disease. |
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Mitral stenosis |
A low pitched diastolic rumbling murmur. Heard best at the apex of the heart or the apical area. Also called an opening snap. |
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aortic regurgitation |
A high pitched diastolic murmur. That's right at the second intercostal space at the right side of the sternum. High-pitched blowing murmur. |
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Heart sounds: S2 diastole |
The dub sound. Closure of the aortic and Pulmonic valves. Semi lunar valves. |
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S3 heart sound |
Pathognomic for CHF. Occurs during early diastole also called the ventricular Gallup or he S3 Gallup. Sounds like Kentucky. Always considered abnormal if it occurs after the age of 35. |
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S4 heart sound |
Caused by increased resistance due to a stiff left ventricle, usually indicates left ventricular hypertrophy, considered a normal finding in some elderly. S4 occurs during late diastole also called and atrial Gallup or atrial kick. Best heard at the apex or apical area (mitral area) using the bell of the stethoscope. |
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The bell of a stethoscope can be used for which tones |
Low tone such as the extra heart sounds S3 or S4 or mitral stenosis |
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The diaphragm of the stethoscope is best used for |
Mid to high-pitched tone such as long sounds, mitral regurgitation, and Aortic stenosis. |
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Where is a benign split S2 best heard |
Over the Pulmonic area or second intercostal space left of the sternum. This is due to the splitting of the aortic and pulmonary components. It's a normal finding it appears during inspiration and disappears and expiration. |
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Timing of systolic murmur |
Use the MR. As pneumonic |
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Diastolic murmur |
Use the MS. AR pneumonic |
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Where is the mitral area |
The apex or apical area of the heart. Fifth left intercostal space about 8 to 9 cm from the midsternal line and slightly medial to the midclavicular line. PMI or the apical pulse is located in this area. |
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How do you evaluate pulsus paradoxus |
It is measured by using blood-pressure cuff and a stethoscope. The apical pulse can still be heard even though The radial pulse is no longer palpable. |
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What is the treatment plan for raynauds phenomenon |
Avoid touching cold objects, cold weather, avoid stimulants, smoking cessation, nifedipine or amlodipine. |
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Mitral valve prolapse |
The classic finding is an S3 click followed by a systolic murmur. |
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How do you treat triglycerides |
Use niacin first |
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Metabolic syndrome |
Metabolic disorder with a cluster of symptoms. These patients are at a higher risk for diabetes and cardiovascular disease. At least three characteristics must be present to diagnose metabolic syndrome. Abdominal obesity, hypertension, and hyperlipidemia. |
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What are some examples of target organ damage |
Microvascular damage to eyes: silver and or copperware arterials, AV junction nicking, flame shaped hemorrhages, papilledema. Kidneys: microalbuminuria and protein urea, elevated serum creatinine and abnormal GFR, peripheral or generalized edema, macrovascular damage. Heart: S3, S4, carotid bruit, CAD and acute MI, decreased or absent peripheral pulses. Brain: TIAs with damage and hemorrhagic strokes. |
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What are the three major groups that cause secondary hypertension |
Renal, endocrine, and other causes such as obstructive sleep apnea. |
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What are some side effects of loop diuretics |
Electrolyte imbalance, hypokalemia, hyponatremia and hypomagnesemia |
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What are some side effects of aldosterone receptor antagonist diuretics? |
Gynecomastia, hyperkalemia, G.I. Examples of these medications are spironolactone. |
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What are some Side Effects of calcium channel blocker |
Headaches, ankle edema, heart block or bradycardia, reflect hernia. These medications are the PINES family or verapamil/diltiazem |
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Alpha-1 blocker/antagonist |
Also known as alpha adregenic blockers. Suffix of Zosyn. Vasodilator. Side effects are dizziness and hypotension so give at bedtime and a very low dose. Examples: Hytrin and Flomax. |
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How do you treat isolated systolic hypertension in the elderly |
thiazide diuretics used first, add a calcium channel blocker and or an ace inhibitor or ARB. |
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What symptoms do you see with left ventricular failure |
Crackles, Bibasilar rails, cough, dyspnea, decreased breath sounds, Dullness to percussion. Nighttime dyspnea, orthopnea, cough at night, and wheezing. |
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Right ventricular failure |
Jugular venous distention, and large spleen, enlarged liver, nausea, abdominal pain, lower extremity edema with cool skin. |
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Isolated systolic hypertension increases the risk for |
Myocardial infarction and stroke |