Cardiopulm DDXI

• S1 = lub

  • closing of tricuspid and mitral valve
  • marks the start of ventricular systole
• Tricuspid valve is at the L sternal border, 4th and 5th ICS
• Bicuspid valve is at the L midclavicular line, 5th ICS
• S2 = dub

  • closing of the pulmonary and aortic valves
  • beginning of ventricular diastole
• AV is at the right sternal border, 2nd ICS
• PV is at the left sternal border, 2nd - 4th ICS
• S3 = lub de dub - right after S2

  • early diastolic ventricular filling that occurs after the AV valves open
  • Hallmark sign of heart failure
• S4 is always abnormal, signifies ventricular filling that occurs after atrial contraction

  • right before S1
• S4 indicates stiff or hypertrophic ventricle causing turbulent flow

  • conditions: HTN, cardiomyopathies, coarctation of the aorta
• Heart murmurs is vibrations resulting from turbulent blood flow

  1. caused by high rates of flow either through normal or abnormal valves
  2. caused by forward flow through a constricted valve or by flow into a dilated vessel
  3. caused by backward flow through a valve
• Systolic murmur is the most common

  • caused by ejection or regurgitation
  • aortic stenosis
  • heard between S1 and S2
  • Swishing (lush-dub)
• Diastolic murmur

  • uncommon
  • Aortic and pulmonary regurgitation, mitral stenosis
  • Heard immediately following S2
• Pericardial friction rub is a sign of pericardial inflammation associated with each beat

  • sounds like a creak or leather being rubbed together
  • if the patient holds their breath and you still hear it, it is pericardial friction rub
  • 3rd-4th ICS, anterior axillary line
• Pericardial friction rub

  • pain:
  • increases with inspiration and swallowing
  • continuous
  • Radiates to L shoulder
• Primary prevention is active intervention for risk factors that cause CVD
• Primary prevention for CVD

  • aerobic exercise
  • dietary counseling
  • stress management
  • smoking cessation
  • pharmacologic management
• BORG RPE 6-20 correlates better with HR
• MET = metabolic equivalent of energy expenditure

  • 1 MET = the energy used by the body as you sit quietly
  • 3-6 = moderate physical activity
  • >6 = vigorous physical activity