week 4 module 12 cardiac dx Flashcards by Chelsey Miller

angina patho

pain r/t myocardial ischemia

- myocardial O2 demand > supply

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angina subjective info

sub-sternal pain/pressure
radiates: neck, jaw, arms: mostly left 
SOB
fatigue
sweating
faintness
syncope

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angina objective info

tachycardic
inc. RR
HTN
diaphoretic 
Co-morbidities: 
- COPD
- xanthelasma
- HTN
- PAD
- murmur
- arrhythmia

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bacterial endocarditis patho

bacterial infection of the endothelial layer of heart and valves

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bacterial endocarditis subjective

fever
fatigue
sudden onset of congestive heart failure
- SOB, ankle edema

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bacterial endocarditis objective

murmur
signs of neurologic dysfunction
janeway lesion: small erythematous macules on palms and soles
Osler nodes: red, painful, raised lesions on fingers or toes r/t septic emboli

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left sided CHF patho

heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary circulation
- LV hypertrophy
- cardiomyopathy
…

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L. side CHF subjective

fatigue
SOB
orthopnea
exercise intolerance

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L side CHF objective

acute pulmonary edema or gradual onset
crackles
systolic CHF narrow pulse pressure
diastolic CHF wide pulse pressure

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R. side CHF patho

heart fails to propel blood forward with usual force resulting in congestion in the systemic circulation
- Dec. CO -> dec. blood flow to tissues

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R. side CHF subjective

peripheral edema, especially at end of day

weight gain

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R. side CHF objective

pitting edema lower extremities
jugular venous distention
ascities
hepatomegaly

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pericarditis patho

inflammation of pericardium

- often a result of viral infection

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paricarditis subjective

Sharp and stabbing chest pain 
- heart rubbing against pericardium 
Pain worse with coughing, swallowing, deep breathing, lying flat, or movement 
Pain in back, neck, or left shoulder 
Diff. breathing while lying down
Dry cough
Anxiety 
Fatigue

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Pericarditis objective

scratchy, grating, triphasic friction rub

friction rub heard just L. of sternum in 3rd and 4th intercostal space

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Cardiac tamponade patho

excessive accumulation of effused fluids or blood between the pericardium and the heart

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cardiac tamponade subjective

anxiety, restless
chest pain
difficulty breathing
discomfort relieved by sitting upright or forward
syncope, lightheaded
pale, gray, or blue skin
palpitations
rapid breathing
swelling of the abd or arms or neck veins

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cardiac tamponade objective

Beck triad
- jugular venous distention
- hypotension 
- muffled heart sounds 
pericardium may scar and constrict
-> limits cardiac filling, muffled heart sounds, hypoTN, weakened rapid pulse

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Cor Pulmonale patho

enlargement of the R. ventricle secondary to chronic lung disease

Cor Pulmonale subjective

fatigue
inc. RR
exertional dyspnea
cough
hemoptysis
lightheaded
syncope

Cor Pulmonale objective

wheezes and crackles
inc. chest diameter
labored resp. efforts with chest wall retractions 
right heart failure and hypertrophy 
distended neck veins
cyanosis
L. parasternal systolic heave 
loud S2 in pulmonic region 
lower extremity edema

MI patho

ischemic myocardial necrosis caused by abrupt dec. in coronary blood flow to a segment of the myocardium

MI subjective

deep substernal or visceral pain 
- radiates to jaw, neck, left arm 
discomfort may be mild, esp. in older adults or pt with DM 
nausea
fatigue
SOB

MI objective

dysrhythmia comon 
S4 
distant heart sounds
soft, systolic, blowing apical murmur
thready pulse
blood pressure varies 
new ST elevation in 2 leads

VSD patho

opening between the left and right ventricles

VSD subjective

recurrent respiratory infections

VSD objective

arterial pulse is small, JV pulse unaffected holosystolic murmur: loud, coarse, high-pitched left peristernal lift smaller defected causes a louder murmur and thrill

tetralogy of fallot patho

4 cardiac defects - VSD - pulmonic stenosis - dextroposition of aorta (overriding) - r. ventricular hypertrophy

tetralogy of fallot subjective

dyspnea with feeding poor growth exercise intolerance paroxysmal dyspnea with loos of consciousness and central cyanosis

tetralogy of fallot objective

parasternal heave and precordial prominence systolic ejection murmur older children: clubbing

PDA patho

failure of the ductus arteriosus to close after birth - blood flows from aorta through the ductus to the pulmonary artery inc. pressure in the pulmonary circulation -> inc. workload R. heart

PDA subjective

small shunt can be asymptomatic | larger: dyspnea on exertion

PDA objective

dilated and pulsatile neck vessels wide pulse pressure harsh, loud, continuous murmur with machine like quality

ASD patho

congenital defect in the septum dividing the left and right atria - extra blood from L. atria can cause volume overload of the right atrium and ventricle - can lead to shunt reversal (right to left) and heart failure

ASD subjective

often asymptomatic | HR rarely occurs in children but can in adults

ASD objective

systolic ejection murmur - loud, high pitched, harsh. Over pulmonic area systolic thrill may be felt, and peristernal thrust S2 may be widely split

acute rheumatic fever patho

systemic connective tissue disease occurring after strep pharyngitis or skin infection - may result in cardiac valvular involvement -- usually mitral or aortic valve affected valve becomes stenotic and regurgitant

acute rheumatic fever subjective

``` fever swollen joints painless rash with pink margins with pale centers and a ragged edge: erythema marginatum jerky movements small, painless nodules beneath the skin chest pain palitations fatigue SOB ```

acute rheumatic fever objective

``` major and minor manifestations murmurs of mitral regurg. and aortic insuff. cardiomegaly friction rub signs of congestive HF ```

Jones criteria for rheumatic fever Major

``` carditis polyarthritis chorea erythema marginatum subcutaneous nodules ```

Jones criteria for rheumatic fever Minor

``` Clinical - previous rheumatic fever or rheumatic heart dis. - polyarthralgia - fever Labs -acute phase reaction -- ESR, c-reactive protein, leukocytosis - Prolonged PR interval ```

atherosclerotic heart disease Patho

narrowing of the small blood vessels that supply blood and O2 to the heart - deposition of cholesterol, lipids, or inflammatory process - vascular wall thickening and narrowing of lumen

atherosclerotic heart disease subjective

``` may be asymptomatic angina pectoris SOB palpitations Family Hx ```

atherosclerotic heart disease objective

dyslipidemia dysrhythmias signs of congestive heart failure

senile cardiac amyloidosis patho

amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart

senile cardiac amyloidosis subjective

palpitations lower extremity edema fatigue reduced activity tolerance

senile cardiac amyloidosis objective

``` pleural effusion arrhythmia lower extremity edema dilated neck veins hepatomegaly or ascites EKG/echo: small, thickened L. ventricle, R. thickening poss. ```