WEEK 3: Cardiac symptoms & signs Flashcards
(44 cards)
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.
State the heart causes of palpitations
Heart Causes:
1- Changes in heart Tachycardia, Bradycardia)
2- Changes in rhythm. (arrhythmias)
3- Changes in force. (Heart failure, Cardiomyopathy: A disease of the muscle tissue of the heart. There are four major morphological types: dilated, hypertrophic, restrictive, and arrhythmogenic right ventricular cardiomyopathy.)
What is syncope?
State the common causes of syncope not requiring electrical or chemical cardioversion.
Definition
Sudden and transient loss of consciousness
associated with loss of postural tone with spontaneous recovery.
Not requiring electrical or chemical cardioversion
due to:
-Fall in cerebral perfusion pressure.
-Reduction of energy substrate- hypoglycemia or hypoxia
What is a cough?
Outline the causes of a cough.
Defined as explosive expiration for clearing the tracheobronchial tree of secretions and foreign bodies.
Cardiovascular causes include those that lead to
-Pulmonary venous hypertension
-Interstitial and alveolar oedema
-Pulmonary infarction
-Compression of the tracheobronchial tree
Describe the causes of Fatigue in cardio.
-Non-specific
-Common in patients with impaired cardiovascular function.
-Consequent to a reduced cardiac output
associated with muscular weakness.
-May be caused by drugs e.g. β-blockers
-May also result for excessive blood pressure reduction in patients with hypertension or heart failure
caused by excessive diuresis or diuretic induced hypokalemia.
State other cardiovascular symptoms.
Cyanosis
Anorexia
Abdominal fullness
Right upper quadrant abdominal discomfort
Weight loss
Cachexia
What is cyanosis?
What is oxygen saturation?
Cyanosis is bluish discoloration of skin, nail beds and mucous membranes as a result from insufficient oxygenation, when arterial reduced hemoglobin exceeds 5 g/dL.
Normally hemoglobin carries most of the oxygen in blood. This oxygen carrying capacity of hemoglobin in the blood (present in the arteries) is called oxygen saturation.
Each hemoglobin molecule can bind to four oxygen molecules. Oxygen saturation measures the proportion of these hemoglobin binding sites that are occupied by oxygen molecules.
For example, if all hemoglobin molecules in the blood are fully saturated with oxygen, the oxygen saturation would be 100%.
If only half of the available hemoglobin binding sites are occupied by oxygen, the oxygen saturation would be 50%.
Compare the type of cyanosis: Peripheral and central cyanosis.
CENTRAL CYANOSIS
-Central cyanosis is caused by diseases of the heart or lungs or by abnormal hemoglobin.
-Aortic blood carries de-oxygenated blood.
-Noticed in tongue, lips, ear lobes, conjunctiva of the eyes.
-Warm extremities
PERIPHERAL CYANOSIS
-May be seen in heart failure, exposure to cold temperatures and diseases of blood circulation.
-Due to de-oxygenated blood flow through the peripheries.
-Noticed in fingers, cheeks, nose, and outer areas of the lips.
-Cold extremities
