Cardiovascular diseases

What is the leading cause of death in industrialized nations

heart disease

prevalence of heart disease in america

1 in 3

risk factors of heart disease

• advancing age (>45)

• HTN

• obesity

• sedentary lifestyle

• excessive alcohol

• oral contraceptive

• family history tobacco use

• abnormal cholesterol

• race

What is the most common symptom of CV disease

chest pain/discomfort

What symptoms is typically accompanied by chest pain

radiation to neck, jaw, upper trap, upper back, or arms (L)

define palpitation

irregular heartbeat

description of palpitation

jump, pound, flop, flutter, or racing sensation

common symptoms accompanied by palpitation

lightheadedness

syncope

at what point is palpitation no longer considered normal and should be refered

>6 mins and pain, SOB, fainting, lightheadedness

what can cause dyspnea

cardiac or pulmonary pathology

examples of extreme dyspnea

paroxysmal nocturnal dyspnea

orthopnea

when should a patient be referred for dyspnea

• cannot climb single flight of stairs without feeling mod-severe winded

• awakens at night or experiences SOB when laying down

• know cardia issue

What causes cardiac syncope

reduced oxygen to the brain

When should patient be referred for cardiac syncope

immediately due to risk of sudden cardiac death

When should fatigue be closely monitored

goes beyond expectations during/after exercise

why might patient report cough as symptom

pulmonary complication of CV pathology (backup of fluid)

define cyanosis

bluish discoloration of lips and nail beds due to inadequate blood O2 levels

When is edema a concern for CV disease

3 lb or greater weight gain

cardiac diseases involving heart muscle

CAD

MI

pericarditis

CHF

aneurysm

cardiac diseases involving heart valves

rheumatic fever

endocarditis

mitral valve prolapse

congenital deformities

cardiac diseases involving cardiac NS

arrythmias

tachycardia

bradycardia

describe CAD

artery carrying oxygenated blood to the myocardium becomes narrowed/blocked leading to ischemia

What can CAD lead to

angina or MI

at what point does CAD start to present symptoms

75% blockage

describe angina

acute pain in the chest due to imbalance between cardiac workload and O2 supply to myocardial tissue

What pathos often accompany angina

HTN and PVD

s/s of angina

• hold clenched fist to sternum (levine’s sign)

• radiates to shoulder/arm

• indigestion

• squeezing/burning/pressing/choking/aching/bursting

• 1-3 mins long

When should patient go to ED with angina

not relieved by rest or 3 nitro

When does chest pain screening become a red flag

when MSK findings dont align

define MI

occlusion of a coronary artery that has caused ischemia and necrosis of myocardial tissue

classic warming signs of MI

severe unrelenting chest pain describes as “crushing”, lasting 30 mins or more and not relieved by rest or nitro

define pericarditis

inflammation of the pericardium (protective sac over heart)

s/s of pericarditis

chest pain, SOB, tachycardia, fever, fatigue, substernal pain, cough

referral for pericarditis

cardiac referral

how is MI different than pericarditis

P: symptoms change with position,

MI: unaffected by breathing, position, or movement

define heart failure

heart is unable to pump enough blood to meet metabolic needs of body

results of right sided heart failure

congestion in peripheral tissues and viscera

s/s of right sided HF

swelling

liver enlargment

ascites

fatigue

right upper quadrant pain

cyanosis of nail beds

results of L ventricular HF

pulmonary congestion

HF typically starts on which side

L →R

When is HF dxed

EF <40%

s/s of L sided HF

• fatigue

• dyspnea

• spasmodic cough

• paroxysmal nocturnal dyspnea

  • orthopnea

define aneurysm

abnormal dilation due to weakening in wall of an arter, vein, or heart

what divides thoracic vs abdominal aneurysms

diaphragm

What is the most common aneurysm

abdomina aortic

s/s of an aneurysm

• CP

• palpable, pulsating mass

• dull ache in flank

• abdominal heartbeat when laying down

• hip, groin, scrotal, butt, and/or leg pain

• weakness/transient paralysis of legs

s/s of aneurysm rupture

• sudden, sever chest pain

• pain radiating to MI distribution

• tearing/ripping pain

• pulsating abdominal mass

• cold, pulseless LE

• BP changes

• HR >100

• ecchymoses in flank/perineal area

• lightheaded and nauseas

AAA rupture referrao

symptoms of valve issues

• fatigue

• dyspnea

• palpitations

• CP

• pitting edema

• dizziness or syncope

• orthopnea

types of valve issues

stenosis

insufficiency

prolapse

describe rheumatic fever

infection cause by strep that damages the heart valves

most common symptom of rheumatic fever

fever and joint pain

Who is most likely to contrac rheumatic fever

young children (5-15)

describe endocarditis

bacterial infection of the innerlining of the heart

where does damage occur for endocarditis

tricuspid, aortic, or mitral valves

types of congenital heart defects

• ventricular septal defect (VSD)

• atrial septal defect (ASD)

• L→ R shunts

• acyanotic

describe coarctation of the aorta

congenital narrowing of the aorta after the UE branches

describe tetrolagy of fallot

combination of VSD, PA stenosis, overriding aorta, and R ventricular hypertrophy leading to R→L shunt

s/s associated with patent ductus arteriosus

• fast breathing

• poor feeding habits

• rapid pulse

• SOB

• seating while feeding

• tires very easily

• poor growth

When is patent ductus arteriosus typically discovered

infants, when having difficulty feeding

s/s bradycardia

syncope

s/s of tachycardia

palpitation, restlessness, chest discomfort, agitation, axiety, apprehension

msot common type of arrhythmia

A-Fib

normal range for K

3.5-5.0 mm/L

normal range for Mg

1.3-2.1mmol/L

normal range for Ca

9.0-10.5 mg/dL

normal range fofr Na

136-145 mmol/L