PT 728 Screening for Cardiovascular Disease

______ is the leading cause of death in industrialized nations

- heart disease

what are the risk factors for cardiovascular diseases

- advancing age (>45)

- hypertension

- obesity

- sedentary lifestyle

- excessive alcohol consumption

- oral contraceptive use

- family history

- tobacco use

- abnormal cholesterol

- race

what are the signs and symptoms of cardiovascular disease

- chest pain or discomfort

- palpitation

- dyspnea

- cardiac syncope

- fatigue

- cough

- cyanosis

- edema

- claudication

- vital signs

what is the primary or common symptom for cardiovascular disease

- chest pain/discomfort

what symptoms may people experience with chest pain

- pain radiating to neck, jaw, upper trap, upper back shoulder, or arms

what can cardiac chest pain come from

- angina

- MI

- Pericarditis

- endocarditis

- mitral valve

- prolapse

- dissecting aortic aneurism

what are the spinal segments of heart innervation

- C3-T4

what nerve can often present similar to cardiac radiating pain

- ulnar nerve

_____- is the presence of irregular heartbeat

- palpitations

what can often be described along with a palpation (the way it feels)

- jumps

- pound

- jump

- flop

- flutter

- racing sensation

palpitations are often accompanied

lightheadedness or syncope

what is considered normal palpitations

- less than 6 per minute

when would we need to refer a patient for palpitations

- when lasting for hours

- pain pain

- SOB

- fainting

- lightheadedness

what are the extreme types of dyspnea

- paroxysmal nocturnal dyspnea

- orthopnea

when should a patient with dyspnea be referred to an MD

- cannot climb a single flight of stairs without feeling mod-severe windedness

- awakens at night or experiences SOB when lying down

- patient with known cardiac issues with progressively worsening SOB

________ is fainting or more mild lightheadedness that can be caused by a reduced amount of oxygen to the brain

- cardiac syncope

due to sudden cardiac death a medical referral is recommended for

any unexplained syncope (especially in the present of heart or circulatory problems or any risk factors)

what is the sign for fatigue being a cardiac issue

- when provoked by minimal exertion indicating lack of energy

if fatigue is cardiac in nature what is it often accompanied with

- dyspnea

- chest pain

- palpitations

- headaches

_________ is typically associated with pulmonary conditions but can occur as a pulmonary complications of cardiac pathology

- cough

what can appear as a bluish discoloration of lips and nail beds

cyanosis

_________ is caused by inadequate blood oxygen levels and often appears as signs in the integumentary system

- cyanosis

_____ is swelling in the form of a 3 pound or greater weight gain or gradual continuous gain over several days

edema

what are associated signs/symptoms of edema

- swelling of the ankles, abdomen, hands

- SOB

- fatigue

- dizziness

what are the diseases of the heart muscle

- coronary artery disease

- myocardial infarct

- pericarditis

- congestive heart failure

- aneurysm

what are the cardiac disease of the heart valves

- rheumatic fever

- endocarditis

- mitral valve prolapse

- congenital deformities

what are the cardiac disease of the cardiac nervous system

- arrhythmias

- tachycardia

- bradycardia

_______ occurs when an artery carry oxygenated blood to the myocardium becomes narrowed or blocked leading to ischemia

- coronary artery dieseae

what can coronary artery disease lead to

angina and myocardial infarction

what does CAD include

- atherosclerosis

- thrombus

- spasm

when do symptoms of CAD appear

around 75% blockage

***angina

what are the modifiable risk factors for CAD

- physical inactivity

- tobacco/smoking

- elevated serum

- cholesterol

- high blood pressure

- diabetes

- obesity

what are the nonmodifiable risk factors for CAD

- age

- male

- family history

race

- postmenopausal

what are the contributing factors for CAD

- response to stress

- personality (typeA)

- peripheral vascular disease

- hormonal status

- alcohol consumption

- obesity

_____ is acute pain in the chest due to imbalance between the cardiac workload and oxygen supply to myocardial tissue

-angina

what is angina often accompanied with

- hypertension

- PVD

what is the mechanism of angina

- blood vessels become lines with atheroclerotic plaque, the symptoms are due to inadequate blood supply

what are the types of anginal pain

- chronic stable

- resting/angina decubitus

- unstable

- nocturnal

- atypical

- prinzmetal's

______ is a predictable level of physical or emotional stress, responds promptly to rest or nitroglycerin

chronic stable angina

_____ has chest pain at rest in supine, frequently at the same time everyday

resting/angina decubitus

_____ angina is when a patient is woken from sleep with the same sensations as experienced during exertion

nocturnal

what are the signs and symptoms of angina

- may hold clinched fist to sternum

- most commonly radiates to left shoulder inside of arm to fingers

- generally described as squeezing, burning, pressure

- indigestion, nausea, belching

- lasts 1-3 minutes

when should a patient be referred for angina

- if not relieved by rest or up to 3 nitroglycerin (1 every 5 min x3) or lasting for 3-5 minutes

when is chest pain a red flag

- when screened for chest pain and having no objective findings for MSK pain

_____ is an occlusion or coronary artery that has caused ischemia and necrosis of myocardial tissue

- MI

what are the main arteries that cause a lack of blood supply to the myocardium in an MI

- LAD

- RC

- occasionally circumflex

what are additional causes of MI

- coronary artery spasm

- platelet aggregation

- embolism

- thrombus

- endocarditis

- aortic stenosis

- thrombus on prosthetic valve

what are the classical warning signs of MI

- severe unrelenting chest pain (Crushing)

- pain lasting longer than 30 min and not alleviated by rest or nitro

what are common S/S of MI

- may be silent

- sudden cardiac death

- prolonged or severe substernal chest pain or squeezing pressure

- pain radiating down arm/s, up to throat, neck, back, jaw, shoulders

- feeling nausea or indigestion

- angina lasting more than 30min or unrelieved

- pain not relieved by rest or position change

- nausea

- sudden dimness or loss of vision/speech

- pallor

- diaphoresis

- SOB

- weakness, numbness, and felling faint

what are S/S seen in women for MI

- older women - mental status change or confusion

- dyspnea

- weakness and lethargy

- indigestion, heart burn, stomach pain

- anxiety/depression

- sleep disturbance

- sensation similar to inhaling cold air unable to talk or breathe

- pain in midthoracic or interscapular region

- aching, heaviness, or weakness in one or both arms

_____is inflammation of the pericardium

- pericarditis

______ can occur in any age group, or a history of recent infection in the presence of new onset of chest, neck or left shoulder pain

- pericarditis

what are the signs/symptoms of pericarditis

- chest pain

- SOB

- increase in pulse rate

- increased temperature

- fatigue

how do we differentiate between MI vs pericarditis

- MI unaffected by postional, breathing or movement

- pericarditis can be relieved by kneeling on all fours or leaning

- pericardial chest pain worsens with anything that causes movement in the mediastinum but relived by holding breath

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

- heart failure

______ sided heart failure leads to congestion in the peripheral tissues an visera causing swelling, liver enlargement or ascites

- right

____ heart failure is causes pulmonary congestion or disturbance in respiratory control

left

heart failure typically begins with

left sided failure progressing to right

how is heart failure diagnosed

- with ejection fraction

what are the clinical signs and symptoms of left sided heart failure

- fatigue and dyspnea after mild physical exertion

- persistent spasmodic cough, especially when lying down, while fluid moves from the extremities to the lungs

- paroxysmal nocturnal dyspnea

- orthopnea

- tachycardia

- fatigue and muscle weakness

- edema and weight gain

- irritability/restlessness

- decreased renal function or frequent urination

what are the clinical signs and symptoms of right sided heart failure

- increased fatigue

- dependent edema

- pitting edema

- edema in sacral area or back of thighs

- right upper quadrant pain

- cyanosis of nail beds

____ is an abnormal dilation in the wall of an artery, vein or heart wall becomes weakened

- aneurysm

____ is classified as a tear in the inner lining of the aortic wall

thoracic or peripheral arterial aneurysm

what is the most common type of aneurysm

- abdominal aortic

aneurysm signs and symptoms include

- chest pain

- palpable, pulsating mass

- abdominal heartbeat felt when lying down

- dull ache in midabdominal left flank or low back

- hip, groin, scrotal, buttock or leg pain

- weakness or transient paralysis of legs

what are the signs/symptoms of a ruptured aneurysm

- sudden severe chest pain with a tear sensation

- pain extending to neck, shoulders, between scapula, low back/abdomen, radiating to posterior thighs

- pain not relieved by positional change

- cold, pulseless LE, BP changes

- HR >100

- ecchymoses in flank and perianal area

- lightheadedness and nausea

what are the types of valve deformities

- stenosis

- insufficiency

- prolapse

what are the symptoms of a valvular issue

- fatigue easily

- dyspnea

- palpitations

- chest pain

- pitting edema

- dizziness or syncope

- orthopnea or paroxysmal dyspnea

______ is an infection caused by streptococcal bacteria

- rheumatic fever

____ causes damage to the heart valves and most common symptoms are fever and joint pain

rheumatic fever

what are additional S/S of rheumatic fever

- subcutaneous nodules

- fever

- sore throat

- rash

- carditis

- chorea

- weakness

- weight loss

______ is due to inflammation of the cardiac endothelium

- endocarditis

____ causes damage to the tricuspid, aortic or mitral vales

endocarditis

what is endocarditis caused by

- bacteria entering bloodstream

what are musculoelastic symptoms that can be accompanied by endocarditis

- arthralgia

- arthritis

- LBP

- myalgia

what are the congenital heart defects

- VSD

- ASD

- shunts

____ is a congenital narrowing of the aorta

- coarctation

what is the tetralogy of fallot

1) pulmonary stenosis

2) overriding aorta

3) RVH

4) VSD

Most common cyanotic congenital heart disease in children

what are the S/S of patent ductus arteriosus

- fast breathing

- poor feeding habits

- rapid pulse

- shortness of breath

- sweating while feeding

- tired easily

- poor growth

_____ is the uncoordinated contraction of the heart muscle

- atrial fibrillation

what is the most common arrhythmia

- atrial fibrillation

what is the normal lab value for potassium

- 3.5-5.0mmol/L

what is the normal range for magnesium

- 1.3-2.1 mmol/L

what is the normal range for calcium

- 9-10.5 mg/dL

what is the normal sodium levels

136-145 mmol/L