Aquifer Pearls Flashcards
five main causes of palpitations
Main Causes of Palpitations:
- Cardiac arrhythmias
- Structural heart disease
- Psychiatric disorders
- Systemic causes
- Effects of medical or recreational drugs
time period for Holter Monitor
24-48 hrs
it records everything for that time period
time period for Loop Recorder
weeks to months
Loop recorders increase the diagnostic yield with regard to detecting dysrhythmias in patients with palpitations and may be more cost effective. These recorders can monitor heart activity for weeks to months, while the patient goes about her regular daily activities. A permanent record is kept only when the patient activates the recorder during periods when symptoms are felt.
three lab tests for palpitations, and what they rule out
CBC
TSH
urine drug screen
- (CBC) to answer the question of anemia
- TSH would help rule out hyperthyroidism.
- Depending on the patient, a urine drug screen may be indicated. Have a low threshold for ordering this test.
three pain characteristics that rule out angina
THREE P’s:
Palpation reproduced pain
Pleuritic pain
Positional pain
Positional pain (C) and palpation reproducing pain (A) suggest the underlying process is inflammation of certain structures—such as the pericardium, pleura, or costochondral joints. Pleuritic chest pain (B) comes from irritation of nerve endings in the pleura surrounding the lungs, not from cardiac ischemia.
Cardiology:
women are more likely than men to have ________
single vessel disease
who gets a prescription for daily low-dose aspirin?
pts over 50 with >10% 10-year CVD risk
The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk; are not at increased risk for bleeding; have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years (grade B recommendation).
what three prodromal symptoms of ACS are more common in females than males?
Palpitations, nausea, and vomiting are seen as prodromal symptoms of ACS in females more than males.
A 52-year-old female with a history of diabetes and rheumatoid arthritis presents for her annual examination. She works in an office 10 hours a day and rarely gets exercise. Her BMI is 23 and her blood pressure is 152/85. Her previous visit two months ago showed blood pressure of 148/82. Her father had a history of diabetes and her maternal grandmother died of rheumatic heart disease at the age of 42. She admits to marijuana drug use in the past and is a nonsmoker. Which of the following is a major risk factor for coronary heart disease (CHD) that this patient has?
A. Age B. Family history C. Hypertension D. Obesity E. Rheumatoid arthritis
C. hypertension
Which of the following symptoms are most likely to be due to acute coronary syndrome?
A. 23-year-old male with acute onset of difficulty breathing and hyperresonance upon lung auscultation
B. 35-year-old male with chest pain radiating down his left arm after falling off a ladder at work one week ago
C. 42-year-old female with a pulsating pain in the center of her chest at night
D. 55-year-old female with diffuse central chest pain that is worse when lying down
E. 59-year-old female with palpitations that increase with exercise and are associated with nausea and vomiting
E. 59-year-old female with palpitations that increase with exercise and are associated with nausea and vomiting
A 35-year-old overweight female in good health comes to the clinic for a routine physical. Which of the following screenings are recommended by the U.S. Preventive Services Task Force (USPSTF)?
A. Blood pressure screening B. Cholesterol panel C. Complete blood count D. HbA1C E. Thyroid stimulating hormone levels
A. Blood pressure screening
Which of the following patients is an appropriate candidate for an exercise stress test?
A. A 44-year-old female with a BMI of 40 kg/m2 and history of asthma
B. A 48-year-old female with a history of intermittent anginal episodes that have been controlled on medications
C. A 52-year-old female with new atypical chest pain with a history of elevated cholesterol, smoking and family history of coronary artery disease
D. A 58-year-old male who presents to the emergency room with constant substernal chest pressure, diaphoresis and shortness of breath
C. A 52-year-old female with new atypical chest pain with a history of elevated cholesterol, smoking and family history of coronary artery disease
what are significant changes for orthostatic bp readings?
reduce 20 mmHg systolic reading - or -
10 mmHg diastolic reading
(after 3 minutes)
A reduction of systolic or diastolic blood pressure of at least 20 or 10 mmHg respectively, measured three minutes after a patient who has accommodated to the supine position assumes a standing or sitting position.
Some experts also consider the test to be positive when the pulse rate remains increased by 20 beats per minute or more (16 beats per minute in the elderly).
what is a TUG test?
Timed Up and Go test
Instructions to the patient:
- Sit in the chair with your back to the chair and your arms resting in your lap.
- Without using your arms, stand up from the chair and walk 10 ft. (3m).
- Turn around, walk back to the chair, and sit down again.
Timing begins when the person starts to rise from the chair, and ends when he or she returns to the chair and sits down. The person should be given one practice trial and then three actual trials. The times from the three actual trials are averaged.
<10 seconds = Freely mobile
> 30 seconds = Impaired mobility
what is the structure of a summary statement?
1 - Epidemiology and risk factors, i.e. “70-year-old man with poorly controlled hypertension and hyperlipidemia.”
2 - Key clinical findings about the present illness using qualifying adjectives and transformative language:
