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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
listening; to listen;
technical term for listening to the internal sounds of the body, usually using a stethoscope
abnormal loss of color from normal skin or mucous membrane may result of decreased blood supply to the skin
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.
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
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
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
point of maximum impulse; palpated manually;
example: The PMI is the left fifth interspace at the midclavicular line.
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
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
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
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
murmur heard just before systole
caused by narrowing of the mitral or tricuspid valve (valves between the atria and the ventricles
excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity)
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
is patchy discoloration indicating primary or secondary changes of the deep, middle, or superficial dermal blood vessels
fusion of S3 and S4 with tachycardia (rapid heartrate);
results in a loud diastolic filling sound
early diastolic sound
Common in constrictive pericarditis (with
or without pericardial calcification)
an abnormal heart rhythm on auscultation; includes 3 to 4 sounds, resembling a gallop
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
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
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
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