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Med Screening > Screening for Cardiac Disease > Flashcards

Screening for Cardiac Disease Flashcards

1
Q

screen vs examination

A

SCREEN - for referral to medical practitioner for more info

EXAMINATION - for care related to previously diagnosed cardiac dysfunction

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2
Q

how many deaths per year d/t CVD

A

1million deaths/yr

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3
Q

how common is CVD

A

1 in 3 Americans

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4
Q

what are common sx reported to PT (9)

A
  1. fatigue/poor exercise tolerance
  2. peripheral edema
  3. chest, shoulder, back neck, jaw, arm pain
  4. n/v
  5. DOE
  6. loss of body hair
  7. cyanosis (lips, nails, nose, earlobes)
  8. HA (suboccipital and temporal)
  9. dizziness/syncope
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5
Q

why are HA a common sx of cardiac dz

A

due to HTN

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6
Q

why is dizziness/syncope a common sx of cardiac dz

A

due to arrhythmias

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7
Q

what are the biggest signs of cardiac dz in most general of terms

A

anything worse w exercise, better w rest, and belly up

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8
Q

what are modifiable risk factors for CAD

A

HTN
HLD
smoking
obesity
stress
diabetes
inactivity

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9
Q

what modifiable risk factors for CAD are part of metabolic syndrome

A

HTN
HLD
obesity
DM

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10
Q

what are non-modifiable risk factors for CAD

A

age
gender
genetics / socioeconomic factors

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11
Q

what risk factors seen in a woman might inc their risk of CAD at a minimum age of 35yo

A

taking birth control pills
smoking

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12
Q

at ethnicities inc the risk of CAD

A

african american
mexican american
native american
pacific islander

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13
Q

what are constitutional sx of CAD (8)

A

n/v
diarrhea
malaise/fatigue
fever
night sweats
pallor
diaphoresis
dizziness

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14
Q

who should be screened for cardiac dz?

A

anyone w one or more risk factors

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15
Q

initial steps for screening a person for cardiac dz

A

PMH
med review
VS
- HR
- bp
- RR
- temp

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16
Q

activity recommendations for HR <60bpm

A

okay to exercise if not symptomatic and normal ECG
- refer to MD if sx

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17
Q

activity recommendations if HR 100-150

A

100-120 - yellow flag

120-150
- precaution to initiating exercise
- refer to MD

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18
Q

activity recommendations if HR >150bpm

A

contraindication to any exercise/activity

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19
Q

activity recommendations for DBP <70

A

no action if not symptomatic

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20
Q

at what DBP inc you risk of CAD

A

> 90

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21
Q

activity recommendations for DBP >115

A

contraindication to activity/exercise
- refer to MD

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22
Q

activity recommendations for SBP <90

A

no action if not sx
- refer to MD if sx

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23
Q

activity recommendations if SBP 150-160

A

yellow flag

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24
Q

activity recommendations if SBP >160

A

check w MD

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25
Q

activity recommendations if SBP >200

A

contraindication to initiating exercise
- refer to MD

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26
Q

activity recommendations if temp >100

A

consider deferring exercise

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27
Q

activity recommendations if temp >101

A

no exercise
- functional activity is one thing
- not aerobic exercise tho

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28
Q

activity recommendations if temp 100-101

A

yellow flag

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29
Q

what are the most common CV dx that mimic sx of NMS

A

MI
angina
pericarditis
AAA

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30
Q

what is the pathophysiology CAD

A

problem w blood supply to heart

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31
Q

when do you start seeing sx for CAD

A

75% occlusion of coronary artery

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32
Q

how long can angina last

A

1-3min

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33
Q

how is angina relieved

A

rest and nitroglycerine

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34
Q

what is a consideration when a pt is taking nitroglycerine

A

potent vasodilator
- should be sitting or laying down when taking it

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35
Q

what is the etiology behind atypical or transmittal angina

A

coronary spasm
- this is usually pretty rare

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36
Q

what are s/sx for angina (6)

A
  1. gripping, vise pain or pressure substernal (80-90%)
  2. neck, back, jaw, shoulder, or arm pain
  3. indigestion
  4. dyspnea
  5. nausea
  6. belching
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37
Q

what are the most concerning forms of CAD

A

nonocclusive and asymptomatic
- scary bc lethal
- not presenting any sx

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38
Q

what is one characteristic of MIs

A

more likely in the AM
- related to circadian rhythms

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39
Q

s/sx of an MI

A

angina w nitro not helping

angina sx and
- diaphoretic
- asystole

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40
Q

how do females typically present w an MI

A

more subtle sx

less chest sx than men
heaviness and weakness in arms
sx can start 1mo before event
“flu sx” - fatigue, nausea, lower belly pain

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41
Q

why is sex an important factor to consider when screening for cardiac dz

A

females more atypical angina sx
female MI s/sx more subtle

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42
Q

what are causes of pericarditis (4)

A

secondary to infection related to usually viral (bacterial is less common)
- HIV
- TB
- influenza

can be related to recent MI, chest crushing injury (MVA), open cardiac surgery

43
Q

s/sx of pericarditis (7)

A

anginal pattern
difficulty swallowing
cough
LE edema (feet and ankles)
hx of fevers, chills, recent MI

pain > DB, cough, laugh, lying down, trunk movements (rotation, flexion)

pain < leaning forward, sitting up straight (trunk ext), holding breath

44
Q

what are the 3 types of CHF

A

left
right
diastolic

45
Q

what inc the risk of CHF

A

age

46
Q

diastolic CHF presentation

A

sx are pretty similar, esp left CHF
- can’t tell difference clinically without a cardiac US

47
Q

why do you see edema in CHF

A

renin-angiotensin system

48
Q

L vs R CHF

A

L - backs up into lungs
R - backs up into periphery

treat them differently

49
Q

s/sx of L CHF (6)

A

pulmonary issues

fatigue/DOE
cough - persistent, spasmodic, worse lying down
orthopnea
tachycardia
ms weakness
edema/wt gain - 3lbs in a day

50
Q

s/sx of R CHF (5)

A

can occur w L CHF

fatigue
dependent edema
pitting edema (5-10# fluid)
R UQ pain
cyanosis of nails

51
Q

s/sx of diastolic CHF (4)

A

stiff heart ms

fatigue and DOE
orthopnea
edema
jugular v. distention

52
Q

risk factors for AAA (4)

A

smoking
CAD
Marfans syndrome
HTN

53
Q

when is medical screening for AAA recommended

A

US for men 65-75yo
>50yo and sx

54
Q

abdominal palpation screen for AAA

A

b/w xiphoid process and umbilicus to left
- AAA = bounding HR
- normal = faint

55
Q

if found an AAA during abdominal palpation screen, what is the next step

A

refer them back
- usually MDs won’t do anything surgical, just keep an eye on it

56
Q

flag for AAA rupture

A

red flag - medical emergency

57
Q

s/sx of AAA (2)

A

pain in low back, hip, groin, gluts
abdominal heartbeat

58
Q

s/sx of AAA rupture (4)

A

severe pain
no change in pain w positioning
BP - systolic drop <100 (not previous)
pulse changes (>100bpm)

59
Q

why do we screen for hyperlipidemia

A

usually clustered w other cardiac issues

60
Q

what are s/sx for valve dz (8)

A

fatigue
dyspnea
palpitations
chest pain
pitting edema
orthopnea
dizziness
syncope

61
Q

what is the significance of having a valve dz and HF

A

dec CO

62
Q

what are types of valve dz (4)

A

rhematic fever
endocarditis
lupus carditis
mitral valve prolapse (MVP)

63
Q

what population do you typically see rheumatic fever in

A

children

64
Q

how is rheumatic fever a valve disease

A

stretp infection scars valves

65
Q

endocarditis additional sx besides general valve dz sx

A

MS sx
- joint and back pain

66
Q

what is endocarditis

A

bacterial or viral vegetations on the heart valves
- can cause an issue for valves acutely or later

67
Q

what is lupus carditis

A

related to lupus w general valve sx

68
Q

what valve dz is the most common

A

MVP

69
Q

presentation of MVP

A

2/3 have no sx
1/3 have sx

70
Q

implications for other procedures if have MVP

A

may prescribe antibiotics
- even for routine procedures (ie teeth cleaning)
- surgery

71
Q

what is afib’s defining characteristic

A

irregularly irregular

72
Q

risk factors for afib

A

same as cardiac
h pylori (GI)

73
Q

sx of afib (7)

A

palpitations
pounding
dyspnea
anxiety
dizziness
chest pain
fatigue

74
Q

why do you see fatigue in afib

A

dec CO
- losing 10-20% of atrial kick

75
Q

what does having afib inc your risk of

A

blood clot migration

76
Q

pacemaker cells lifespan

A

10% left at 80yo

77
Q

s/sx of sinus tachycardia (4)

A

HR >100
palpitations
anxiety
chest pain

78
Q

s/sx of sinus bradycardia (3)

A

HR <60
syncope
LOC

79
Q

3 cardiac nervous system issues

A

afib
sinus tachy
sinus brady

80
Q

what is a TIA

A

mini stroke
lasts 5-20min
stroke sx resolve quickly

81
Q

what 3 CV disorders can a BP screen r/o

A

HTN - take initial BP
OH - BP drops, pulse inc
TIA

82
Q

s/sx of arterial occlusive dz (6)

A

intermittent claudication
burning pain
skin color/temp changes in distal extremities
loss of hair on limbs
ulcerations
sx dec w dependent position

83
Q

sx of a DVT (4)

A

leg pain (unilateral)
swelling
warmth
pain

thinking Wells criteria

84
Q

sx of lymphedema (4)

A

edema on dorsum of extremities
sx inc w dependent position
heavy or full feeling
loss of motion (function)

85
Q

sx of Raynoud’s (4)

A

at digits

pallor
cyanosis
cold
intense redness

86
Q

statin SE

A

seen in 5-18%
myalgia
rhabdomyolysis - dark urine, weakness

87
Q

what are emerging SE of statins

A

ms and tendon degradation

88
Q

how to r/o exercise induced fatigue from med related sx of statins

A

exercise induced - 24-48hrs to resolve
- related to ms worked

statin induced >48hrs to resolve
- not related to ms worked

89
Q

pathophys of SE from diuretics

A

electrolyte imbalances -> fluid shifts -> HoTN

90
Q

SE of diuretics (5)

A

ms weakness
HA
ms cramps/spasms
dizziness
nausea

91
Q

why would a pt be taking a daily low does of ASA

A

preventing thromboembolism

seen in at risk pts

92
Q

SE of ASA

A

bleeding and bruising risk
- careful w hands on techniques

93
Q

what is a consideration for long term usage of statins

A

want to monitor over time
- monitor liver enzymes
- monitor creatinine kinase levels

94
Q

what lab values will cause cardiac dysfunction

A

potassium
sodium
calcium
magnesium (less common)

95
Q

what cardiac dysfunction do you see caused by K, Na, C, Mg imbalances

A

arrhythmias
- K (inc can be lethal) & Na primarily
- Ca & Mg long term

96
Q

what electrolyte imbalances are significant for PT implications

A

K red flag if <3 ore >6
Na red flag if <125 or >150

97
Q

what causes K imbalances

A

loss w:
- diuretics
- vomiting
- sweating
- diarrhea

inc w:
- renal and endocrine problems
- medication errors

98
Q

what causes Na imbalances

A

loss w:
- water overload
- diuretics
- vomiting
- diarrhea

inc w:
- dehydration
- food intake

99
Q

what causes Ca imbalances

A

loss w:
- transfusions
- renal failure
- laxative or antacid abuse
- parathyroid dz

inc less common

100
Q

what causes Mg imbalances

A

less common overall

loss w:
- alcoholism
- K and Ca loss

101
Q

what are 7 red flags for immediate medical attention

A

sudden intermittent claudication
- thromboembolism

DVT sx
TIA
angina if no sx dec after 3min rest
3 nitro and no relief/worsening
angina changes - worsening sx
MI

102
Q

what patient should be referred to be soon but not necessarily urgently

A

doesn’t fit a pattern

103
Q

what are 5 cardiac screening questions to ask if hx of

A

high bp
heart problems
heart palpations
heart murmur
angina/chest pain

Med Screening (17 decks)

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