Flashcards in Cardiac History Deck (33):
What comprises 80% of all cardiology?
history and physical
Is "chest pain" a good descriptive word when taking a cardiac history for coronary artery disease (CAD)?
What are good descriptive terms for CAD?
pressure, tightness, gripping-like sensation, elephant sitting on my chest, man-hole cover on my chest
Where do cardiac symptoms start initially?
sub-xiphoid and CAN radiate to the neck, jaw, either arm, and/or to the back
What is angina pectoris?
decreased blood supply (ischemia) to the heart muscle lasting no longer than 20 mins.
With what is angina pectoris associated?
dyspnea, diaphoresis, lightheadedness, nausea, vomiting and circadian rhythm (6-10am to 4-6pm).
What classically brings on angina pectoris?
exertion, anxiety, cold weather, or sex. REMEMBER that relieves within 20 mins.
What specific group of people usually don't present with chest discomfort from CAD?
Older, middle aged, obese, white women, especially diabetics. Instead they present with dyspnea and develop neuropathy (dullness) to their heart muscle.
Can you have true angina w/o CAD?
YES. Severe hypertension, coronary artery spasm, valvular heart disease, PE, pulmonary hypertension, esophageal spasm
Why can you get chest discomfort and shortness of breath (SOB) when moving around after eating a large meal?
because we shunt blood from our heart to our digestive tract when we eat.
What percentage of angina is due to spasm?
What happens to the fluid when you lie flat?
The fluid returns to the center of your body, because you are removing gravity from the equation, decreasing systemic vascular resistance. This is why older men get up in the middle of the night to pee more.
Why might a person not be able to lie flat?
They state that "it feels like i'm being smothered." This occurs, again because of the build of of fluid coming back at them, due to left ventricular dysfunction.
What is the most common cause of left ventricular dysfunction (LVD)?
What causes legs to swell (edema)?
Right sided heart failure
What is the mismatch of supply and demand with angina?
you do some form of activity that drives up your HR, increasing myocardial O2 demand, but the blood supply is insufficient, resulting in pain, pressure, and tightness.
So you stop, collect yourself, and move on.
What relieves angina?
rest or nitroglycerin
What are the 3 types of angina?
1. pure spasm
2. severe obstructive disease (lumen > 70% narrowed)
3. mixed disease (spasm + narrowed lumen)
What is unstable angina?
pain at rest with minimal activity or in early waking hours (can awaken you).
Can you differentiate spasm from unstable angina?
NO. Admit patient (DO NOT SEND HOME).
What are the big 4 risk factors for CAD?
2. obesity (BMI >30)
3. diabetes (PRE-DIABETES = DIABETES)
4. smoking (ALWAYS ASK WHEN THEY STOPPED).
What are the many other important risk factors for CAD?
diet, hyperlipidemia, family history, sedentary lifestyle, hypertriglyceridemia, increased c-reactive protein, GFR, gout, rheumatic fever (dead in the U.S., but not in SE Asia and south america), hepatitis/AIDS, arthritis, cancer, lung disease (Tb, pleuracy, pneumonia, bronchitis..), prior surgery (valve, bypass, aneurysm...), and meds.
What are the dietary risk factors?
meat, caffeine, eggs/cheese, milk, coffee, tea, coke/pepsi
Why ask about kidney disease?
People with kidney disease have the same risk factors as CAD
Why ask about arthritis?
inflammation causes atherosclerosis, which also causes arthritis along with immune complex disease (Lupus, progressive sclerosis, rheumatoid arthritis..).
What is significant about hypothyroid disease?
The most you will gain is 12 pounds. It will also cause bradycardia.
What does hyperthyroidism do to HR?
causes tachycardia and possible atrial fibrillation
Why ask about the gallbladder and ulcer disease?
it can present with rest discomfort just like angina.
Why ask about hepatitis/AIDS?
can cause cardiomyopathy
Why ask about lung disease?
it can cause pulmonary hypertension
Are the symptoms experienced by patients prior to cardiac surgery, the same as those symptoms that may return after surgery?
YES. They will know it, because they felt it before.
What questions are important to ask about alcohol?
How many shots? How many beers? When did they drink it? When did they stop?