Cardiology - Symptomatology Overview
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Questions and Answers

What characterizes a diastolic thrill in relation to heart sounds?

  • It is present during systole.
  • It is associated with aortic stenosis.
  • It indicates normal heart function.
  • It is indicative of mitral stenosis. (correct)

Which heart sound is typically described as 'slapping'?

  • First heart sound for mitral stenosis. (correct)
  • Second heart sound for aortic stenosis.
  • Second heart sound for mitral stenosis.
  • First heart sound for aortic regurgitation.

What is the expected feature of the apex during diastole?

  • Systolic thrill is palpated.
  • There is no thrill noted.
  • Thrill is present, systolic is absent. (correct)
  • Apex is directed downwards.

In the context of percussion findings, what indicates dullness in the pulmonary area?

<p>Pulmonary hypertension. (A)</p> Signup and view all the answers

How is hepatic dullness tested during percussion?

<p>Beginning from the 2nd ICS and asking for a breath. (C)</p> Signup and view all the answers

What question should be asked to assess for the presence of palpitations?

<p>Do you feel your heart palpitations? (C)</p> Signup and view all the answers

What is the expected pressure differential in the YiL?

<p>10-20 mmHy (A)</p> Signup and view all the answers

Which of the following is associated with peripheral cyanosis?

<p>PDA (Patent Ductus Arteriosus) (A)</p> Signup and view all the answers

Which condition is indicated by jaundice from hepatic congestion?

<p>Right-sided heart failure (C)</p> Signup and view all the answers

Which clinical finding is indicative of Right Side Heart Failure?

<p>Ascites (C)</p> Signup and view all the answers

During the local examination of the heart, which area is defined as the outermost, lowermost palpable visible pulsation?

<p>Apex (B)</p> Signup and view all the answers

What does the presence of a congested pulsating neck vein indicate?

<p>Congestive heart failure (A)</p> Signup and view all the answers

Which set of symptoms would most likely indicate the need to assess blood pressure?

<p>Shortness of breath and headache (A)</p> Signup and view all the answers

What characteristic findings might be observed upon inspection of the chest wall?

<p>Dilated veins (A)</p> Signup and view all the answers

Which scar is associated with valve replacement surgery?

<p>Median sternotomy (A)</p> Signup and view all the answers

What is a potential sign of subacute bacterial endocarditis in the upper limb?

<p>Splinter hemorrhage (B)</p> Signup and view all the answers

Epigastric pulsation in a patient is likely due to enlargement of which heart chamber?

<p>Right ventricle (D)</p> Signup and view all the answers

Which symptom would you inquire about to evaluate thrombogenic symptoms?

<p>Any other symptoms? (B)</p> Signup and view all the answers

In the pulmonary area, where is the site for palpation typically located?

<p>Right 2nd intercostal space (B)</p> Signup and view all the answers

Does the presence of orthopnea suggest which type of heart lesion?

<p>Left-sided heart lesion (D)</p> Signup and view all the answers

What causes visible vigorous pulsation in carotid arteritis?

<p>Suprasternal pulsation (C)</p> Signup and view all the answers

What causes an accentuated S1 heart sound?

<p>Mitral stenosis (MS) (B), Tricuspid stenosis (TS) (D)</p> Signup and view all the answers

Which condition is associated with a weak S1 heart sound?

<p>Mitral regurgitation (MR) (B), Bradycardia (C)</p> Signup and view all the answers

What is the primary cause of the second heart sound (S2)?

<p>Closure of aortic and pulmonary valves (D)</p> Signup and view all the answers

What physiological event causes the splitting of S2?

<p>Right ventricular ejection phase (A)</p> Signup and view all the answers

Which sound is characteristic of a

<p>S4 phenomenon in hypertension (A), S3 gallop due to heart failure (D)</p> Signup and view all the answers

Which condition would most likely lead to a wide splitting of S2?

<p>Right bundle branch block (D)</p> Signup and view all the answers

Which of the following heart sounds is associated with the closing of the aortic valve?

<p>A2 (B)</p> Signup and view all the answers

What effect does tachycardia have on diastolic time?

<p>Decreases diastolic time (A)</p> Signup and view all the answers

What does the presence of an opening snap (O.S) indicate regarding the mitral valve?

<p>It indicates stenosis of the mitral valve. (A)</p> Signup and view all the answers

Which heart sound is associated with forceful atrial contraction against ventricular end diastolic pressure?

<p>S4 (A)</p> Signup and view all the answers

Under what condition can an ejection click (EC) typically be heard?

<p>When the pulmonary or aortic valve opens. (D)</p> Signup and view all the answers

What causes S3 to be present in a patient with a patent ductus arteriosus (PDA)?

<p>Excess blood flow across either normal or diseased valves. (A)</p> Signup and view all the answers

In which situation would a pericardial knock likely be identified?

<p>During isovolemetric relaxation. (D)</p> Signup and view all the answers

What indicates that the ejection click (EC) sound is organic?

<p>It occurs before S2. (D)</p> Signup and view all the answers

Which of the following is a cause of S4 heart sound?

<p>Tension overload leading to ventricular hypertrophy. (A)</p> Signup and view all the answers

How can opening snaps (O.S) be characterized regarding their impact on the valve's status?

<p>Suggests that the valve is still viable and not calcified. (D)</p> Signup and view all the answers

What is the most likely cause of S3 heart sound in relaxed diastole?

<p>Speed of blood flow into the ventricle (D)</p> Signup and view all the answers

What characterizes the murmur associated with aortic stenosis?

<p>Harsh with marked thrill (D)</p> Signup and view all the answers

In which position is aortic valve pathology best assessed?

<p>Sitting and leaning forward (B)</p> Signup and view all the answers

Which condition is characterized by a pericardial knock?

<p>Constrictive pericarditis (D)</p> Signup and view all the answers

Which type of murmur is characterized as soft and associated with regurgitation?

<p>Mitral regurgitation murmur (C)</p> Signup and view all the answers

What is the correct grade classification for a very faint murmur?

<p>Grade 1 (A)</p> Signup and view all the answers

Which heart condition is typically compounded by atrial fibrillation?

<p>Rheumatic heart disease (C)</p> Signup and view all the answers

Which sound might be heard from the two layers of pericardial tissue?

<p>Pericardial rub (A)</p> Signup and view all the answers

Flashcards

Lateral Position (Heart)

Examining the heart's apical impulse, or point of maximal impulse (PMI), in a lateral position. This helps in assessing the location and character of the apex beat.

Apex Beat (PMI)

The point on the chest wall where the apex of the heart beats most strongly.

Hyperdynamic Apex Beat

An abnormally strong and forceful apex beat, often associated with high blood flow and volume.

Sustained Apex Beat

An apex beat that is sustained and prolonged, suggesting a thickened or stiff ventricle.

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Slapping Apex Beat

A forceful apex beat with a brief pause, characteristic of mitral stenosis.

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Diastolic Thrill

A vibration felt during diastole (relaxation phase of the heartbeat), often associated with mitral stenosis.

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Systolic Thrill

A vibration felt during systole (contraction phase of the heartbeat), often associated with heart valve problems like aortic stenosis.

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1st heart sound

The first sound of the heartbeat, indicative of the closure of the mitral and tricuspid valves.

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Pulmonary area Percussion

Percussion on the left side of the chest, assessing the resonance over the pulmonary area.

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Aortic area Percussion

Percussion on the right side of the chest, assessing the resonance over the aortic area.

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Shortness of Breath (PVC)

Difficulty breathing, occurring with exertion or at rest, or occurring suddenly and resolving by morning. A symptom to investigate in cardiovascular conditions.

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Leg Swelling (SVC)

Edema in the legs, a symptom that can indicate cardiovascular issues, particularly right-sided heart failure.

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Cyanois

Bluish discoloration of the skin, lips, or fingertips, often indicative of a lack of oxygen.

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Chest Pain

Pain in the chest, a symptom with various causes, some related to heart health (cardiac).

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Palpitations

A feeling of a rapid or irregular heartbeat. Investigating palpitations is a symptom associated with heart conditions and a possible indicator.

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Swelling of the legs (SVC)

Edema in the legs, often indicating right-sided heart failure.

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Malar flush

Reddish discoloration of the face.

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Neck veins

Veins in the neck may be a sign of congestive heart failure.

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Pallor

Paleness of the skin, often associated with anemia, but potentially related to conditions like subacute bacterial endocarditis.

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Cyanosis (Peripheral)

Bluish discoloration of the skin, lips, or fingertips, occurring outside the heart.

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Jaundice

Yellowing of the skin and eyes, due to liver or bile duct issues.

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Orthopnea

Difficulty breathing when lying down, a symptom commonly associated with congestive heart failure.

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Vital Signs

A measure of vital parameters like pulse, blood pressure, respiratory rate, and body temperature.

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Right-sided Heart Failure (RHF)

A condition where the right side of the heart is unable to pump blood effectively, leading to fluid buildup in the body.

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Ascites

Abnormal fluid accumulation in the abdominal cavity, often a consequence of heart failure.

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Bilateral Crepitation

Crackling sounds heard upon auscultation of the lungs, often associated with fluid build-up in the lungs.

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Median Sternotomy

A surgical incision down the center of the breastbone (sternum), often performed for open-heart surgeries.

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Lateral Thoracotomy

A surgical incision on the side of the chest wall, often used in cardiac procedures (like mitral valvotomy),

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Pericardial Effusion

Abnormal accumulation of fluid around the heart, potentially compressing the heart.

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Apex of the Heart

The outermost, lowermost palpable point of the heart, located at the 5th intercostal space (MCL).

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SVC Obstruction

Blockage of the superior vena cava, a major vein returning blood to the heart.

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Corrigan pulse

A prominent and forceful pulse, often a symptom of aortic regurgitation(AR).

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Epigastric Pulsation

A pulsation felt in the upper central abdomen, can be due to various heart conditions.

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RVE

Right Ventricular Enlargement

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Aortic Area Pulsation

Pulsation felt at the right second intercostal space near the sternum, possible due to aortic aneurysm or hypertension.

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Pulmonary Area Pulsation

Pulsation felt in the area around the left second intercostal space near the sternum , possible due to pulmonary aneurysm or pulmonary HTN.

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H.parasternal Area

Pulsation felt in the area near the sternum on the left side, likely suggestive of Right Ventricular Enlargement.

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Inspection(in context of heart examination)

Visual examination of the chest during a heart examination

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Palpation(in context of heart examination)

Physical examination of the chest, including feeling for pulsations during a heart examination

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Dullness: LA enlargement

A finding during physical examination where the percussion of the left anterior chest reveals a dull sound, indicating an enlarged left atrium.

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Retrosternal bare area

The area behind the sternum, devoid of lung tissue, used for percussion to assess heart dullness in the right ventricle.

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S1 heart sound

The first heart sound, caused by closure of the mitral and tricuspid valves, marking the start of ventricular contraction.

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S2 heart sound

The second heart sound, caused by closure of the aortic and pulmonary valves, representing the end of ventricular systole.

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Accentuated S1

A louder-than-normal S1 heart sound, often indicative of mitral stenosis (MS) or tricuspid stenosis (TS).

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Weak S1

A softer-than-normal S1 heart sound, often caused by mitral regurgitation (MR), tricuspid regurgitation (TR), or myocardial diseases.

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Splitting of S2

A separation of the two components of the S2 heart sound, usually during inspiration.

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Causes of Wide Splitting of S2

Pulmonary stenosis (PS), right bundle branch block (RBBB), ventricular septal defect (VSD).

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Causes of S2 splitting (during inspiration)

Longer ejection time of the pulmonary valve due to increased venous return to the right side of the heart.

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Paradoxical Splitting

A splitting of the second heart sound that widens during inspiration and narrows during expiration.

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S3 sound

An extra heart sound heard during early diastole, often due to rapid blood flow into a dilated ventricle.

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S3 cause (ASD/VSD)

An S3 sound can occur with Atrial Septal Defect (ASD) or Ventricular Septal Defect (VSD), due to abnormal blood flow.

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S4 sound

A late diastolic heart sound heard just before S1, caused by stiff ventricles.

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S4 cause (MI/HOCM)

Stiff ventricles, like in a heart attack (MI) or hypertrophic cardiomyopathy (HOCM), can cause an S4 sound.

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Opening Snap (OS)

A high-pitched sound heard in mitral stenosis, indicating the opening of the mitral valve.

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OS viability

If an opening snap is heard, it suggests the mitral valve is still working and not calcified.

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Ejection Click (EC)

A high-pitched sound heard before S2, usually indicating a problem with the pulmonary or aortic valve opening.

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EC causes (PS/AS)

Aortic stenosis (AS) or pulmonic stenosis (PS) can cause an ejection click because of the valve opening difficulty.

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EC and S2 difference

Ejection clicks come before S2, while S2 is the sound of valve closure.

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Pericardial knock

An abnormal heart sound, often described as a sharp, brisk sound that occurs early in diastole.

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Constrictive Pericarditis

Condition where the pericardium thickens and restricts ventricle relaxation.

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Pericardial Knock

A specific sound (S3) heard in constrictive pericarditis due to rapid ventricular filling.

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Pericardial Rub

Scratching sound from the rubbing of two pericardial layers.

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Murmur

Musical sound due to turbulent blood flow through a narrowed or leaking valve.

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Murmur Timing

When during the heartbeat a murmur is heard (systole or diastole).

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Murmur Character

The quality of the murmur (soft, harsh, rumbling).

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Murmur Site

Location on the chest where the murmur is heard loudest.

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Murmur Grading

The intensity of a murmur, described using distinct terms (very faint, extremely loud).

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Associated Thrill

A vibration felt on the chest wall during a murmur.

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Aortic Stenosis Site

Location where an aortic stenosis murmur is loudest.

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Rheumatic Aetiology

Heart issues arising from rheumatic fever.

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Congenital Aetiology

Heart problems present from birth

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Compensated Heart Failure

Heart failure where symptoms are not yet apparent.

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Decompensated Heart Failure

Heart failure where symptoms are obvious.

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Study Notes

Cardiology - Symptomatology

  • PVC (Premature Ventricular Contractions):
    • Symptoms include dyspnea, orthopnea, paroxysmal nocturnal dyspnea (PND), cough, and hemoptysis.
    • Questions to ask the patient include: chest pain, palpitations, or other discomfort; does dyspnea worsen with exertion or is it independent of activity, Does the patient experience shortness of breath while lying down?, etc (Specific questions are included to help assess the issue)
  • SVC (Superior Vena Cava):
    • Symptoms include cyanosis, edema, palpitations, and swelling of legs and abdomen.
    • Questions to assess the patient include: is there any dizziness or lightheadedness when walking long distances?, etc
  • COP (Congestive Heart Failure):
    • Symptoms include cyanosis, low blood pressure, pain.
    • Questions to ask the patient include: Have your lips or fingernails turned bluish before?, etc
  • Palpitations:
    • Characterized by a feeling of irregular or rapid heartbeat.
    • Questions to ask include: Do you feel your heart flutter or beat irregularly?, Does the heart beat faster than usual?, chest pain, location, radiation, intensity, and associated characteristics (e.g., whether it is relieved by a particular action.)
  • Chest Pain:
    • Questions to assess include: Is there sharp or stabbing pain or tightness in your chest?, etc
  • Blood Pressure:
    • Can indicate abnormalities.
    • Additional questions regarding the patient's history are included.
  • Fever:
    • Often associated with other medical issues.
    • Questions include asking about the patient's recent medical history.
  • Thromboembolic Events/PVD/Other Systems:
    • Indicate potential complications.
    • More detailed questions could be included to assess if there's a history of similar events (Previous problems to rule out similar medical occurrences)
  • Systemic Infections:
    • Indicate underlying conditions.

General Examination

  • General Observation:

    • Body build (average, underweight, overweight)
    • Mental status (average, alert, disoriented, etc)

  • Pallor:

    • Pale skin, possible edema (swelling) of one side of the body, due to heart failure.

  • Cyanosis:

    • bluish discoloration of the skin (Peripheral cyanosis is in the extremities while central cyanosis is throughout the body)

  • Jaundice:

    • Yellowing of skin and mucous membranes (typically indicates liver problems).

  • Hepatomegaly:

    • Enlarged liver (sometimes associated with jaundice).

  • Hepatosplenomegaly:

    • Enlarged liver and spleen (indicates dysfunction in the spleen and liver).

  • Cardiomegaly:

    • Enlarged heart.

  • Peripheral edema:

    • Swelling in the lower extremities (often associated with heart failure.)

  • Vital signs:

    • Blood pressure, pulse, and respiratory rate.

  • Head and neck:

    • Examine for signs of congestion and pulsations.

  • Thorax

    • Observe for abnormalities in chest structure (shape, appearance)
    • Auscultate for abnormal sounds and pulsations during inspection.

  • Upper limbs:

    • Palpate for nail changes (e.g., blueness in cyanosis) and possible irregularities in nail appearance (e.g., splinter hemorrhages) that could indicate infections or heart conditions.

  • Lower limbs:

    • Assess for edema (swelling) in the lower extremities (ankles, feet)

  • Other systems:

    • Assess for related symptoms in other parts of the body that could indicate a wide range of issues

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Cardiology Sheet PDF - DR. Ahmed Khalifa

Description

This quiz covers the key symptoms and assessment questions for various cardiological conditions such as PVC, SVC, and COP. Understand how to evaluate patient symptoms, including dyspnea and palpitations, to identify potential heart conditions effectively. Test your knowledge and improve your clinical assessment skills.

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