WEEK 3: Cardiac symptoms & signs Flashcards
Outline the cardiovascular signs and symptoms.
-Dyspnea
-Chest pain
-Fatigue
-Syncope
-Edema
-Cough
Define breathlessness (dyspnea).
Difficult or labored breathing or unpleasant awareness of breathing.
State the 3 types of dyspnea.
*Orthopnea
*Exertional dyspnea
*Paroxysmal nocturnal dyspnea
Outline diseases associated with breathlessness.
Associated with diseases of
Heart: heart failure
Lungs: airway diseases
Chest wall: deformities
Metabolic causes: diabetic acidosis
Describe Exertional dyspnea.
What is the common cause of Exertional dyspnea?
Describe the four grades of exertional dyspnea.
Exertional dyspnea
Comes on during exertion or physical activity and subsides with rest.
Commonly due to HF or lung disease
Grade I: Dyspnea on extra ordinary effort.
Grade II: Dyspnea on ordinary effort.
Grade III: Dyspnea on less than ordinary effort.
Grade IV: Dyspnea even at rest.
It is a common symptom of various cardiovascular and respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD), or heart disease.
Describe Orthopnea.
What is the common cause of Orthopnea?
Orthopnea
Literally, “straight up breathing”)
Breathlessness in supine position, promptly relieved by assuming upright position (sitting or standing)
Individuals with orthopnea often find relief from their symptoms by sitting up or propping themselves up with pillows.
It is commonly associated with conditions such as heart failure, where fluid accumulates in the lungs when lying flat but redistributes when sitting or standing.
Related to increase in venous return.
A symptom of left ventricular failure.
Describe Paroxysmal Nocturnal dyspnea.
What is the common cause of Paroxysmal Nocturnal dyspnea?
Paroxysmal Nocturnal dyspnea
-Occurs during sleep, 2-3 hours after going to bed
patient awakes from sleep -
*Severely breathless
*Persistent cough, may have white frothy sputum
*Sudden onset
*Relieved by assuming an upright position for 5 -15 mins.
-Patients may report going to the window for “better air.”
A manifestation of left ventricular failure.
Outline the causes of Chest Pain or Discomfort.
-Cardiovascular diseases: Coronary artery diseases, aortic dissection, pericarditis
-Respiratory: pneumothorax, pleurisy, pneumonia
tissues of the neck and thoracic wall: skin, thoracic muscles, cervicodorsal spine, costochondral junctions, breasts, sensory nerves and spinal cord
-Gastrointestinal: esophageal spasm, esophageal reflux, Esophageal rupture, peptic ulcer
-Functional or factitious
What are the points to note in the history for Chest pain.
Site
Onset
Character
Radiation
Alleviating factors
Timing: Duration, frequency and pattern of occurrence
Exacerbating factors
Setting in which it occurs
Associated factors
What is peripheral edema?
Where can peripheral oedema be found in ambulant and recumbent patients?
Peripheral edema is a medical condition characterized by the accumulation of excess fluid in the body’s tissues, particularly in the extremities such as the legs, ankles, feet, arms, and hands.
A feature of chronic heart failure
due to excessive salt and water retention
In ambulant patients: “Ambulant patients” refers to individuals who are able to walk and move around independently, as opposed to those who are bedridden or have limited mobility.
-found in the ankles, legs, thighs and lower abdomen
In patients who are recumbent: Bedridden
-over the sacrum
State the causes of peripheral edema.
Cardiac failure
Chronic venous insufficiency
Hypoalbuminemia – nephrotic syndrome, liver disease, protein losing enteropathy.
Drugs:
1. NSAID
-By reducing prostaglandin levels, NSAIDs may alter the balance of vasodilation and vasoconstriction in the body, potentially leading to increased vascular permeability and fluid leakage into tissues.
-Sodium and Water Retention.
- Calcium channel blockers
-Dilation of Arterioles: Calcium channel blockers work by blocking the influx of calcium ions into smooth muscle cells of blood vessels, causing relaxation and dilation of arterial walls. While this dilation can help reduce blood pressure and improve blood flow, it can also lead to increased leakage of fluid from the bloodstream into the surrounding tissues, contributing to edema formation.
-Venous Dilation: Some calcium channel blockers, particularly dihydropyridine derivatives (e.g., amlodipine, nifedipine), primarily affect arterial smooth muscle cells and cause predominantly arterial dilation. However, others, such as verapamil and diltiazem, also have significant effects on venous smooth muscle cells, leading to dilation of veins. Venous dilation can increase the capacitance of veins, reducing venous return to the heart and causing blood to pool in the extremities. This pooling of blood can contribute to increased hydrostatic pressure in the capillaries, promoting fluid leakage and edema formation.
-Increased Capillary Permeability: Calcium channel blockers may also affect capillary permeability, making blood vessel walls “leakier” and allowing fluid to escape into the surrounding tissues more easily. This increased permeability can exacerbate fluid accumulation and edema.
Define pitting oedema.
PITTING EDEMA
Definition
A type of edema characterized by residual indentation following the application of pressure to the site of the swelling.
Discuss the causes of pitting oedema.
CAUSE
1. Fluid retention
Reduced cardiac stroke volume in cardiac failure → impaired renal perfusion → activation of renin-angiotensin system → increased renal fluid retention → increased hydrostatic pressure in the capillaries → secretion of fluid into the interstitium (edema formation)
- Pharmaceutical side effects (e.g., due to calcium channel blockers)
- Protein deficiency (mainly hypoalbuminemia): nephrotic syndrome, liver cirrhosis, malnutrition, protein-losing enteropathy
- Hydrostatic: chronic venous insufficiency, pregnancy, deep vein thrombosis, post thrombotic syndrome
- Increased capillary permeability: inflammation, infections, toxins, burns, allergic reactions, trauma
Describe the grading system of pitting edema.
-Grade +1: up to 2 mm of depression, rebounding immediately
-Grade +2: 3–4 mm of depression, rebounding in ≤ 15 sec
-Grade +3: 5–6 mm of depression, rebounding in ∼ 60 sec
-Grade +4: 8 mm of depression, rebounding in ∼ 2–3 min
Define non-pitting edema.
A type of edema in which there is no residual indentation following the application of pressure to the site of swelling.
Discuss the causes of non-pitting edema.
Lymphedema: due to lymphatic obstruction (see below)
Myxedema:
-A collection of fluid caused by deposition of glycosaminoglycans (mucopolysaccharides) in various tissues.
Most commonly occurs in the lower legs (pretibial myxedema), behind the eyes (exophthalmos), and in the heart (myxedematous heart disease).
Etiologies include hypothyroidism and Graves’ disease.
hypothyroidism (generalized), hyperthyroidism (typically pretibial)
Describe palpitations.
State the common cause of palpitations.
Unpleasant awareness of forceful or rapid beating of the heart.
-Include feeling a rapid heartbeat, a pounding in the chest, a fluttering of the heart, being conscious of the beating of the heart, or feeling missed or skipped beats of the heart
Caused by disorders of cardiac rhythm and rate.
