Cardiac Ax Flashcards
Important details to note in a pt interview:
■ Quality and location of any felt cardiac
symptom
■ Pain is not always what patients feel
■ Occasions of heaviness, shortness of breath,
aching, heartburn, or general malaise
■ Precipitating and relieving factors
■ Duration and frequency of symptoms
a type of dyspnea which occurs when provoked by activity; nasobrahan sa exercise; bigla na lang na
stress
Dyspnea on excursion-
dyspnea that awakens from sleep and is relieved on upright position; associated c left ventricular failure
■ Paroxysmal nocturnal dyspnea-
influence by gravity’s effect of an
increased venous return
■ Orthopnea-
When the pt. Experience some degree of
chest pain (tinatawag na ANGINA), pt.
Will demonstrate a sign called ____
LEVINE’S
SIGN (Clenching of the fist close to chest
➢ D. CARDIAC SIGNS AND SYMPTOMS
○ Chest pain or discomfort
■ Location: ____
■ Referral:____
Loc: Substernal/Retrosternal
Referral: ● (L) arm in an ulnar nerve distribution ● Jaw and/or Neck ● Upper Back ● (B) Shoulders
Nagraradiate yung pain, minsan mararamdaman sa Left arm, yung panga naninigas or nanginginig, yung leeg parang nagkakastiff neck, pakiramdam n’ya mabigat ‘yong balikat parang may nakadagan
Anginal Scale ● 0 – ● 1+ ● 2+ ● 3+ ● 4+
● 0 – No Angina ● 1+ Light, barely noticeable ● 2+ Moderate, bothersome ● 3+ - Severe, very uncomfortable ● 4+ Most severe pain ever experienced
■ Usually the type of angina that the pt. Feel is
transient
● When Cardiac pt. experience angina
(feeling of tightness/heaviness/discomfort
in chest) we could still grade it, some are
reversible (nawawala rin), some are
triggered by activity
● Itanong kung kailan nakakaexperience ng
angina para malaman ang pattern
■ Using the anginal scale, magdedecide ka kung
bababan mo ng intensity or continue lang
■ If it is bothersome o noticable na angina, you
have to see if the exercise na ibibigay mo ay
appropriate
CARDIAC SIGNS AND SYMPTOMS
○ Chest pain or discomfort ○ Shortness of breath or Dyspnea ○ Edema and weight gain ○ Palpitations ○ Cardiac syncope ○ Fatigue ○ Dizziness and Syncope/ Loss of Consciousness ○ Cough
○ Shortness of breath or Dyspnea
● SOB with mild exertion
● Pulmonary Congestion
■ Dyspnea on Exertion (DOE)
○ Shortness of breath or Dyspnea
● At night
● May benefit with inclination in their
pillows or beds
■ Paroxysmal Nocturnal Dyspnea (PND)
○ Shortness of breath or Dyspnea
● Inability to breathe in a supine position
● Supine position increases the amount of blood returning from the LE to the heart and lungs
■ Orthopnea
● Orthopnea + 1 = 1 pillow to relieve the
symptoms
● Orthopnea + 2 = 2 pillows
● Minsan naka semifowler position yung pt.
■ Dyspnea Scale: ● +1 - ● +2 - ● +3 - ● +4 -
■ Dyspnea Scale:
● +1 - Mild, noticeable to the patient but not
to the observer
● +2 - Mild, some difficulty, noticeable to
the observer
● +3 - Moderate difficulty, patient can
continue
● +4 - Severe difficulty, the patient cannot
continue
● Usually ginagamit kapag pinapalakad o
nasa treadmill si pt.
an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body
○ Edema and weight gain
■ RED FLAG!! in edema-
Increased 3 pounds or more
with swelling on ankle, abdomen, and hands
with SOB, fatigue, and dizziness
■ Ask the pt. About sudden weight gain >3
pounds, it could signal symptoms of heart
failure
■ Minsan kapag severe umaakyat sa abdomen =
madaling mahilo and possible SOB
○ Edema and weight gain
■ Grading: ● 1+ Trace - ● 2+ Mild - ● 3+ Mod - ● 4+ Severe -
○ Edema and weight gain
■ Grading: ● 1+ Trace - Barely perceptible ● 2+ Mild - 0.6cm depression rebounds <15sec ● 3+ Mod - 0.6 - 1.3cm rebounds 15-30s ● 4+ Severe - 1.3 - 2.5cm rebounds >30s
● Graded after palpating the pt.
● Put sufficient pressure and grade it base
on the depression and the time it goes up
● Usually edema is not painful
When is Palpitations normal & not normal
Normal lalo na sa mga mahihilig magkape,
pero kapag matagal na yung palpitation at
lasting for hours c unbearable pain, yun yung
mga tinitingnan natin signs sa palpitations
■ RED FLAGS!! ● If lasting for hours, or occurring in association with 1. pain, 2. SOB, 3. fainting, or 4. severe lightheadedness requires medical evaluation ● If with a family history of palpitation with a history of unexplained sudden death (medical referral) ● Heart dse may run in the family
■ Caused by dec. oxygen delivery to the brain
■ Arrhythmia, OH, Poor ventricular fxn, CAD, Vertebral artery insufficiency
■ Sudden death may occur
Cardiac syncope
● IMMEDIATE REFFERAL
● Nabawasan yung oxygen sa brain and if
does not recover it can cause sudden death
● Dec. oxygen delivery = nagkaroon ng problema sa puso, either sa conduction or nagkaroon ng bara sa puso at huminto yung pagtibok ng puso
● Binibiggyan agad ng CPR
○ Cough
■ Aggravated by:
● Exercise,
● Supine position
● PND
● Cardiac cough symptoms may overlap c respiratory symptoms ● Labored breathing = parang nasasamid ● Sa pag-auscultate tinitingnan din kung dahil ba sa pagpump ng heart yung wheezeling sound
■ More debilitating than dyspnea or angina;
○ Claudication