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Flashcards in Diff Dx - Cardio Deck (25)
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1
Q

Abdominal Aortic Aneurysm

A

Risk Factors: -smoking -CAD -recent infection -age -heredity Signs and Symptoms -Aneurysm: -back pain, left lower quadrant, flank pain -syncope -LE motor/sensory loss -awareness of pulse in abdomen -ruptured aneurysm: -acute, stabbing pain -cold, pulseless legs -drop in BP with sudden tachycardia -lightheaded, nausea

2
Q

Cardiovascular Disease

A

-Heart dx is the leading cause of death in industrialized countries -1 in 3 americans have some form of CVD (half of deaths are unexpected and sudden Risk Factors: -advancing age -HTN -obesity -sedentary lifestyle -excessive alcohol consumption -oral contraceptives -first generation family history -tobacco use -race

3
Q

Follow Up Questions for Cardio:

A
  1. Angina - discomfort in chest, jaw or shoulder? 2. Endocarditis - bouts of rapid heart action, irregular heartbeats or palpitations after visit to dentist? 3. Rheumatic fever/endocarditis - skin rash on chest within the last 3 weeks? 4. Cardiac Ischemia - waking up FROM pain at night 5. Psychogenic stress induced - waking WITH pain 6. Has a physician ever told you that you have heart trouble?
4
Q

Heart Palpitations are a concern when:

A

-last for hours -more than 6 in a min -post menopausal women -personal family history of heart dx or sudden death -presence of other symptoms (SOB, chest pin, dizzy, lightheadedness)

5
Q

Cardinal s/s for Cardiovascular Dysfunction

A
  1. chest, neck, and/or arm pain or discomfort -radiating pain to neck, jaw, upper trap, upper back, shoulder or arms (left arm) 2. accompanied by constitutional s/s 3. Palpitations 4. Dyspnea - CHF, PND, Orthopnea 5. Syncope 6. Fatigue 7. Diaphoresis 8. Cyanosis 9. Edema (greater than 3lb weight gain) 10. Leg pain/claudication
6
Q

Coronary Artery Disease

A
  1. Atherosclerosis 2. Thrombosis 3. Spasm (intermittent constriction) Modifiable Risk Factors: -physical inactivity -tobacco -elevated serum levels -high BP -diabetes -obesity
7
Q

Women and Heart Disease

A

-women are 10x more likely to die of CVD than cancer (1:2.5 deaths) -S/s: -unexplained, severe episodic fatigue and weaknes associated with decreased ability to carry out normal activities of daily living -fatigue, weakness, trouble sleeping -nausea -classic pain for CAD = crushing, heavy, squeezing sensation -signs may not appear until 75% of narrowing of coronary artery

8
Q

Types of Angina

A

*Primary cause is CAD -Chronic Stable Angina: occurs w/ predictable physical or emotional stress, no p! at rest, p! is consistent over time -Resting Angina: chest p! that occurs at rest in supine position and frequently at same time of day, p! not brought on by exertion nor relieved by rest -Unstable Angina: crescendo, an abrupt change in the intensity and frequency of symptoms with decreased threshold of stimulus such as onset while at rest, duration 20-30 min -unrelieved by rest or nitroglycerin report to MD -Nocturnal Angina: weakness at night, assoc w/ CHF -Atypical Angina: unusual s/s related to physical/emotional stress, subside with NG and rest -MI

9
Q

Signs/Symptoms of Angina

A

-clenched fist against sternum -gripping, viselike feeling of pressure behind breast bone -described as squeezing, burning, pressing, choking, aching - can be confused with heartburn or burning indigestion -radiates commonly to L shoulder and down ulnar distribution -refers to neck, jaw, teeth, upper back, possibly down R arm and occasionally abdomen -dyspnea -belching -women complain of weaknes, breathing in cold air, lethargy and SOB

10
Q

Myocardial Infarction: Cardiac Arrest

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-strikes suddenly without warning -sudden loss in responsiveness -no normal breathing -no signs of circulation -call for help, begin CPR, use AED if available

11
Q

Myocardial Infarction - Typical

A

-may be silent, smokers/diabetics -sudden cardiac death -prolonged and severe substernal chest pain -p! possibly radiating down one or both arms and/or up to the throat, neck, back, jaw, shoulders, arms -nausea, indigestion -angina >30 min, unrelieved by NG, rest, antacids -sudden dimness or loss of vision/speech -pallor, diaphoresis -SOB -weakness, numbness and feeling faint

12
Q

Myocardial Infarction in Women

A

-does not follow classic patterns -chest discomfort -mental status changes or confusion -dyspnea -weakness/lethargy interferes with ADLs -indigestion, heart burn, stomach pain (mis dx for GERD) -anxiety or depression -sleep disturbance -sensation of inhaling cold air -isolated, continuous mid thoracic or interscapular pain -aching, heaviness or weakness in both arms -sx relieved by antacids - sometimes better than NG

13
Q

Pericarditis

A

-previous infection -presence of new onset chest, neck or L shoulder p! -substernal pain that may radiate to neck, upper back, upper trap, left supraclavicular, down L arm, costal margins -dif with swallowing -***pain relieved by sitting upright -***pain relieved/reduced by holding breath -aggravated by deep breathing, trunk movements and laying down -h/o fever, chills, weakness, heart disease -cough -LE edema

14
Q

Endocarditis

A

Risk Factors: valve damage, IV drug users, post cardiac surg, heart disease, aortic stenosis, valve replacement Signs/Symptoms -arthralgias -arthritis -MS problems - LBP/SI -myalgias -constitutional s/s -cold painful extremities

15
Q

CHF - L Sided Heart failure -L Ventricular Failure causes pulmonary congestion/disturbance

A

L Sided heart failure: -fatigue/dyspnea after mild exertion -persistent spasmodic cough (lying down) -paroxysmal nocturnal dyspnea -orthopnea -tachycardia -muscle weakness -edema -decreased renal function or frequent urination

16
Q

CHF - R Sided Heart Failure - occurs in response to L CHF or as result of PE

A

-increased fatigue -dependent edema -pitting edema -right upper quadrant pain -cyanosis of nail beds

17
Q

Diastolic Heart Failure - L ventricle stiffens and hypertrophies = Decreased Filling of heart

A

-fatigue and dyspnea after mild exertion -orthopnea -edema -jugular vein distention

18
Q

Systolic Heart Failure - L ventricle becomes weak or flabby = decreased contractility = decreased pumping to organs and tissues

A

-low ejection fraction <35% with symptoms is suggestive of heart failure

19
Q

Cardiovascular Medications

A

Angina pectoris -organic nitrates -beta blockers -calcium channel blockers Arrhythmias -sodium channel blockers -beta blockers -calcium channel blockers -agents prolonging depolarization CHF -cardiac glycosides (digitalis) -diuretics -ACE inhibitors -vasodilators HTN -diuretics -beta blockers -ACE inhibitors -vasodilators -calcium channel blockers -alpha 1 blockers

20
Q

Cardiovascular Signs and Symptoms that Require Immediate Medical Attention

A
  1. Sudden worsening of intermittent claudication may be due to thromboembolism 2. Symptoms of TIAs in any individual especially those with a history of heart dx, HTN, tobacco use 3. Onset of Anginal attack which requires immediate cessation of exercise - symptoms associated with angina may be reduced immediately and should subside within 3-5 min with cessation of activity 4. Clients taking nitroglycerin should administer meds themselves - relief should be within 1-2 min, if anginal p! is not relieved within 20 minutes or presence of constitutional s/s - immediate med intervention is needed 5. Changes in the pattern of angina 6. Client should not be advised to leave unaccompanied
21
Q

Pt presents with chest, breast, neck, jaw, back or shoulder p! look for the following clues:

A

-personal or family history or heart disease -age (post menopause or over 65) -ethnicity (black women) -other s/s such as pallor, unexplained perspiration, inability to talk, n/v, sense of impending doom -3 p’s (pleuritic, position, palpation) -chest p! brought on by excessive coughing -angina is activated by exertion, emotional stress, large meal, or exposure to cold and has a lag time of 5-10 min -angina does not occur immediately after physical activity (more likely MS, TOS, psychologic) -upper quad p! than can be effected by lower quad activity -insidious onset of jt/ms p! in pt w/ heart murmur may be bacterial endocarditis (w/ morning stiff = rheumatoid arthritis) -symptoms from vascular claudication are relieved by rest -throbbing p! at base of neck/intrascapular area that increases with exertion - check vitals/ palpate for AAA

22
Q

The 3 P’s

A

-Pleurtic Pain = Pulmonary or Cardiac -relief or reduction of p! with valsalva for p! exacerbated by respiratory movements involving the diaphragm -Pain on Palpation = Musculoskeletal -Pain with changes in position = Musculoskeletal or Pulmonary -p! that is worse when lying down and that improves when sitting up or leaning forward is often pleuritic in origin

23
Q

Important Points - Cardiac

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-RED FLAG = fatigue beyond expectation -be on alert for cardiac risk factors -systolic BP may be low with CHF -cervical disk dx/arthritis can mimic atypical chest pain -if pt uses NG be sure to have on site -Elevated BP common side effect with NSAIDs and ACE inhibitors -Beta blockers may not allow HR to increase - monitor with return to resting within 2 min -No smoking or eating immediately before exercise -RED FLAG = 3lb or greater weight gain + SOB/dizzy -Pericardium is adjacent to diaphragm and p! is experienced in the shoulder because they are both supplied by C5-6 spinal segment -watch for muscle pain, cramps, stiffness, spasms, and weakness that cannot be explained by arthritis, exercise, fever, recent fall or other common causes in patients taking STATINS

24
Q

ACSM Risk Factors for Cardio

A
  1. Family hx of CVD - MI, coronary revascularization or sudden death - before age 55 in father or 1st degree relative - before age 65 in mother or 1st degree relative 2. Cigarette Smoking - current or quit within last 6 mo 3. Hypertension - SBP >/= to 140 or DBP 90 or HTN meds 4. Dyslipidemia - LDL > 130 - HDL < 40 - Total cholesterol >200 mg/dL 5. Fasting Glucose - >/= 100 on 2 separate occasions 6. Obesity - BMI > 30 kg/m2 7. Sedentary lifestyle - persons not meeting the PA guidelines of accumulating 30 min of mod activity most days of the week.
25
Q

Recommendations for Medical Clearance and exercise testing

A

low risk = men 45 women >55 2 or more risk factors High Risk = known CVD, pulmonary, or metabolic dx s/s of CVD