Approach to the Cardiovascular Patient Flashcards
What are signs and symptoms of an MI?
- Prolonged >30 min of chest pain
- Pain radiation to both arms
- Tachycardia
- Diaphoresis
- N/V
- Dyspnea
- Feeling of impending doom
- S4 gallop
How does one diagnose an MI?
Pt. with chest pain and >1mm ST elevation in 2 contiguous leads OR a new left bundle branch is having an acute MI and should receive immediate therapy
Do not wait for troponin results, the ECG is diagnostic here
What labs/imaging are helpful in diagnosing an MI?
Measurement of blood levels of proteins that leak out of irreversibly damaged myocytes (myocardial injury is not always due to infarction, may be due to heart failure, myocarditis, pericarditis)
What are the cardiac enzymes that can be used to diagnose an MI? What is the most sensitive and specific cardiac enzyme for diagnosing an MI?
Cardiac specific troponins: Proteins that regulate calcium-mediated contraction of cardiac and skeletal muscle .
Most sensitive and specific, these are not normally detectable in the circulation) LR+ 47 / LT- 0.3.
o cTnT
o cTnI
Troponins may not be elevated until 4-6 hours after an acute event:
• Once elevated, troponin levels can remain high for days-weeks
• ECG changes occur at the onset of myocardial compromise, while elevations in troponin may take longer
(T or F) Myocardial injury is not always due to infarction.
True. Can be due to heart failure, myocarditis, pericarditis.
What is dyspnea?
Dyspnea: Uncomfortable awareness of breathing that is inappropriate to given level of exertion
Dyspnea on exertion (DOE): In and of itself without chest discomfort is an anginal equivalent in the patient with coronary artery disease
What are the organ systems in the differential diagnosis of dyspnea?
Cardiovascular • Coronary artery disease • Heart failure • Valvular heart disease • Dysrhythmia • Cardiac tamponade • Constrictive pericarditis • Cardiomyopathy
Pulmonary • Obstructive pulmonary disease • Restrictive pulmonary disease • Pulmonary hypertension • Pulmonary embolism • Pneumonia • Pneumothorax
Hematologic
• Anemia
Physical deconditioning
Mental/emotional
• Anxiety
Define orthopnea
Orthopnea: Dyspnea that occurs when the patient is supine and improves when patient sits up.
Increase venous return (preload) on lying down.
Relieved by elevating the head and upper torso (pillows when sleeping).
Define Paroxysmal Nocturnal Dyspnea
Paroxysmal Nocturnal Dyspnea: Episodes of sudden dyspnea that awaken the patient from sleep brought on by lying flat after the patient has been asleep for a few hours. Pt sits up and goes to a window for air (may be accompanied by coughing, wheezing (cardiac asthma). Fluid accumulation in lungs due to reabsorption of dependent edema with fluid in the interstitial and or alveolar spaces of the lungs.
What may be labs or imaging that is indicated for evaluating a patient with dyspnea?
Labs: CBC, comprehensive metabolic panel, B-type natriuretic peptide (BNP)* *Becomes elevated in heart failure
Imaging: Chest X-ray, echocardiogram, stress testing, spirometry, full pulmonary function tests
What are palpatations?
Palpitations: Awareness of the heartbeat. Typically, normal sinus rhythm is not perceived, and palpitations usually reflect changes in cardiac rate, rhythm, or contractility.
What are important history questions in evaluating a patient with palpitations?
- Quality: Skipping, Racing, Fluttering, Pounding, Stopping, Flip-flop
- Regularity: Regular/Irregular
- Timing: Sudden, Rapid, Slow
- Duration
- Frequency
- Triggers: Coffee, Tea, Alcohol
- Associated symptoms: Lightheadedness/syncope, dyspnea, chest pain
What is the differential diagnosis of palpitations?
Palpitations are not always cardiac in origin: • Hyperthyroidism • Anemia • Electrolyte abnormalities • Anxiety • Caffeine • Sympathomimetic drugs: • Albuterol • Amphetamines • Cocaine
What labs and imaging would one consider when evaluating a patient with palpitations?
Labs: CBC, Comprehensive metabolic panel, TSH
Imaging: ECG, Holter monitor (24-48 hours), Ambulatory telemetry monitoring: Up to 30 days, Patch testing: Zio patch (14 days), Implantable event recorders: (Up to three years), Echocardiogram
What is syncope versus lightheadedness?
Lightheadedness: In presyncope, lightheadedness and a sense of impending faint without loss of consciousness.
Syncope: Transient loss of consciousness. Sudden, brief loss of consciousness with loss of postural tone followed by spontaneous revival
