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Cardiology Module 12, Lesson 10; Systemic Circulation - Blood Vessel; History and Physical Exam

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


shortness of breath


rapid breathing


listening; to listen;

technical term for listening to the internal sounds of the body, usually using a stethoscope




bluish skin color

skin pallor

abnormal loss of color from normal skin or mucous membrane may result of decreased blood supply to the skin


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


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


abnormal heart sound; scratchy, grating, or squeaking


abnormal heart sound; resembling the sounds of a gallop


swishing heart sounds heard over an artery that may also produce a palpable vibration


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








respiratory distress


dialated jugular vein



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


slow pulse


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











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



pradoxic or fixed splitting of S2


attenuated A2


fixed S2


pulmonary sounds (P1, P2)






systolic click




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.




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



left ventricle


right ventricle


left atrium


right atrium




pulmonary arteries


calculated ratio between weight and height that correlates with body fat


murmur; an extra noise that the blood makes as it flows through the heart


resting stage heart rate


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



murmur grades

grade 1 is the softest and grade 6 is the loudest


swelling of the liver beyond it normal size


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


nasal flaring; occurrence of respirations usually in a child that sound like grunting but usually indicated upper airways obstruction

cool extremities



blood infection;

severe illness in which the bloodstream is overwhelmed by bacteria


inflammation of a vein


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)


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


breath sound; a continuous, coarse, whistling sound produced in the respiratory airways during breathing;

continuous; expiratory or inspiratory; associated with asthma


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


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


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)

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