Skills Check

• Beta blockers are to lower BP
• Calcium channel blockers are to lower BP
• Nitrates are for angina and symptoms of heart failure
• Thrombolytics are clot busting drugs, reduce heart attacks
• bronchodilators are used to treat conditions like COPD or asthma
• Corticosteroids are to reduce inflammation
• Normal sinus rhythm is 60-100 bpm
• Sinus bradycardia <60 bpm

  • normal in athletes or patients taking beta-blockers
  • seen in increased ICP from tumors and TBI
  • Sx: syncope, dizziness, angina, and diaphoresis
  • PT not contraindicated unless showing poor CO
• Sinus tachycardia >100 bpm

  • benign, happens when increased sympathetic stimulation such as exercise, fear, and emotional distress
  • asymptomatic unless HR is significantly elevated
  • PT not contraindicated unless HR is >150 bpm
• Atrial Fibrillation is a condition where the atria beat erratically and irregularly

  • >120 bpm
  • No distinct P wave, PR interval is absent
  • multiple ectopic foci
• Atrial Fibrillation is caused by age, CHF, dioxin toxicity, stress, pain, infection

  • predisposed to blood clots
  • Sx:
  • palpations, fatigue, dyspnea, lightheadedness, syncope, chest pain
• Atrial Flutter is a rapid atrial contraction that occurs in the absence of ventricular contraction

  • one etopic focus in atria
  • SAWTOOTH P wave
  • 250-300 bpm
• Atrial Flutter is caused by rheumatic heart disease, mitral valve disease, CAD, stress, drugs

  • sx: palpations, lightheadedness, angina, rapid rate
  • PT held is >100 bpm at rest
• Normal heart sounds are S1 and S2

  Abnormal are S3 and S4
• S1: lub, closing of mitral and tricuspid valve

  • start of ventricular systole
  • TV: L sternal border, 4th/5th ICS
  • MV: L midclavicular line, 5th ICS
• S2: Dub, closing of pulmonary and aortic valve

  • systolic contraction complete, beginning of ventricular diastole
  • AV: right sternal border, 2nd ICS
  • PV: L sternal border, 2nd to 4th ICS
• S3: after S2

  • early diastolic ventricular filling after AV valves open
  • Hallmark sign of heart failure
• S4: before S1

  • rapid ventricular filling after atrial contraction
  • Hypertrophic ventricle
• Systolic Murmur is the most common

  • aortic stenosis, ejection or regurgitation
  • heard between S1 and S2
  • Swishing sound
• Diastolic Murmur

  • aortic and pulmonary regurgitation, mitral stenosis
  • Heart after S2