signs, symptoms, complications, risk factors for disease

sign

objective evidence for disease, something that can be seen

symptom

subjective evidence of disease, a feeling

angina

chest pain caused by myocardial ischemia

stable angina

chest pain controlled by nitroglycerin or by reducing activity at the time of pain

unstable angina

chest pain at rest

what medications can be used to treat angina

• propanolol

• nitroglycerin

in patients w angina, what is echo looking for

wall motion abnormalities

reduced ef

stress echo for angina looks for

cardiac reasons for the symptom, induces symptoms to do so

sob

difficulty breathing at rest

what symptoms is sob associated with

• valvular stenosis

• pulmonary htn

• significant regurgitation

• chf

• decreased ef

paroxysmal nocturnal dyspnea

difficulty breathing interrupts sleep, seen w pulmonary edema

trepopnea

difficulty breathing when laying on left or right side

apnea

cessation of breathing

hemoptysis

bloody sputum caused by pulmonary edema or hemorrhage

what is hemoptysis seen with commonly

• significant mitral stenosis

• significant acute mitral regurgitation

cyanosis

blue discoloration of skin and mucus membranes

what is cyanosis associated with

• pulmonary disease

• eisenmenger syndrome

• right to left shunts

what is seen in the fingers and toes w cyanosis

clubbing

edema

accumulation of fluid in tissues and cells

what heart problems can lead to edema

• left ventricular failure

• right ventricular failure

• systemic htn

bilateral pedal edema is seen with

right heart failure

pulmonary edema is seen with

left heart failure

edema caused by venous insufficiency vs edema caused by heart failure

• venous involves legs but not feet

• heart involves legs and feet

when does brawny edema occur

chronic tissue edema leads to tissue fibrosis, edema and skin discoloration occur without pitting

what causes jugular vein distension

increased right heart pressure causes backlog of blood into vena cava and tributaries

what heart problems can be found with jugular vein distension

• tricuspid stenosis

• significant pulmonary htn

• severe tr

• constrictive pericarditis

• cardiac tamponade

pulsus paradoxus

over 10 mmHg drop in systolic bp w inspiration

what is pulsus paradoxus associated with

• cardiac tamponade

• constrictive pericarditis

• pe

• copd

palpitations

patient is aware that heart is beating, may feel as though the heart is pounding or fluttering

what can palpitations be caused by

• exercise

• anxiety

• smoking

• caffeine

• arrhythmia

syncope

fainting or passing out

what can cause syncope

• hypotension

• arrhythmia

• myocardial infarction

• subaortic stenosis

• severe aortic valvular stenosis

cachexia

overall ill state of health, malnutrition and wasting caused by chronic heart disease

what lab results indicate acute myocardial infarction

• elevated troponin

• creatine kinase-MB

• LDH (lactic dehydrogenase)

what does hyperkalemia indicate

elevated potassium levels, causes reduced hr and strength of contraction

what does hypernatremia indicate

elevated sodium levels, causes reduced hr and strength of contraction

increased epinephrine and hypercalcemia have what effect on hr and contraction

increased hr and contraction

first heart sound (s1)

mitral and tricuspid closing after atrial contraction, occurs at onset of qrs wave

second heart sound (s2)

aortic and pulmonic valve closing after ventricular contraction, occurs at the end of the t wave

s1 is _____ pitched than s2

lower

s3 and s4 are _____ sounds

abnormal

s3

• ventricular gallop

• caused by oscillation of blood back and forth between the walls of ventricles due to inflow of blood from atria

after age 40, what is s3 associated w

correlates with dysfunction or volume overload of the ventricles

indicates rapid ventricular filling (pregnancy, anemia, chf, dilated cardiomyopathy)

s4

presystolic gallop or atrial gallop

caused by sound of blood being forced into a stiff or hypertrophic ventricle during atrial kick

what is s4 seen w

• htn

• severe aortic or pulmonic stenosis

• cad

• cardiomyopathy

opening snap - what is it associated with and when is it head

mitral stenosis

onset of diastole

ejection click - what is it associated with and when is it heard

congenital aortic valve or pulmonic valve stenosis

follows s1 and occurs w ventricular contraction

midsystolic click - what is it associated with and when is it heard

mvp

mid to late systole

pericardial rub

friction sound caused by inflammation due to acute pericarditis

pericardial knock - what is it associated with and when is it heard

constrictive pericarditis, heart is “knocking” against thickened rt pericardial sac

occurs in early diastole

when do systolic murmurs occur in terms of heart sounds

between s1 and s2

mid systolic murmur

aortic or pulmonic stenosis

increased flow through normal semilunar valves

dilation of aortic root or pulmonary trunk

late systolic murmur

mitral or tricuspid valve prolapse

papillary muscle dysfunction

holosystolic murmur

mr, tr, vsd

occurs when valve is opening and during isovolumic contraction

systolic ejection murmur

occurs when valve is opening but not during isovolumic contraction

semilunar valve stenosis, hypertrophic obstructive cardiomyopathy

when do diastolic murmurs occur in terms of heart sounds

s2 of one cardiac cycle and s1 of the next

regurgitant diastolic murmur

early diastolic, start immediately after s2, continues through isovolumic periods

semilunar valve regurg

diastolic ejection murmur

atrioventricular valve stenosis, mid diastolic murmur

occur when the valve is opening but not during isovolumic relaxation period

what does a late diastolic murmur mean

complete heart block

austin flint murmur

functional diastolic murmur caused by significant aortic regurgitation

dock murmur

early diastolic murmur caused by stenosis of lad

continuous murmur

continuous flow throughout systole and diastole

pda, av fistula, anomalous coronary origin

valsalva maneuver will increase murmur with what

mvp

hypertrophic cardiomyopathy

amyl nitrate

vasodilator

venous return and blood pressure drops upon initial inhalation

amyl nitrate augments murmurs caused by

lvot stenosis

mvp

amyl nitrate diminishes murmurs caused by

aortic and mitral regurgitation

contraindications to amyl nitrate

• severe as

• allergy to nitrites

• recent stroke

acquired immune deficiency syndrome

damages immune system and inhibits the bodys ability to fight disease

what complications can aids cause

(most common) pericardial effusion, tamponade is a concern

myocarditis, dilated cardiomyopathy

valvular regurg, pulmonary htn common

acromegaly

pituitary gland produces too much growth hormone, causing enlargement of the face, hands and feet

acromegaly effects on heart

left ventricular hypertrophy

increased lv mass

impaired relaxation

aging effects on the heart (general)

increased lv thickness/mass

sigmoid ventricular septum

increased la size

reduced cardiac output, stroke volume

calcification, thickening

effects of alcohol abuse on the heart

acute myocardial infarction

reduced ventricular systolic function

dilated cardiomyopathy

ankylosing spondylitis

autoimmune disorder that causes inflammatory changes

what effects does ankylosing spondylitis have on the heart

• aortitis, aneurysm formation

• dilated aortic root w thick walls

• valve thickening and stenosis

beckwith-wiedmann syndrome

overgrowth disorder present at birth, increased risk of childhood cancer

what effects can beckwith-wiedmann syndrome have on the heart

• left ventricular hypertrophy, potentially obstructive

• subvalvular stenosis

• secundum asd

cardiac changes w pregnancy, when do these changes occur

late 3rd trimester or shortly after birth

cardiac changes w pregnancy

• increased hr

• small pericardial effusion

• increased stroke volume, co

• slight overall increase in heart size

• increased rt heart size and volume

if dilated cardiomyopathy occurs in the third trimester or after birth, when should further evaluation be considered

after 6 months

chagas disease

caused by parasite found in the feces of the triatomine bug, cardiac changes occur many years after infection

what effects does chagas disease have on the heart

dilated ventricles with reduced function (chagas cardiomyopathy)

lv apical aneurysm

most common cardiac complication of cocaine abuse

acute myocardial infarction

compliations of cocaine abuse on the heart

• reduced ventricular systolic dysfunction

• dilated cardiomyopathy

• endocarditis

• aortic dissection

• significant systemic htn

cushing disease

elevated cortisol levels usually related to a pituitary tumor

what effects does cushing disease have on the heart

left ventricular hypertrophy

strongest risk factor for coronary artery disease

diabetes

diabetes

diminished rate of secretion of insulin by beta cells of the pancreas

what effects can diabetes have on the heart

• lvh

• left atrial enlargement

• diastolic dysfunction

• aortic stenosis

• dilated cardiomyopathy

• myocardial ischemia and infarction

what effects can ehlers-danlos syndrome have on the body

• aortic root dilation

• sinus of valsalva anuerysm

• bicuspid aortic valve

• mvp

• asd

• common atrium

fabry disease

inherited disorder that results in the buildup of fat in the cells of the body

what effect does fabry disease have on the heart

lvh with hyperechoic endocardial layer of the wall

symmetric and asymmetric ventricular hypertrophy

conduction defects

mvp

fen-phen

appetite suppressant linked to heart disease

what effects can fen-phen use have on the heart

aortic and mitral valve thickening

mitral regurgitation and aortic insufficiency

pulmonary htn

friedrich ataxia

autosomal recessive disorder of spinocerebellar degeneration

left ventricular hypertrophy, reduced systolic function

gaucher disease

sphingolipid disorder

increased left ventricular mass, apical akinesis

chronic anemia can lead to

volume overload, presents as left ventricular hypertrophy

holt oram syndrome

“heart and hand syndrome”

causes upper extremity skeletal and cardiac defects

asd, vsd

effects of hiv on the heart

• formation of pericardial effusion and pericarditis

• regional or global lv systolic dysfunction

• diastolic dysfunction

• hiv cardiomyopathy (dilated cardiomyopathy)

hypothyroidism

decreased function of the thyroid gland