Cardiovascular System lecture

Cardinal signs of cardiac disease

- Chest, neck, or arm pain/discomfort

- Palpitations

- Dyspnea

- Syncope (fainting)

- Fatigue

- Cough

- Cyanosis

- Edema and leg (claudication): most common symptoms of vascular component

Chest pain /discomfort

- Tightness and or pressure

- Can radiate to: (Neck, jaw, upper trapezius, upper back shoulder or arms (commonly in the left arm))

- Pain of cardiac origin can be experienced in the shoulder because the heart (and diaphragm) are supplied by C5-C6, which refers to the somatic area

- Often occurs with: (Nausea, vomiting, diaphoresis, dyspnea, fatigue, pallor or syncope)

Angina

- Occurs when cardiac muscle is deprived of oxygen

- A symptoms of coronary artery disease

- Usually starts behind sternum, but can project to arm, shoulder, neck, jaw, throat and back

- Pressure, squeezing, or tightness in the chest

- Can be mistaken for indigestion

- Shortness of breath, weakness, lightheadedness and sweating can occur

Palpitations

- Irregular, fast or extra heartbeat

- AKA arrhythmias, dysrhythmias

- Caused by benign conditions (mitral valve prolapse, caffeine, anxiety, exercise, athletes heart)

- or caused by severe conditions (CAD, cardiomyopathy, complete heart block, mitral or aortic stenosis)

- Bump, pound, jump, flop, flutter or racing sensation

- Associated symptoms: (Lightheadedness, syncope)

- Palpated pulse: (Rapid or irregular, "skipped a beat")

Dyspnea

- Breathlessness or shortness of breath

- Cardiovascular or pulmonary in origin

- Dyspnea relieved by specific breathing patterns (pursed-lip breathing) or by specific body positions (leaning forward on arms to lock the shoulder girdle) is more likely to be pulmonary in origin

Cardiovascular syncope

- Fainting or lightheadedness

- Reduced O2 to the brain when the hearts pumping ability is compromised

- Arrhythmias, OH, aortic dissection, hypertrophic cardiomyopathy, CAD, vertebral artery insufficiency, and hypoglycemia

Ischemic heart disease

- When coronary arteries become narrowed or blocked

- Major disorders of the myocardium due to insufficient blood supply are collectively known as: (Ischemic heart disease, Coronary heart disease (CHD), Coronary artery disease (CAD))

- Atherosclerotic disease (narrowing of arteries) and their thrombotic complications are the #1 cause of mortality and morbidity in the US

Coronary artery disease (CAD)

- Arteriosclerosis

-Atherosclerosis

arteriosclerosis

> Group of diseases characterized by thickening and loss of elasticity of the arterial walls

> AKA hardening of the arteries

Atherosclerosis

> Thickening of the arterial wall because of the accumulation of lipids, macrophages, smooth muscle cells, necrotic debris, etc

> Can affect any of the arteries... AKA cardiovascular disease

- No direct symptoms at first

- There must be a critical deficit in blood supply to the heart or other structures (before symptoms are noted) (Lumen of the coronary artery narrows by 75%)

- If it develops slowly, collateral circulation developed to meet the needs of the heart

- Atherosclerosis of coronary artery: (Angina pectoris, MI or heart attack, sudden death are the common sequelae)

- can happy anywhere in the body

- When the arteries of the heart are affected: (Coronary artery disease (CAD) or coronary heart disease (CHD))

- When the arteries of the brain are affected: (Cerebrovascular disease develops)

- Other parts of the body: (Peripheral vascular disease (PVD), aneurysm, intestinal infarction)

risk factors for coronary artery disease: atherosclerosis

-No direct symptoms at first

-There must be a critical deficit in blood supply to theheart or other structures (before symptoms are noted)

--Lumen of the coronary artery narrows by 75%

-If it develops slowly, collateral circulation develops tomeet the needs of the heart

-Atherosclerosis of coronary arteries:

--Angina pectoris, MI or heart attack, sudden death arethe common sequelae

Metabolic syndrome

- 3 of these 5 components = metabolic syndrome

> Waist size > 40'' in men, > 35'' in women

> Low HDL cholesterol (good cholesterol), < 40 in men, < 50 in women

> BP of 130/85 or greater

> Fasting blood glucose = 100 mg/dl or more

> Triglyceride levels = 150 mg/dl or more

- If someone has metabolic syndrome it directly promotes development of atherosclerosis

- Obese and physically inactive: (Require lifestyle changes (exerciser, stop smoking) and possible drug therapy)

- Primary goal: (Reduce risk of atherosclerotic cardiovascular disease)

Angina and Coronary artery disease: men

- Angina is the first symptom of CAD in ⅓, MI or sudden death in majority of cases

Angina and Coronary artery disease: women

- Angina in ½ of all cases, other ½ are asymptomatic or have atypical symptoms

- Atypical symptoms: Breathlessness, pain in L chest, upper abdominal pain, back or arm pain (with no substernal pain))

- less likely to get advice about risk reduction while still healthy (even though they are more likely to die with their 1st MI)

Heart rate recovery

- Heart rate recovery after submaximal exercise is a predictor of mortality

- Usually obtained during exercise testing

- Subtract the HR 2 minutes post exercise from the HR immediately post exercise

- Abnormal HRR: reduction of 12 beats/min or less

- People with abnormal HRR are 4x more likely to die

- Screening tool can be used with healthy and cardiac pt

Exercise and Coronary artery disease

- Moderate - intensity exercise for at least 30 minutes on most days of the week (Reduces the risk of: coronary events, ischemic stroke, metabolic syndrome and insulin resistance, DM)

- Exercise alone (independent of weight loss or diet changes) can have significant beneficial effects on cardiovascular risk factors in overweight people with high cholesterol

- Comparing medications and exercise on coronary artery perfusion: "exercise is the most powerful drug available in preventing cardiac events"

exercise can reduce CAD risk factors

- Exercise is the one single intervention with the ability to influence the greatest number of risk factors:

> Helps with smoking cessation

> Alters cholesterol levels

> Decreases BP

> Helps control blood glucose levels

> Reverses the effects of a sedentary lifestyle

> Contributes to weight loss

> Helps to manage stress induced increases in HR and BP

Treatment of Coronary artery disease

- Medical management is directed towards which blood vessels were blocked

- Treatment choices:

> Surgery

> Cardiac rehabilitation

> Gene therapy

> Complementary and integrative medicine

Surgery for Coronary artery disease (PCI)

- percutaneous coronary intervention

- Can open an occluded artery without opening the chest

- Coronary angiography to determine location, then a catheter is threaded through the femoral artery into the L coronary artery

- Performed more often than bypass surgery

- Angioplasty combined with a stent reduces the high rates of restenosis (esp. For pts with DM, who have a high restenosis rate after balloon angioplasty)

Surgery for Coronary artery disease (CABG)

- coronary artery bypass graft

-Take a portion of a vein or artery from the chest or leg, grafting it to the coronary artery (can be from either Saphenous vein, internal mammary artery)

-Bypassing the clogged vessel provides an alternate route for blood to reach the heart muscle

- Requires a sternotomy

- Most effective in pts who have several severely blocked coronary arteries and a previously damaged heart muscle

Surgery for Coronary artery disease (Coronary stent)

- Blocked coronary artery is held open using a balloon- expandable device

- Stent is drug coated

- Bare metal covered with a polymer (plastic) coating that holds and releases a drug to inhibit the growth of endothelial cells

- Stent is expanded by the balloon, and then holds the coronary artery open to allow blood to pass through freely

Post op considerations (Cardiac rehabilitation)

- Important for anyone treated medically for CHF, arrhythmias, unstable angina, CAD, MI, valvular disease, or heart transplantation

- Multidisciplinary program of education and exercise

- Promotes the development /maintenance of physical, social and psychological function

-Specific goals: (Stratifying risk, improving emotional well being and psychological factors, reducing CAD risk factors, and decreasing symptoms)

Postoperative exercise

- CNS dysfunction is a common consequence of otherwise uncomplicated CABG (cause unknown)

- Program to increase strength/flexibility of pectoral and leg muscles recommended

- Elastic stockings worn to prevent fluid accumulation at incision site

- Special exercises to improve chest wall function, facilitate breathing, and prevent adhesive capsulitis (common finding 6-12 weeks post CABG or other open heart surgical procedure)

Angina pectoris

- When cardiac workload exceeds the O2 supply to myocardial tissue... ischemia occurs... causes temporary chest pain/discomfort

- People 65+ and more often in men

stable angina

Classic exertional angina, occurs at predictable levels of physical/emotional stress, responds promptly to rest or nitroglycerin

unstable angina

unpredictable, abrupt change in the intensity/frequency of symptoms

Lasts longer than 15 minutes

Symptom of worsening cardiac ischemia

new-onset angina

angina that has developed for the1st time within last 2 weeks, considered unstable

nocturnal angina

wakes them up, inc. HR from dreams, or congestive heart failure

angina pectoris

CAD accounts for 90% of all cases of angina

Mild-moderate (rarely severe), usually lasts 1-3 mins (sometimes3-5 mins), can persist 15-20 mins

Relieved by rest or nitroglycerin (women, may be relieved byantacids)

angina pectoris clinical manifestations

Temporary pain/discomfort that starts suddenly in the chest (substernal/retrosternal)

Can radiate to L shoulder and ulnar border of arm and fingers.

Can also refer to any dermatome from C3 to T4

Back of neck, lower jaw, teeth, upper back, interscapular area, abdomen and right arm

Described as: squeezing, burning, pressing, heartburn, indigestion,or choking

angina pectoris in women

Symptoms often atypical

Breathlessness and pain (left chest, upper abdomen, back or arm)... no substernal chest pain

Pain is more diffuse, is sharp or fleeting, unrelated to exercise, unrelieved by rest or nitroglycerine

Relieved by antacids

Characterized by palpitations without chest pain

Pain may be repeated and prolonged

Chronic stable angina: more likely to occur during rest, sleep or periods of mental stress

Angina pectoris recommendations

- Reduce activity and sit down for a few minutes until symptoms disappear

- Exercise can be reinitiated at a reduced intensity (some experts recommend waiting several hours)

- Nitroglycerin can be used 5 minutes pre exercise for activities that are likely to prove angina

- Should be seated (when taking nitro) to avoid syncope and falls

- Contact MD if 3 doses of nitro in 10-15 minutes does not relieve the symptoms

Angina diagnosis

- History, if sublingual nitroglycerin shortens attack

- ECG normal in 25-30%

- Exercise tolerance test is more useful, non-invasive procedure to evaluate ischemic response

Angina prevention and treatment

- Avoid stressors, modifying risk factors

- Sublingual nitroglycerin: usually relieves symptoms within 1-2 minutes

Angina prognosis

- 1/3 die suddenly from Myocardial infarction or arrhythmias

Nitroglycerin

- Inactivated by light, heat, air and moisture

- Should be stored in the refrigerator in an amber container with a tight fitting cover

- Short shelf life, should be replaced every 3 months

- Tablet should produce a burning sensation under the tongue (if not, check the expiration date)

- Important to educate your patients about these facts, many of them may not have understood these instructions initially

primary/essential hypertension

idiopathic hypertension

90-95% of all cases

secondary hypertension

Results from an identifiable cause

labile hypertension

intermittent elevated BP

malignant hypertension

Markedly elevated (systolic >180, diastolic >120)

Target organ damage (retinal hemorrhages, renal insufficiency, stroke)

hypertension clinical manifestations

Frequently asymptomatic

HA

Vertigo

Flushed face

Spontaneous epistaxis

Blurred vision

Nocturnal urinary frequency

Myocardial infarction (MI)

- AKA heart attack or coronary

- Most common site is the L ventricle (chamber with the greatest workload)

- Thrombosis of anterior descending branch of L coronary is the most common cause of infarction, effects the anterior L ventricle

- Ischemia and necrosis of myocardial tissue

- 80-90% of MIs result from coronary thrombus at the site of a pre existing atherosclerotic stenosis

-Other causes: (Cocaine, vasculitis, aortic stenosis)

- Smokers: (More than 2x as many MIs, Sudden cardiac death 2-4x more frequently, After an MI, poorer chance of recovery)

MI risk factors

Occur more frequently:

-Early morning hours (inc. BP and clotting factors)

-Between Thanksgiving and New Year's Day

Acute respiratory tract infections (cold, flu,bronchitis) increase the risk of MI by 17x within 1 week

Silent MI: unrecognized, atypical or no symptoms

-Significantly increased risk of mortality

-Highly prevalent in patients with DM

Clinical manifestations of Myocardial infarction (MI)

- Sudden sensation of pressure (prolonged crushing chest pain) occasionally radiating to arms, throat, neck and back

- Pain is constant (30 mins to hours) (May have pallor, shortness of breath, profuse perspiration)

- Women: SOB, chronic unexplained fatigue

Myocardial infarction (MI) prognosis

- First 24 hours is the time for highest risk for sudden death

- 80% with acute MI survive initial attack if in a CCU

- Factors negatively affecting prognosis

> Age (>80 years old have a 60% mortality)

> Other cardiovascular/respiratory dz, or uncontrolled DM

> Anterior location of MI (30% mortality)

> Hypotension (systolic < 55 mHg have a 60% mortality rate)

most common warning signs of heart attack

- Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest (prolonged)

- Pain that spreads to the throat, neck, back, jaw, shoulders, or arms

- Chest discomfort with lightheadedness, dizziness, sweating, pallor, nausea, or SOB

- Prolonged symptoms unrelieved by antacids, nitroglycerin, or rest

atypical warning signs of heart attack (women)

-unusual chest pain (quality, location, e.g. burning, heaviness: left chest), stomach or abdominal pain

-continuous midthoracic or interscapular pain

-continuous neck or shoulder pain

-pain relieved by antacids; pain unrelieved by rest or nitroglycerin

-nausea and vomiting: flu-like manifestation without chest pain/discomfort

-unexplained intense anxiety, weakness, or fatigue

-breathlessness, dizziness

Heart failure

- The heart is unable to pump sufficient blood to supply the body's needs (disorder of pericardium, myocardium, valves or large vessels, or metabolic abnormalities)

-affects one side of heart and can progress to the other

Left sided heart failure

- Failure of the L ventricle, heart doesn't pump enough blood through arterial system, causes pulmonary edema or respiratory issues

- Signs and symptoms: (Dyspnea, fatigue, muscular weakness, renal changes)

- Severe heart failure: may sleep upright in a recliner

Right sided heart failure

- Failure of the right ventricle to adequately pump blood to the lungs... results in peripheral edema and venous congestion to the organs

- Signs and symptoms: (Dependent edema, jugular vein distension, abdominal pain (enlarged liver), cyanosis)

medical management of heart failure

- Echocardiogram is the main diagnostic tool

- Treatment of underlying cause of CHF if possible

- Pts are placed on sodium restricted diet, may have fluid intake limitations

- Physical activity and exercise are prescribed per client tolerance

- 40-50% of clients with CHF die suddenly (d/t ventricular arrhythmias)

- Prognosis is poor... annual mortality rates

> 10% in stable clients with mild symptoms

> Over 50% in clients with advanced, progressive symptoms

>half will die within 5 years of diagnosis

Orthostatic hypotension

- AKA postural hypotension (Take their bp when supine, sitting, and standing and looking for changes)

-Decrease of 20 mmHg or greater SBP OR a drop of 10mmHg in SBP and DBP with a HR increase of 15beats/min or more when standing from sit/supine​

Acute and temporary, OR can be chronic​

Occurs frequently in older adults (>50% of frail olderadults)​

Morbidity d/t syncope, falls, MI, TIA​

- Symptoms: (Dizziness, blurring/loss of vision, syncope)

> May have confusion, pallor, tremor, unsteadiness

causes of orthostatic hypotension

- Causes:

> Volume depletion (burns, DM)

> Venous pooling (pregnancy)

> Side effects of meds (antihypertensives)

> Prolonged immobility

> Malnutrition

> Autonomic NS dysregulation (DM, PD, FM, CRF)

Orthostatic hypotension (instructions for PT)

- Rise slowly from bed

- Ankle pumps, raise arms, diaphragmatic breathing

- Abdominal blinders and elastic stocking

- If they become hypotensive, should assume a supine position with legs elevated to increase venous return and to ensure cerebral blood flow

myocarditis

Relatively uncommon

Acute or chronic inflammation of myocardium

Most often due to bacterial or viral infection

Clinical manifestations:

-Mild continuous chest pain (epigastric or sternal)

-Palpitations

-Fatigue

-Dyspnea

Acute myocarditis: contraindication for therapy(athletes must discontinue sports for 6 months)

cardiomyopathy

Group of conditions affecting the heart muscle(contraction/relaxation impaired)

Primary (heart muscle only) or secondary (systemic, affectsheart + other organs)

Can affect any age group

-Often seen in young adults in 2nd and 3rd decades

hypertrophic cardiomyopathy

Autosomal genetic trait

Most common type of cardiomyopathy

Most common cause of sudden cardiac death in young people

Disease affecting heart valves

- Caused by infection (endocarditis) congenital deformity, or disease

- Valve conditions increase workload of the heart, heart has to pump harder

valve deformities

Functional:

-stenosis (narrowing that prevents the valve from opening full)

-insufficiency (valve doesn't close properly and blood flows back to heart chamber)

Anatomic (prolapse, congenital, trauma, infection))

mitral stenosis

Primarily affects women

Often in patients with a h/o rheumatic heart disease

Mild cases are asymptomatic

Moderate cases: dyspnea and fatigue

Severe cases: dyspnea, fatigue and right ventricularfailure

mitral valve prolapse

Common (2-3% of normal adults, esp. young women)

Detected most often in pregnancy

Blood leaks back into left atrium

>50% are asymptomatic, 40% have occasional symptoms

Triad of symptoms:

-Profound fatigue

-Palpitations

-Dyspnea

Common in connective tissue disorders (will see jointhypermobility, TMJ syndrome, scoliosis, etc...)

aortic stenosis

A disease of aging (>80% are men)

Caused by progressive aortic valve calcification

Decreased resting ejection fraction (amount of bloodthe ventricle ejects, normal is 55-60%)

-A sign of ventricular failure (d/t added stress onventricular muscles)

Asymptomatic until 6th decade

-Fatigue, chest pain, dizziness and SOB

infective endocarditis

Infection of the lining inside the heart (+ valves)

Most commonly damages the mitral valve (but canaffect the aortic, tricuspid and pulmonary valves)

Any age (rarely in children), 50% are 60+

-Men>women

Formation of wart-like growths (vegetations)

-Can break off the valve and embolize, causing septicinfarction in other organs

infective endocarditis clinical manifestations

Develops insidiously or immediately

Valve dysfunction

Many organ systems: lungs, eyes, kidneys, bones, joints,and CNS

Classic findings: fever, cardiac murmur, petechial lesions(skin, conjunctivae and oral mucosa)

50% have MSK symptoms first (arthralgia, arthritis, LBPand myalgia) and no other symptoms

rheumatic fever and heart disease

Type of endocarditis, caused by a strep A bacterial infection

2 most common symptoms: fever and joint pain

Can be fatal or lead to rheumatic heart disease (chronic condition caused by scarring/deformity of heart valves)

Infection starts with strep throat in children (5-15 y.o.)and damages the heart in 50% of cases

Aneurysm

- Abnormal stretching in the wall of an artery or vein, or the heart with a diameter that is at least 50% greater than normal

- Most common site of arterial aneurysm is the aorta

- Aortic aneurysms: (Approx. 200,000 people a year are diagnosed in the US (150,000 severe enough to rupture)

- Much more common in men, and ½ of affected pts have hypertension

conditions affecting the pericardium

Acute pericarditis

Constrictive pericarditis (chronic condition, rare)

Pericardial effusion(fluid within pericardial sac)

Most common types of pericarditis caused by:

Drug induced

Associated with autoimmune diseases (SLE, RA)

After MI or open-heart surgery

Associated with renal failure

After radiation therapy

Pericarditis: Clinical Manifestations

Pleuritic chest pain (worsens with supine position, deep breathing and coughing; relieved by sitting up)

-Pain is substernal, can radiate to neck, shoulders, upper back, upper traps, L supraclavicular area, or L arm

-Fever, joint pain, dyspnea, difficulty swallowing

-Auscultation: lower L sternal border, hear a high-pitched scratchy sound at the end of expiration

aneurysm

Abnormal stretching in the wall of an artery, a vein, or the heart with a diameter that is at least 50% greater than normal

Named according to the specific site of formation

Most common site of arterial aneurysm is the aorta

-Thoracic (above the diaphragm)

--Occur less often, but more life-threatening

-Abdominal Aortic Aneurysm(AAA)

--Below the diaphragm, 4x more common than thoracic type

aneurysm risk factors

Age (50+) is the most significant risk factor for AAA

Much more often in men, but women have a higher risk of aneurysm rupture

AAA less common in African Americans, Hispanics,Asian Americans and people with DM

7x increase with h/o cigarette smoking

Increased salt intake, HTN, peripheral artery disease and cerebrovascular disease

Risk decreased: eating fruits/veggies >3x/wk, and exercising >1x/wk

Aneurysm pathogenesis

- Plaque formation erodes the vessel wall, predisposing the vessel to stretching of the inner and outer layers of the artery and formation of a sac

- With time, the aneurysm becomes more fibrotic, but it continues to bulge with each systole

Aneurysm clinical manifestations

- May be asymptomatic

- Persistent but vague substernal back, neck, or jaw pain (as the enlargement of the aneurysm impinges nearby structures)

- Abdominal aortic aneurysm:

> Most are asymptomatic (25-30% have mild to severe mid- abdominal or lower back pain)

> Might have groin or flank pain

> Abdominal heartbeat in supine

Aneurysm treatment

- Based on the size of the bulge, speed of expansion, and pt's clinical presentation

- Small aneurysms: watchful waiting

- 5cm of greater: surgical repair (At this stage, risk of rupture exceeds the risk of repair, Surgical intervention before rupture has a good prognosis)

- Surgical repair is still associated with high morbidity and substantial mortality rates (MI, respiratory failure, renal failure, CVA)

Peripheral vascular disease (PVD)

- Peripheral arterial disease (PAD)

- Peripheral vascular disease

- Terms often interchangeably

- PVD is a broader, more encompassing grouping of disorders of both arterial and venous blood vessels (PAD is for arterial blood vessels)

- PVD affects legs more often (but it can affect UE's)

- Approximaltry 8 million americans >60

- Arterial occlusive forms of PVD most common d/t atherosclerosis

- Intermittent claudication of Peripheral vascular disease

> Classic symptoms of PAD (like angina with CAD)

> Predictable and nearly always develops after the same amount of exertion

> Usually in the calves (less common in thighs/butt)

> Usually improves rapidly with rest

> Sharply increases in late middle age, slightly higher incidence in men

Intermittent claudication (PVD)

- Distance walked before onset of pain indicates the degree of circulatory inadequacy

> 2 blocks or more = mild

> 1 block = moderate

> ½ block or less = severe

> Primary symptoms may only be weakness or tiredness in the leg

inflammatory disorders affecting blood vessels

often triggered by immunologic conditions (often an autoimmune disease)

-Inflammation causes damage to vessels, leading to end-stage damage

Vasculitis is a group of disorders

-Narrowing/occlusion of lumen OR

-Formation of aneurysms that can rupture

-Nerves can be affected

Primary target organs:

Muscle, peripheral nerve, skin, testicle or kidney

kawasaki disease

Acute febrile illness associated with systemic(multiorgan) vasculitis

Most prevalent in Asian populations

80% of all cases are children younger than 4

-20% develop cardiac complications (can be fatal)

3 phases:

-Acute (5 days): sudden high fever, extreme irritability

-Subacute (25 days): no fever, still irritable, anorexia,rashes, peripheral edema, conjunctivitis and oralirritation

-Convalescent (6-8 wks): resolution of symptoms

venous diseases

Can be acute or chronic

Acute:

-Thrombophlebitis

Chronic:

-Varicose vein formation

-Chronic venous insufficiency

Thrombophlebitis

Swelling of a vein due to vein wall inflammation(phlebitis)

-Caused by a thrombus (blood clot) deposited in the vein

-2 types (based on location):

--DVT (deep vein thrombosis)

--Superficial thrombophlebitis

DVT and Pulmonary Embolism(PE)

Vein thrombosis can be partial (mural thrombus) or complete (occlusive thrombus)

Venous thromboembolism (VTE):

-DVT and PE together

DVT:

-Distal: below the knee

-Proximal: popliteal vein or above

Most common superficial vein thrombosis is in thesaphenous vein in the LE

Most common DVT is in the femoral or iliac veins

pulmonary embolism

-Occurs when part of a thrombus (embolus) in a DVT breaks loose, travels through R side of heart into thepulmonary artery.

-Blood flow is occluded in that area of the lung, causingdamage and impaired gas exchange

Approximately 50% of VTE triggered by:

-Immobility, surgery, trauma or hospitalization

-20% linked to cancer

risk factors for DVT

immobility

trauma

lifestyle

hypercoagulation

DVT clinical manifestations

Early stages: 50% asymptomatic

Mostly in the LE's (90%)

-Symptoms: dull ache, tight feeling, pain in the calf

-Often misdiagnosed

-Signs: often absent, may be variable and unreliable

--Leg/calf swelling

--Pain/tenderness

--Dilatation of superficial veins

--Pitting edema

--May feel warmer

PE Clinical manifestations

Can occur without warning, can cause sudden death

Signs and symptoms dependent on size and location of the PE:

-Pleuritic chest pain

-Diffuse chest discomfort

-Tachypnea and tachycardia

-Hemoptysis

-Anxiety

-Restlessness and apprehension

-Dyspnea

-Persistent cough

varicose veins

Abnormal dilation of veins (usually saphenous)

-Tortuosity (twisting and turning) of blood vessels

-Incompetence of the valves

-Propensity for thrombosis

Women>men

Symptoms:

-Dull, aching heaviness, tension or feeling of fatigue afterperiods of standing

-Leg cramps (night)

-Elevation of legs brings relief

normal vs varicose veins

normal: functional valves aid in flow of venous blood back to the heart

varicose veins: failure of valves and pooling of blood in superficial veins

chronic venous insufficiency

AKA venous stasis

Inadequate venous return over a long period of time

Contributing factors:

-Poor nutrition, immobility, diabetes, obesity, local trauma

Clinical manifestations:

-Progressive edema of the leg, with thickening and brownish pigmentation of skin around the ankles

-Venous stasis ulceration (above medial malleolus)

--Shallow and painful; moderate to large amount of drainage

vasomotor disorders: Raynaud Disease and Phenomenon

Intermittent episodes of small artery constriction, causes temporary pallor, cyanosis of digits, changes ins kin temperature

In response to cold temperature or strong emotion

Raynaud Disease: idiopathic

Raynaud Phenomenon: secondary to another disease

Raynaud disease prevalence

-80% women aged 20-49

-4x more experience migraine

Raynaud phenomenon prevalence

Women 20x more than men, aged 15-40