Week 7: Cardio/Peripheral Vascular Flashcards Preview

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Flashcards in Week 7: Cardio/Peripheral Vascular Deck (42)
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1

What would symptoms or peripheral artery disease include? 6)

  1. Pain or swelling in the legs or arms
  2. Discoloration
  3. Pain/Cramping at rest or exertion
  4. Cold, numbness, pallor
  5. Hair loss
  6. Abdominal, flank or back pain (relates to perfusion of the organs)

2

What is claudication? What are the types of claudication? What do they indicate? 

  • Claudication: pain caused by too little blood flow to muscles during activity
  • Exertional claudication: Pain in the legs during exertion that is relieved within 10 minutes of rest
  • Neurogenic claudication: pain with walking or prolonged standing radiating from the spinal area into the buttocks, thighs, lower legs or feet

3

What symptoms and exam findings would you expect in peripheral arterial disease? (10)

  1. exertional claudication
  2. atypical leg pain
  3. local fatigue
  4. numbness
  5. cool dry hairless skin
  6. trophic nail changes
  7. diminished to absent pulses
  8. pallor with elevation
  9. ulceration
  10. gangrene

4

What symptoms and exam findings would you expect in DVT? (2)

  1.  painful or painless calf swelling with erythema
  2. asymmetric calf diameters

5

What symptoms and exam findings would you expect in thrombophlebitis? (2)

  1. swelling
  2. redness and warmth with a possible subcutaneous cord

6

What symptoms and exam findings would you expect in cellulitis? (4)

  1. erythema
  2. edema and warmth
  3. involves deeper dermis, adipose tissue
  4. may include enlarged, tender lymph nodes and fever

7

What symptoms and exam findings would you expect in lymphangitis? (4)

  1. infection spreads up the lymphatic channels from a distal portal of entry
  2. red streaks on the skin with tenderness
  3. enlarged, tender lymph nodes
  4. fever

8

What symptoms and exam findings would you expect in compartment syndrome? (5)

  1. tight bursting pain in calf muscles, usually in anterior tibial compartment
  2. overlying dusky red skin
  3. tingling, burning sensations in calf
  4. muscles may feel tight or full
  5. numbness, paralysis if unrelieved

9

What symptoms and exam findings would you expect in Buerger disease (thromboangiitis obliterans)? (3)

  1. digit or toe pain progressing to ischemic ulcerations
  2. gangrene at the tips of digits
  3. migratory phlebitis and tender nodules along blood vessels

10

What symptoms and exam findings would you expect in Raynaud disease?

  1. reversible vasoconstriction in the fingers and toes
  2. distinct digital color changes of pallor, cyanosis and hyperemia; if secondary - ischemia, necrosis and loss of digits, capillary loops distorted

11

What is the Allen test? What does a positive test indicate?

  • Compares patency of the ulnar and radial arteries
  • Technique
    1. Make a tight fist with one hand then compress both radial and ulnar arteries firmly between thumbs and fingers
    2. Ask patient to open hand into a relaxed, slightly flexed position - palm should be pale
    3. Release pressure over the ulnar artery
      • Results: palm should flush within 3-5 seconds which indicates a patent ulnar artery
    4. Release radial artery while compressing ulnar artery
      • Results: palm should flush within 3-5 seconds which indicates a patent radial artery

12

What are the American Heart Association Cardiovascular Categories for Women? 

  • High Risk 
    • ≥1 of the high-risk states, including existing CHD, CVD, peripheral arterial disease, abdominal aortic aneurysm, diabetes mellitus, or end-stage or chronic renal disease
    • 10-year predicted risk of >10% 
  • At Risk 
    • ≥1 major risk factors including smoking, blood pressure ≥120/≥80 or treated hypertension, total cholesterol ≥200 mg/dL, HDL-c <50 mg/dL, or treated dyslipidemia, obesity, poor diet, physical inactivity, or family history of premature CVD
    • Evidence of advanced subclinical atherosclerosis (e.g., coronary calcification, carotid plaque, intima-media thickness), metabolic syndrome, or poor exer-cise capacity on a treadmill test
    • Systemic autoimmune collagen vascular disease (e.g., lupus or rheumatoid arthritis)
    • History or preeclampsia, gestational diabetes, or pregnancy-induced hyper-tension

13

What are the values that fall under the stages of hypertension? Normal, elevated, stage 1, stage 2, hypertensive crisis

Normal: Less than 120/80 mm Hg

Elevated: Systolic between 120-129 and diastolic less than 80

Stage 1: Systolic between 130-139 or diastolic between 80-89

Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg

Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage

14

What type of cardiac screening do athletes require?

H&P, no imaging unless risk factors or physical exam abnormalities

15

Sports physicals - questions to ask regarding personal history (6)

  1. Chest pain
  2. Exercise intolerance
  3. Lightheadedness?
  4. Birth history
  5. Previous identified murmur
  6. Congenital heart defects

16

Sports physicals - questions to ask regarding family history (3)

  1. History of sudden cardiac death?
  2. Sudden cardiac death before the age of 50?
  3. Heart disease identified before the age of 50?

17

Sports physicals - special considerations for exam (3)

  1. Auscultate heart at all five points while sitting and lying down
  2. Listen with bell AND diaphragm
  3. Palpate for heaves and lifts

18

What are the events of the cardiac cycle?

Systole: ventricular contraction - L ventricle ejects blood into the aorta

Diastole: ventricular relaxation - ventricular pressure falls and blood flows from atrium to vesicle; later, ventricular pressure rises slightly as it fills with blood from atrial contraction

19

How do you calculate cardiac output?

CO = Heart rate x Stroke Volume

20

Where would the FNP assess for the aortic, pulmonic, mitral, tricuspid, and Erb’s point? 

Aortic: R second intercostal space

Pulmonic: L second and third intercostal spaces

Erb's point: 3rd left intercostal space at the medial left sternal border - can only be heard in the L lateral recumbent position

Tricuspid: near the lower left sternal border

Mitral: cardiac apex; 5th left intercostal space at the midclavicular line

21

What do heaves, lifts and thrills indicate? How would you assess for each? 

  • Heaves/lifts = sustained impulses that rhythmically lift fingers
    • Technique: use palm and/or hold finger pads flat or obliquely against the chest
  • Thrills = buzzing or vibratory sensation
    • Technique: press the ball of your hand firmly on the chest

22

What do the results of the JVP measurement indicate?

JVP will decrease with hypovolemia, increase with hypervolemia - closely parallels aortic pressure

23

What do results of the carotid pulse assessment indicate?

Provides information regarding aortic abnormalities

- will be delayed from S1 on auscultation in aortic stenosis

24

What would S3, S3 opening snap and S4 indicate? 

  1. S3: suggestive of volume overload from L ventricle
  2. S3 opening snap: suggestive of mitral valve stenosis
  3. S4: suggestive of aortic or pulmonic stenosis

25

How would the FNP elicit murmurs?

  • Pt should lean forward and exhale, listen along the L sternal border and at the apex
  • Pt can turn to the left lateral decubitus position, listen at the apical impulse

26

How are murmurs graded? 

Grade 1: heard in expert optimum conditions

Grade 2: Heard by non-expert in optimum conditions

Grade 3: easily heard, no thrill

Grade 4: loud murmur, palpable thrill

Grade 5: very loud murmur, often heard over a wide area, palpable thrill

Grade 6: extremely loud, heard without a stethoscope

27

What would a systolic click indicate? 

Mitral valve prolapse

Extracardiac or mediastinal origin

28

What are the symptoms of an acute MI?

Ischemic chest pain, may be silent and can occur in any position

29

What physical exam findings would be associated with aortic stenosis? (Location, radiation, intensity, pitch, quality, maneuvers, cause)

  • Location: 2nd and 3rd R interspaces
  • Radiation: to carotids, down left sternal border, even to the apex; if severe may radiate to L 2nd and 3rd interspaces
  • Intensity: sometimes soft, often loud with a thrill
  • Pitch: medium, harsh, crescendo-decrescendo may be higher at the apex
  • Quality: often harsh, may be more musical at the apex
  • Maneuvers: heard best with patient sitting and leaning forward
  • Delayed carotid upstroke
  • Cause: most common is bicupsid aortic valve

30

What physical exam findings would be associated with pulmonic stenosis? (Location, radiation, intensity, pitch, quality, cause)

  • prominent ejection click in early systole
  • Location: Left 2nd and 3rd interspaces
  • Radiation: If loud, toward the left shoulder and neck
  • Intensity: Soft to loud; if loud, associated with a thrill
  • Pitch: Medium; crescendo–decrescendo
  • Quality: Often harsh
  • JVP normal 
  • Right ventricular impulse is sustained
  • In severe stenosis, S2 is widely split and P2 softens
  • Causes: Primarily congenital