CARDIAC

Heart Sounds:
S1- tricuspid and mitral valve close
S2- pulmonary and aortic valve close
S3- ventricular filling complete
S4-elevated atrial pressure (atrial kick)

Right Sided Heart Failure

Right Upper Quadrant Pain
Right Ventricular Heave
Tricuspid Murmur
Weight gain
Nausea
Elevated Right Atrial Pressure
Elevated Central Venous Pressure
Peripheral Edema
Ascites
Anorexia
Hepatomegaly

Left Sided Heart Failure

Left Ventricular Heave
Confusion
Paroxysmal Noturnal Dyspnea
DOE
Fatigue
S3 Gallop
Crackles
Tachycardia
Cough
Mitral Murmur
Diaphoresis
Orthopnea

CONGESTIVE HEART FAILURE

Class I describes a patient who is not limited with normal physical activity by
symptoms.
Class II occurs when ordinary physical activity results in fatigue, dyspnea, or other
symptoms.
Class III is characterized by a marked limitation in normal physical activity.
Class IV is defined by symptoms at rest or with any physical activity.
Causes: CAD, Valvular heart disease, Cardiomyopathies, Endocarditis, Extracardiac
infection, Pulmonary embolus
Symptoms: Skin cold or cyanotic, Wheezing, Mitral valvular deficits, Lower
extremity edema, Pulsus alternans, Hypertension, Tachypnea

ARRYTHMIAS

ENDOCRINE
Hyperthyroidism
1. Definition: Excessive production of thyroid hormone
2. Causes: Iodine overdose, Thyroid hormone overdose, Graves disease,
Tumors affecting the reproductive system
3. Symptoms: Skin color changes, weight loss, anxiety, possible goiter,
nausea, exophthalmos, diarrhea, hair loss, elevated BP, fatigue,
sweating
4. Tests: Elevated systolic pressure noted, T3/T4 levels increased, TSH
levels reduced
5. Treatment:
o Radioactive iodine
o Surgery
o Beta-Blockers
o Antithyroid Drugs

Cushings Syndrome
Definition: Abnormal production of ACTH which in turn causes elevated
cortisol levels
Causes: Corticosteroids prolonged use; Tumors
Symptoms: Muscle weakness, central obesity distribution, back pain, thirst,
skin color changes, bone and joint pain, HTN, HAs, frequent urination, moon
face, weight gain, acne
Tests:
o Dexamethasone suppression test
o Cortisone level check
o MRI-check for tumors
Treatment:
o Surgery to remove tumor
o Monitor Corticosteroid levels
Monitor Patient For:
o Kidney stones
o HTN
o Bone fractures
o DM
o Infections

Diabetic Ketoacidosis
6. Definition: Increased levels of ketones due to a lack of glucose

OB
Passage of fetus through birth canal:

Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion