Cardiovascular Assessment

Question 1

What are the s/s of HFpEF?

Answer 1

usually associated with an underlying condition:

HTN

CAD

DM

CKD

valve or mycardial disease

Question 2

What are the criteria for HFrEF?

Answer 2

dilated LV with reduced EF

elevated LV filling pressure

s/s are non-specific

Question 3

What are the cardinal manifesations of heart failure?

Answer 3

dyspnea

fatigue

fluid retention/volume overload

Question 4

If a patient has to sleep upright or wakes up choking with air hunger at times, what is the issue?

Answer 4

paroxysmal nocturnal dyspnea which usually precedes orthopnea

Question 5

Orthopnea usually occurs when?

Answer 5

within a few minutes after lying supine

sleeping upright alleviates

(PND takes longer to manifest after lying supine)

Question 6

Why are HF patients fatigued?

Answer 6

unclear etiology

likely related to ventricular remodeling

contributes to further disability

Question 7

what are some other pathological associations of HF?

Answer 7

thirst

nocturia

oliguria

cerebral sx (insomnia, confusion)

ascites

Question 8

what will be seen on physical exam in a pt with HF with increased sympathetic activity?

Answer 8

diaphroesis

pallow

peripheral cyanosis

sinus tachycardia

Question 9

What cardiac manifestations may be seen on PE in a pt wth HF?

Answer 9

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

Question 10

how many major and minor criteria are required to diagnose HF?

Answer 10

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

Question 11

On presentation, Hf may manifest with what two features?

Answer 11

Congestion (orthopnea, PND, JVD)

Impaired Perfusion (sleepiness, cool extremities, low Na)

Question 12

What lab is important in diagnosing HF in the ACUTE clinical setting?

these labs may be inaccurate in which disease settings?

Answer 12

BNP and NT-proBNP

inaccureate in AKI, CKD, liver dz

Question 13

In pt’s with HF, EKGs should be routinely obtained to monitor for which developments?

Answer 13

underlying structural alterations

rhythm abnormalities

conduction abnormalities

QT interval

Question 14

Why is an ECHO helpful in HF?

Answer 14

may help elucidate the cardiac component of the HF symptoms and lead to targeted treatment (diuresis, vasodilation, inotropic drug)

Question 15

what factors are assessed by an echo?

Answer 15

R and LV size/volume

wall motion abnormalities

hypertrophy

diastolic dysfunction

filling pressure, SV

EF

valve pathology

Question 16

What are some pathophysiologic factors of HFpEF?

Answer 16

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

Question 17

Cardiogenic pulmonary edema is associated with what?

Answer 17

cardiac dysfunction

Question 18

Noncardiogenic pulmonary edema results from damage to what?

Answer 18

damage to the pulmonary capillary lining

Question 19

Halos with dark centers on CXR is known as what?

What is it from?

Answer 19

bronchial cuffing

Due to edema around the airways (pulmonary edema)

Question 20

What to know about pleural effusions

Answer 20

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

Question 21

How are orthostatic vital signs obtained?

Answer 21

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

Question 22

What values indicate a positive orthostatic VS?

Answer 22

pulse increases of 10 beats per minute or greater

BP decreases of 20 or greater

Question 23

Why is it important to check for carotid bruits?

Answer 23

using bell, if bruit is present, could indicate thrombus that could break off and cause stroke

Question 24

If you smoked and are over 50, what screening test may be indicated to check for AAA?

Answer 24

US

Question 25

How is pitting edema graded?

Answer 25

1+ 2mm

2+ 4mm

3+ 6mm

4+ 8mm

Question 26

If a pt presents with pitting edema, what is the likely etiology

Answer 26

CHF, often due to MI or other cause

may be associated with crackles, DOE, S3

Question 27

ACute PAD presents with what?

Chronic PAD presents with what?

Answer 27

severe pallor

claudication, pain with walking, better at rest

Question 28

What are the 6 P’s of acute limb ischemia?

Answer 28

Parastesia

Perishing Cold

Pulselessness

Pain

Paralysis

Pallor

Question 29

how is right ABI measured?

Answer 29

highest pressure in right foot/highest pressure in both arms

Question 30

What is the cause of varicosities?

Answer 30

valves don’t close properly causing backflow and dilation of vessels

Question 31

What is stasis dermatitis

Answer 31

red/purple skin due to hemosiderin deposits staining the skin

due to decrease flow on the venous stasis

advanced-thick skin, brawny edema

Question 32

What is cellulitis?

Answer 32

marked erythema and warmth with swelling

due to infection

Question 33

What are some skin lesions associated with enocarditis?

Answer 33

Janeway lesions-soles and palms, nontender

Osler nodes-fingers and toes, tender

splinter hemorrhages

Question 34

Lymphadema is often seen when?

Answer 34

Filariasis (#1 cause world wide)

crushing injuries

post-mastectomy

treat underlying cause and use compression hose

Question 35

Clubbing of fingers is often due to what

Answer 35

chronic pulmonary disease

(lung dz is most common association)