Cardiovascular Assessment

Question 1

What are Non-modifiable Risk Factors?

Answer 1

1. Patient’s Age
2. Gender
3. Ethnic Origin
4. Family History of CVD

Question 2

What are Modifiable Risk Factors?

Answer 2

1. Personal Lifestyle Habits
   > Cigarette Smoking
   > Physical Inactivity
   > Obesity
   > Psychological Variables

Question 3

Cigarette Smoking

Answer 3

1. Major Risk factor for CVD specifically CAD and PVD
2. Compounds of cigarette smoke include:
   > tar
   > nicotine
   > carbon monoxide
3. Record the smoking history in pack-years ( number of packs per day multiplied by the number of years the patient has smoked)

Question 4

5A Approach

Answer 4

1. Ask about tobacco use
2. Advise the patient to quit
3. Assess readiness to quit
4. Assist by providing resources
5. Arrange follow-up

Question 5

Sedentary Lifestyle

Answer 5

1. Major risk for CVD
2. Regular physical activity promotes cardiovascular fitness and produces changes in BP, blood lipids and clotting factors
3. Recommended Exercise Guidelines:
   > 150 mins of moderate exercise or 75 mins of vigorous exercise per week ( or a combination of the two), plus completing muscle-strengthening exercises at least 2 days per week
4. Encourage increased physical exercise to reduce CAD

Question 6

Obesity

Answer 6

1. Defined as a BMI greater than 30 and is associated with:
   > Hypertension
   > Hyperlipidemia
   > Diabetes

Question 7

American Heart Association Guidelines to combat Obesity

Answer 7

1. Ingest more nutrient-rich foods that have vitamins, minerals, fiber, and other nutrients but are low in calories
2. Teach patients to choose food such as:
   > Vegetables
   > Unrefined whole-grain products
   > Fat-free dairy
3. Teach patients to not eat more calories than they can burn every day

Question 8

Medical History

Answer 8

1. Note any major illnesses:
   > Diabetes
   > Renal Disease
   > Anemia
   > High BP
   > Stroke
   > Bleeding Disorders
   > Connective Tissue Disease
   > COPD
   > Heart Disease
   > Thrombophlebitis

Question 9

Drug History

Answer 9

1. Ask about current or recent use of prescription or over the counter medications (herbal/natural products)
2. Ask about allergies
3. Ask about recent cocaine or IV street drugs

Question 10

Social History

Answer 10

1. Includes information such as:
   > Patient’s living situation
   > Domestic partner
   > Other household member
   > Environment
   > Occupation

Question 11

Nutrition History

Answer 11

1. Includes the Patients:
   > Recall of food and fluid intake during a 24-hour period
   > Self-imposed or medically prescribed dietary restrictions or supplementation
   > Amount and type of alcohol consumption

Question 12

Family History

Answer 12

1. Review the family’s history and obtain information about the age, health status and cause of death of immediate family members
2. A positive family history for CAD in a first-degree relative (parent, sibling or child) is a MAJOR risk factor
   > More important than other factors like: hypertension, obesity, diabetes or sudden cardiac death

Question 13

What are major symptoms identified by patients with CVD?

Answer 13

1. Chest Pain or Discomfort
2. Dyspnea
3. Fatigue
4. Palpitations
5. Weight Gain
6. Syncope
7. Extremity Pain

Question 14

Pain or Discomfort

Answer 14

1. Traditional Symptom of Heart Disease
2. Results From:
   > Ischemic Heart Disease
   > Pericarditis
   > Aortic Dissection
3. Non-cardiac Conditions:
   > Pleurisy
   > PE
   > Hiatal Hernia
   > GERD
   > Neuromuscular abnormalities
   > Anxiety
4. SOCRATES assessment

Question 15

Angina

Answer 15

1. Onset:
   > Sudden, usually in response to exertion, emotion or extremes in temperature
2. Quality and Severity:
   > Squeezing, viselike pain
3. Location and Radiation
   > Usually the left side of the chest without radiation
   > Substernal: may spread across the chest and the back and/or down the arms
4. Duration and Relieving Factors:
   > Usually last 15 mins; relieved with rest, nitrate administration or oxygen therapy

Question 16

Myocardial Infarction

Answer 16

1. Onset:
   > Sudden, without precipitating factors, often early in the morning
2. Quality and Severity:
   > Intense stabbing, viselike pain or pressure, severe
3. Location and Radiation:
   > Substernal; may spread throughout the anterior chest and to the arms, jaw, back or neck
4. Duration and Relieving Factors
   > Pain is often continuous and is not relieved with rest or change in position; relived with morphine and cardiac drugs

Question 17

Pericarditis

Answer 17

1. Onset:
   > Sudden
2. Quality and Severity:
   > Sharp, stabbing, moderate to severe
3. Location and Radiation:
   > Substernal: usually spreads to the left side or the back
4. Duration and Relieving Factors:
   > Intermittent; relieved with sitting upright, analgesia, or administration of anti-inflammatory agents

Question 18

Esophageal-Gastric

Answer 18

1. Onset:
   > Variable
2. Quality and Severity:
   > Squeezing, heartburn, variable severity
3. Location and Radiation:
   > Substernal; may spread to the shoulders or the abdomen
4. Duration and Relieving Factors
   > Variable; may be relieved with antacid administration, food intake or taking a sitting position

Question 19

Anxiety

Answer 19

1. Onset:
   > Variable, may be in response to stress or fatigue
2. Quality and Severity:
   > Dull ache to sharp stabbing; may be associated with numbness in fingers
3. Location and Radiation:
   > Not well located and usually does not radiate to other parts of the body as pain
4. Duration and Relieving Factors:
   > Usually lasts a few minutes

Question 20

Dyspnea

Answer 20

1. Dyspnea on Exertion: associated with activity (early sign of heart failure and experience by woman)
2. Orthopnea: dyspnea that appears when laying flat
3. Paroxysmal Nocturnal Dyspnea: develops after lying down for several hours

Question 21

Fatigue

Answer 21

1.