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104 terms

Cardiology Systemic Circulation, Blood Vessel

Cardiology Module 12, Lesson 10; Systemic Circulation - Blood Vessel; History and Physical Exam
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cardiac history and physical exam
a) Assessment of skin color, respiratory effort, respiratory and heart rate;
b) Precordial examination by inspection and palpation;
c) Cardiac auscultation;
d) Auscultation of lung fields;
e) Abdominal palpation;
f) Palpation of peripheral pulses and
g) Measurements of blood pressure.

is the foundation of the patient's workup

includes: blood studies, radiographs, electrocardiography, echocardiography, and other more invasive methods, such as heart catheterization and coronary arteriography
dyspnea
shortness of breath
tachypnea
rapid breathing
auscultation
listening; to listen;

technical term for listening to the internal sounds of the body, usually using a stethoscope
palpated
felt
cyanosis
bluish skin color
skin pallor
abnormal loss of color from normal skin or mucous membrane may result of decreased blood supply to the skin
diaphoresis
excessive sweating; excessive perspiration aka hyperhidrosis
venous distension
when blood pressure is higher than it should be in the jugular vein, the walls of the vein can distend or swell,

tells the doctor that fluid backup from the right heart is possible present
murmur
abnormal heart sound; described according to loudness;

can be systolic or diastolic;

grading scale of 1 through 6, with 6 being the loudest

example: There is a 2/6 systolic murmur best heard at the fifth interspace over the left costal margin.
ejection click
abnormal heart sound; high-pitched sound occurring shortly after S1; early systolic ejection sound;

associated with bicuspid aortic valve, mitral or tricuspid prolapse, aortic stenosis, prosthetic valve
rub
abnormal heart sound; scratchy, grating, or squeaking
gallop
abnormal heart sound; resembling the sounds of a gallop
bruit
swishing heart sounds heard over an artery that may also produce a palpable vibration
rales
are the clicking, rattling, or crackling noises heard on auscultation of the lung
congestive heart failure (CHF)
inability of the heart to pump enough blood to meet the body's needs
optic (retinal) fundus
interior lining of the eyeball;

including the retina (the light-sensitive screen), optic disc (the head of the nerve to the eye), and the macula (the small spot in the retina where vision is keenest)
blood vessel disease
narrowing of the blood vessels and veins;

aka vascular disease or artery disease
A-V nicking
the Gunn sign; a vascular abnormality in the retina of the eye;

visible on ophthalmologic examination, in which a vein is compressed by an arteriovenous crossing. The vein appears "nicked" as a result of constriction or spasm. It is a sign of hypertension, arteriosclerosis, or other vascular conditions
widened luminous reflex
...
tortuosity of arterioles
...
hemorrhage
...
exudate
...
flushing
...
respiratory distress
...
dialated jugular vein
...
PMI
point of maximum impulse; palpated manually;

example: The PMI is the left fifth interspace at the midclavicular line.
finger breaths
...
heart rate and rhythm
...
normal sinus rhythm
normal heart rhythm
bradycardia
slow pulse
tachycardia
fast pulse
S1 and S2
first and second heart sounds; refer to the closing of the AV valves and semilunar valves respectively

example: S1 and S2 are normal. There is no S3 or S4. There are no murmurs, gallops or rubs.
S3 gallop rhythm
abnormal sound; low-frequency diastolic sound following S2

suggests ventricular enlargement, often secondary to chronic mitral regurgitation, decreased left ventricular ejection fraction, elevated left atrial pressure, acute pulmonary edema, or high-output states (e.g., thyrotoxicosis, pregnancy)
S4 gallop rhythm
abnormal sound; low-frequency sound following S1

occurs with hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy, pulmonary hypertension, coronary artery disease
blowing
murmur
crescendo
...
decrescendo
...
diastole
...
holosystolic
...
midsystolic click
most commonly due to mitral valve prolapse
musical murmur
...
opening snap
abnormal heart sound; high-frequency, early diastolic sound

is caused by a noncompliant valve, most commonly due to mitral stenosis, tricuspid stenosis, ventricular septal defect, thyrotoxicosis
pansystolic
...
pradoxic or fixed splitting of S2
...
attenuated A2
...
fixed S2
...
pulmonary sounds (P1, P2)
...
rasping
murmur;
rumbling
...
systolic click
...
thrills
...
blood pressure
example: BP: 116/82
extremity pulses
lower extremity blood flow; feet, dorsalis pedis, femoral arteries of the groin, posterior tibial

upper extremity blood flow; peripheral vessels: brachial, radial, and ulnar arteries

example: Pedal pulses 2+ and equal.
clubbing
...
erythema
a condition which is characterized by redness of the skin due to congestion of the capillaries
pitting edema
observable swelling of body tissues due to fluid accumulation; the indentation that persists for some time after pressure is released
positive Homan's sign
discomfort behind the knee on forced dorsiflexion of the foot, due to thrombosis in the calf veins
dorsalis pedal pulse
blood vessel (artery) that can be palpated;

dorsalis pedis artery: blood vessel of the lower limb that carries oxygenated blood to the dorsal surface of the foot
femoral pulse
...
popliteal pulse
...
posterior tibial pulse
...
radial pulse
...
ulnar pulse
...
spooning of the nails
...
LV
left ventricle
RV
right ventricle
LA
left atrium
RA
right atrium
AO
aorta
PA
pulmonary arteries
BMI
calculated ratio between weight and height that correlates with body fat
whooshing
murmur; an extra noise that the blood makes as it flows through the heart
diastole
resting stage heart rate
systole
contracting stage heart rate
presystolic murmur
murmur heard just before systole

caused by narrowing of the mitral or tricuspid valve (valves between the atria and the ventricles
innocent murmurs
murmurs that are harmless
syncope
fainting
murmur grades
grade 1 is the softest and grade 6 is the loudest
hepatomegaly
swelling of the liver beyond it normal size
ascites
excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity)
pleural effusion
a buildup of fluid between the layers of tissue that line the lungs and chest cavity
grunting
nasal flaring; occurrence of respirations usually in a child that sound like grunting but usually indicated upper airways obstruction
cool extremities
...
sepsis
blood infection;

severe illness in which the bloodstream is overwhelmed by bacteria
phlebitis
inflammation of a vein
thrombophlebitis
is swelling (inflammation) of a vein caused by a blood clot
mottled skin
is patchy discoloration indicating primary or secondary changes of the deep, middle, or superficial dermal blood vessels
summation gallop
fusion of S3 and S4 with tachycardia (rapid heartrate);

results in a loud diastolic filling sound
pericardial knock
early diastolic sound

Common in constrictive pericarditis (with
or without pericardial calcification)
edema
observable swelling from fluid accumulation in body tissues
peripheral edema
observable swelling in the feet and legs
pulmonary edema
an accumulation of fluid in the interstitial air spaces (alveoli) in the lungs
gallop rhythm
an abnormal heart rhythm on auscultation; includes 3 to 4 sounds, resembling a gallop
breath sounds
respiratory sounds; specific sounds identified through auscultation or the respiratory system with a stethoscope
wheeze
breath sound; a continuous, coarse, whistling sound produced in the respiratory airways during breathing;

continuous; expiratory or inspiratory; associated with asthma
rhonchi
breath sound; is the coarse rattling sound somewhat like snoring, usually caused by secretion in bronchial airways. Rhonchi is the plural form of the singular word rhonchus; continuous; expiratory; associated with bronchitis
inspiratory gasp
breath sound; continuous; inspiratory; as in whooping cough aka pertussis
rales, crackles or crepitations
are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation
Hamman's sign
aka mediastinal crunch; breath sounds; discontinuous; heart beat; as in pneumomediastinum, pneumopericardium
stridor
breath sounds; a high pitched wheezing sound resulting from turbulent air flow in the upper airway; primarily inspiratory
pericardial friction rub
is a to-and-fro sound that waxes and wanes with diastole and sytole present when a patient holds his breath
thrill
is a vibration, high in frequency and sustained
pericardial knock
a high-pitched sound best heard during diastole;

Pericardial knocks are caused by a thick pericardium limiting expansion of the ventricle during the filling phase (diastole)