Cardiovascular Assessment Flashcards
What are the s/s of HFpEF?
usually associated with an underlying condition:
HTN
CAD
DM
CKD
valve or mycardial disease
What are the criteria for HFrEF?
dilated LV with reduced EF
elevated LV filling pressure
s/s are non-specific
What are the cardinal manifesations of heart failure?
dyspnea
fatigue
fluid retention/volume overload
If a patient has to sleep upright or wakes up choking with air hunger at times, what is the issue?
paroxysmal nocturnal dyspnea which usually precedes orthopnea
Orthopnea usually occurs when?
within a few minutes after lying supine
sleeping upright alleviates
(PND takes longer to manifest after lying supine)
Why are HF patients fatigued?
unclear etiology
likely related to ventricular remodeling
contributes to further disability
what are some other pathological associations of HF?
thirst
nocturia
oliguria
cerebral sx (insomnia, confusion)
ascites
what will be seen on physical exam in a pt with HF with increased sympathetic activity?
diaphroesis
pallow
peripheral cyanosis
sinus tachycardia
What cardiac manifestations may be seen on PE in a pt wth HF?
Cardiomegaly
S4-late diastolic sound due to decreased ventricular compliance
S3-diastolic sound due to acute deceleration of ventricular inflow
Systolic murmurs due to mitral/tricuspid regurg
how many major and minor criteria are required to diagnose HF?
presence of two major
-Major: PND, orthopnea, JVD, S3, pulmonary edema
presence of one major and two minor
-Minor: DOE, night cough, tachycardia pleural effusion
On presentation, Hf may manifest with what two features?
Congestion (orthopnea, PND, JVD)
Impaired Perfusion (sleepiness, cool extremities, low Na)
What lab is important in diagnosing HF in the ACUTE clinical setting?
these labs may be inaccurate in which disease settings?
BNP and NT-proBNP
inaccureate in AKI, CKD, liver dz
In pt’s with HF, EKGs should be routinely obtained to monitor for which developments?
underlying structural alterations
rhythm abnormalities
conduction abnormalities
QT interval
Why is an ECHO helpful in HF?
may help elucidate the cardiac component of the HF symptoms and lead to targeted treatment (diuresis, vasodilation, inotropic drug)
what factors are assessed by an echo?
R and LV size/volume
wall motion abnormalities
hypertrophy
diastolic dysfunction
filling pressure, SV
EF
valve pathology
What are some pathophysiologic factors of HFpEF?
impaired LV relaxation
increased LV diastolic stiffness
LV remodeling
Abnormal ventricular-arterial coupling
pulmonary venous HTN
chronotropic incompetence
effects of remodeling
extracardiac causes of volume overload
Cardiogenic pulmonary edema is associated with what?
cardiac dysfunction
Noncardiogenic pulmonary edema results from damage to what?
damage to the pulmonary capillary lining
Halos with dark centers on CXR is known as what?
What is it from?
bronchial cuffing
Due to edema around the airways (pulmonary edema)
What to know about pleural effusions
may be asymptomatic, may have chest pain
commonly dyspnea of large
will see on XR
may have compression atelectasis with contralateral shift of trachea
?pleural friction rub if infarction or pleuritis present
How are orthostatic vital signs obtained?
lay pt down for five minutes and take pulse and BP
assist to seated position and recheck vitals after 1-2 min
if positive seated, don’t worry about checking standing
What values indicate a positive orthostatic VS?
pulse increases of 10 beats per minute or greater
BP decreases of 20 or greater
Why is it important to check for carotid bruits?
using bell, if bruit is present, could indicate thrombus that could break off and cause stroke
If you smoked and are over 50, what screening test may be indicated to check for AAA?
US
How is pitting edema graded?
1+ 2mm
2+ 4mm
3+ 6mm
4+ 8mm
If a pt presents with pitting edema, what is the likely etiology
CHF, often due to MI or other cause
may be associated with crackles, DOE, S3
ACute PAD presents with what?
Chronic PAD presents with what?
severe pallor
claudication, pain with walking, better at rest
What are the 6 P’s of acute limb ischemia?
Parastesia
Perishing Cold
Pulselessness
Pain
Paralysis
Pallor
how is right ABI measured?
highest pressure in right foot/highest pressure in both arms
What is the cause of varicosities?
valves don’t close properly causing backflow and dilation of vessels
What is stasis dermatitis
red/purple skin due to hemosiderin deposits staining the skin
due to decrease flow on the venous stasis
advanced-thick skin, brawny edema
What is cellulitis?
marked erythema and warmth with swelling
due to infection
What are some skin lesions associated with enocarditis?
Janeway lesions-soles and palms, nontender
Osler nodes-fingers and toes, tender
splinter hemorrhages
Lymphadema is often seen when?
Filariasis (#1 cause world wide)
crushing injuries
post-mastectomy
treat underlying cause and use compression hose
Clubbing of fingers is often due to what
chronic pulmonary disease
(lung dz is most common association)
