Cardiac Ax Flashcards

1
Q

Important details to note in a pt interview:

A

■ 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

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2
Q

a type of dyspnea which occurs when provoked by activity; nasobrahan sa exercise; bigla na lang na
stress

A

Dyspnea on excursion-

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3
Q

dyspnea that awakens from sleep and is relieved on upright position; associated c left ventricular failure

A

■ Paroxysmal nocturnal dyspnea-

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4
Q

influence by gravity’s effect of an

increased venous return

A

■ Orthopnea-

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5
Q

When the pt. Experience some degree of
chest pain (tinatawag na ANGINA), pt.
Will demonstrate a sign called ____

A

LEVINE’S

SIGN (Clenching of the fist close to chest

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6
Q

➢ D. CARDIAC SIGNS AND SYMPTOMS
○ Chest pain or discomfort
■ Location: ____
■ Referral:____

A

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
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7
Q
Anginal Scale
● 0 – 
● 1+ 
● 2+ 
● 3+ 
● 4+
A
● 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

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8
Q

CARDIAC SIGNS AND SYMPTOMS

A
○ Chest pain or discomfort
○ Shortness of breath or Dyspnea
○ Edema and weight gain
○ Palpitations
○ Cardiac syncope
○ Fatigue
○ Dizziness and Syncope/ Loss of Consciousness
○ Cough
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9
Q

○ Shortness of breath or Dyspnea

● SOB with mild exertion
● Pulmonary Congestion

A

■ Dyspnea on Exertion (DOE)

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10
Q

○ Shortness of breath or Dyspnea

● At night
● May benefit with inclination in their
pillows or beds

A

■ Paroxysmal Nocturnal Dyspnea (PND)

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11
Q

○ 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

A

■ Orthopnea

● Orthopnea + 1 = 1 pillow to relieve the
symptoms
● Orthopnea + 2 = 2 pillows
● Minsan naka semifowler position yung pt.

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12
Q
■ Dyspnea Scale:
● +1 - 
● +2 - 
● +3 - 
● +4 -
A

■ 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.

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13
Q

an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body

A

○ Edema and weight gain

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14
Q

■ RED FLAG!! in edema-

A

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

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15
Q

○ Edema and weight gain

■ Grading:
● 1+ Trace - 
● 2+ Mild - 
● 3+ Mod - 
● 4+ Severe -
A

○ 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

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16
Q

When is Palpitations normal & not normal

A

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
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17
Q

■ Caused by dec. oxygen delivery to the brain
■ Arrhythmia, OH, Poor ventricular fxn, CAD, Vertebral artery insufficiency
■ Sudden death may occur

A

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

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18
Q
A
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19
Q
A
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20
Q

○ Cough

A

■ 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
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21
Q

■ More debilitating than dyspnea or angina;

A

○ Claudication

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22
Q

● How many min when No oxygen in the brain could cause brain death, minsan less than 60 sec.

A

> 1 min

23
Q

○ Usually caused by peripheral artery dse, wherein there’s a narrowing or blocking of the arteries and causing reduce blood flow to your legs kaya nagkakaroon ng cramping type

A

● Vascular Claudication

24
Q
○ Pseudo = fake
○ Nagkakaroon ng cramping like
pain sa legs but the cause is
different
○ Can be a symptom of lumbar
spinal stenosis = a condition
occurs when the spinal canal
narrows on your lower back;
narrowing can be caused by
bulging disc or bone spurs, the
nerve that controls the movement
and sensation on your legs pass
through the spinal canal = if the
canal becomes too narrow
nagkakaroon ng pressure sa
nerve roots
○ Aggravated by: standing or
walking
○ Relieved by: sitting or lying down
○ Also called neurogenic claudication
A

● Pseudoclaudication

25
Q

refers to the cramping pain in
your tight, calf, or buttocks that happens
when you walk

A

■ Caludification

26
Q

■ Cardiac pt. Mostly experience ___

claudication

A

vascular

27
Q

Red flags in claudication

A

■ RED FLAGS!!
● Abrupt onset of ischemic rest pain
● Sudden worsening of intermittent
claudication

28
Q

E. OCULAR INSPECTION

A
1.  General appearance
■ Attachments, pain distress, preferred
posture, body built
2 Peripheral vs Central Cyanosis
3. Pallor
4 Xanthelasma 
5. Diaphoresis
6. Ecchymosis
7. Signs of Distress
8. Shape of torso
29
Q

■ constant decrease in O2 sat = <85

A

■ Cyanosis = Bluish color = due to dec. O2 sat

30
Q

nail beds or bluish color of the skin

A

■ Peripheral cyanosis =

31
Q

Bluish color, check at the buccal cavity (lips)

A

■ Central =

32
Q

Pallor is best observe sa

A

nails, oral mucosa, at lips

33
Q

(yellowish, slightly raised skin plaques)
■ Can be seen in both the eyelid area or nasal
area

A

Xanthelasma

34
Q

■ Sign of inc. level of cholesterol

A

Xanthelasma

35
Q

■ Excessive sweating = inadequate cardiovascular response

A

Diaphoresis

36
Q

■ Pasa na maliliit

■ Caused by anti-coagulants

A

Ecchymosis

37
Q

■ Pasa na maliliit

■ Caused by anti-coagulants

A

Ecchymosis

38
Q
F. PATIENT INSPECTION AND PALPATION
● Locations:
○ Finger pads = 
○ Ball of the hand = 
○ Carpal bones = 
○ Pulse
■ Palpate for 1-2 mins (if irregular rhythm)
● Get the HR for the full min.
■ Use the finger pads to pulsate
○ Areas for Palpating Pulse
■ Radial Pulse - Most common
● Lateral or radial side of the wrist
■ Carotid Pulse -
● wag diinan; may cause vasovagal
reflex; baka bumaba BP ni pt
kakapindot; lightheadedness
● Between the trachea and the SCM
● Asses only on 1 side
■ Brachial Pulse
● Area to monitor BP
● Middle aspect of the ant. Cubital fossa
■ Femoral Pulse
● Found over the femoral artery in the
inguinal region
■ Popliteal Pulse
● Located behind the knee
● Knee flex slightly
■ Pedal Pulse
● Use to monitor LE circulation
● Dorsal middle aspect of the foot
● Between the 1st and 2nd metatarsal
● Lateral to the tibialis anterior tendon
● Between the Flexor Hallucis longus
● Adult normal Heart rate: 60-80bmp
● Pediatric normal HR: 60-170bmp
● Tachycardia = Normal Population any inc. beyond
100bpm
● Bradycardia = Normal Population <60bmp
● HR is relatively normal depending on the fitness of
the pt.
● Among athletes, Bradycardia is expect
A

○ Finger pads = localized pulsations
○ Ball of the hand = thrills
○ Carpal bones = heaves or lifts

39
Q
F. PATIENT INSPECTION AND PALPATION
● Locations:
○ Finger pads = 
○ Ball of the hand = 
○ Carpal bones = 
○ Pulse
A

○ Finger pads = localized pulsations
○ Ball of the hand = thrills
○ Carpal bones = heaves or lifts

40
Q

○ Pulse
■ Note ____
■ Palpate for ____(if regular rhythm)

A

■ Note rate and rhythm
■ Palpate for 30s (if regular rhythm)
+ Multiply it by 2

41
Q

○ Pulse

■ Palpate for ___(if irregular rhythm)

A

1-2 mins

● Get the HR for the full min.
■ Use the finger pads to pulsate

42
Q

○ Areas for Palpating Pulse

A
■ Radial Pulse -
■ Carotid Pulse -
■ Brachial Pulse
■ Femoral Pulse
■ Popliteal Pulse
■ Pedal Pulse
43
Q

● Adult normal Heart rate:

A

60-80bmp

44
Q

Most common pulse location

● ____side of the wrist

A

■ Radial Pulse

Lateral or radial

45
Q

Pulse:
● wag diinan; may cause vasovagal reflex; baka bumaba BP ni pt kakapindot; lightheadedness
● Between the trachea and the SCM
● Asses only on 1 side

A

■ Carotid Pulse -

46
Q

● Area to monitor BP

● Location of Brachial Pulse

A

Middle aspect of the ant. Cubital fossa

47
Q

■ Femoral Pulse location

A

● Found over the femoral artery in the

inguinal region

48
Q

● Located behind the knee

● Knee flex slightly

A

■ Popliteal Pulse

49
Q

● Pulse Use to monitor LE circulation

A

■ Pedal Pulse

50
Q

Location of pedal pulse

A

● Dorsal middle aspect of the foot
● Between the 1st and 2nd metatarsal
● Lateral to the tibialis anterior tendon
● Between the Flexor Hallucis longus

51
Q

● Pediatric normal HR:

A

60-170bmp

52
Q

● What is Tachycardia =

A

Normal Population any inc. beyond

100bpm

53
Q

●What is Bradycardia

A

= Normal Population <60bmp

54
Q

Among athletes, ___is expect

A

Bradycardia