Chapter 6 - Cardiology

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Chapter 6 - Cardiology
2011-11-29 14:48:50
Podiatry boards II

Pocket Podiatrics chapter 6 cardiology
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  1. You are an oxygen molecule and would like a RBC to take you for a tour of the heart. He gladly lets you attach to him and starts to voyage. You are the RBC...give the tour starting at SVC and ending ultimately to the right dorsalis pedis.
    • -SVC
    • -R atrium
    • -Tricuspid valve
    • -R ventricle
    • -Pulmonic valve
    • -Lungs
    • -Pulmonary veins
    • -left atrium
    • -mitral valve
    • -left ventricle
    • -aortic valve
    • -aorta
    • -abdominal aorta
    • -Right ext. illiac
    • -Femoral
    • -Popliteal
    • -Anterior tib
    • -dorsalis pedis
    • That was fun!
  2. You are on IM rotation, you are asked to see a patient. You look at his chart and notice he has a S1 murmur. You are a podiatrist and have never heard an S1 murmur. Where might the best location be to hear and what can you tell the preceptor about S1 murmurs to help you sound somewhat intelligent.
    • -Heard loudest at mitral area and tricuspid
    • -S1 is due to closure of AV valves (tricuspid and mitral)
    • -Use diaphragm of stethoscope
  3. You are to do a cardiac exam and vocalize what you are listening for with each touch. Make sure you say where you are listening and what area of the heart you are listening to.
    • 1st touch: Right sternal border at the 2 ICS known as the Aortic area
    • 2nd touch: Left sternal border at 2 ICS known as Pulmonic area
    • 3rd touch: Left side at 3ICS known as Erb's point. Area pulmonic or aortic sounds often radiate
    • 4th touch: Left lower sternal border known as tricuspid area.
    • 5th touch: left side at Midclavicular line 5ICS known as mitral area. This is the cardiac apex.
  4. Pt has S2 murmur, what is happening and where might you hear it the loudest?
    How about S3, S4?
    • S2: due to closure of semilunar valves (aortic and pulmonic). Heard best at aortic and pulmonic areas.
    • S3: Caused by rapid ventricular filling. Heard loudest at mitral area.
    • S4: Caused by forceful atrial ejection into a distended ventricle. Heard loudest at mitral area.
    • * Use diaphragm to listen to S1, S2 and use bell to listen to S3, S4.
  5. Give me the quick and easy on murmurs. What are the two main types of murmurs?
    There are diastolic and systolic murmurs. Murmurs are defined by location Aortic, Pulmonic, Mitral, or Tricuspid. And they are either stenotic or regurg.

    murmurs will sound harsh, and regurg will be blowing.

    • Here are some pearls on the 4 basic ones:
    • Aortic stenosis will be heard best at the right sternal border, and the valve has to be open for blood to flow to your brain, making it a systolic murmur. It will radiate into the neck (the direction of the blood flow), and is harsh.

    Aortic regurgitation will be heard in left mid sternal border, and its blowing. The valve has to be closed, making it a diastolic murmur. It radiates along the right sternal border. It is associated with all those weird signs like De Mussets, and the water hammer pulse.

    Mitral stenosis the valve is open, and it helps me to know its the opposite of aortic stenosis in that its a diastolic murmur. Its heard best at the apex, is harsh, and does not radiate. Its easiest to find in the left lateral decubitus position. There is often a loud opening snap heard.

    Mitral regurg the valve is closed, its systolic, blowing, and radiates to the left axilla (direction of flow of the blood as it bounces off the valve).

  6. What type of heart block?
    • 1st degree. There is a delay in transmission of the electrical impulse from the atria to the ventricles.
    • -prolonged P-R interval beyond .20 seconds but constant in duration.

  7. What type of heart block?
    • 2nd degree (type 1)- not all atrial impulses reach the ventricles
    • -P-R interval progressively lengthens until a QRS complex is dropped, then the cycle repeats.
    • -Type II can be differentiated due to no delay or prolongation of P-R interval

  8. What type of heart block is this?
    • Third-degree AV block (yes this image says it).
    • None of the atrial impulses reach ventricles
    • -Atrium and ventricles beat independently at their own regular rates
    • -No correlation between P's and QRST's.

  9. What type of arrythmia is this?
    Premature atrial contraction (PAC)

    • -a focus in the atrium depolarizes prematurely
    • -P wave appears early and abnormally shaped or it may be lost in the previous T wave.
    • Causes: stimulants-coffee, tobacco, EtOH, Heart disease, CHF, meds, hypoxia, low K+ levels.
  10. PSVT

    • A focus in the atrium (other tahn the SA node) depolarizes, giving rise to a series of rapid beats at a regular rate between 150-250/min
    • -begins and ends suddenly (paroxysmal).

  11. What type of arrythmia is this?
    Atrial flutter

    • - Rapid firing of an ectopic atrial focus "sawtooth" pattern
    • -Only some beats pass to the AV node.

  12. What type of arrythmia is this?
    A fibrillation

    • -multiple atrial foci depolarizing in a chaotic manner
    • -a small number pass through the AV node

  13. What type of arrythmia is this?
    Premature ventricular contraction (PVC)

    • -ectopic depolarization in any portion of the ventricular myocardium.
    • -PVC's are of a little concern if they arise from the same foci or if there are less than 5/minute
    • -If they arise from more than one foci or there are greater than 5/min, can lead to V-fib.