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NPTE > Cardiovascular differential diagnosis > Flashcards

Cardiovascular differential diagnosis Flashcards

1
Q

Diagnosis

An imbalance of myocardial oxygen supply and demand resulting in ischemic chest pain

A

acute coronary syndrome (ACS)

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2
Q

When do symptoms present with acute coronary syndrome?

A

when lumen is at least 70% occluded

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3
Q

What is Levine’s sign?

A

patient clenching fist over their sternum

(indicative of angina)

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4
Q

What are the 3 types of angina?

A
  1. unstable angina (crescendo angina)
  2. stable angina
  3. variant angina (Prinzmetal’s angina)
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5
Q

definition

Classic angina occurring during exercise or activity; occurs at a predictable rate-pressure product (RPP) and is relieved with rest and/or nitroglycerin

RPP = (HR x BP)

A

stable angina

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6
Q

diagnosis

coronary insufficiency without any precipitating factors or exertion. Chest pain is difficult to control and increases in severity, frequency, and duration.

A

unstable angina

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7
Q

(true/false) unstable angina is responsive to treatment such as nitroglycerin

A

false

increased risk of MI and/or lethal arrythmia

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8
Q

What is variant angina?

A

Angina caused by vasospasm of the coronary arteries in the absence of an occlusive disease

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9
Q

(true/false) Variant angina is unresponsive to nitroglycerin and/or calcium channel blockers

A

false - it is responsive

calcium channel blockers are used long-term

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10
Q

diagnosis

prolonged ischemia, injury, and death of an area of the myocardium caused by occlusion of one or more coronary arteries

A

myocardial infarction

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11
Q

What are the zones of infarction? Describe them.

A
  1. Zone of infarction: consists of necrotic, noncontractile tissue - ECG showed ST segment deviation
  2. Zone of injury: area immediately adjacent to the central zone; tissue is noncontractile and the cells are undergoing metabolic changes; electrically unstable with elevated ST segments over the injured area
  3. zone of ischemia: outer area with cells undergoing metaolic changes; electrically unstable with T-wave inversion
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12
Q

What are the types of heart failure?

A
  1. Left-sided HF (CHF)
  2. right-sided HF
  3. bicentricular failure
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13
Q

diagnosis

Characterized by pulmonary congestion, edema, and low cardiac input due to backup of blood from the left ventricle to the left atrium and lungs.

  • cardiac arryhtmias and/or heart damage
  • occurs with insult of the left ventricle from myocardial disease and excessive workload of the heart
A

Left-sided heart failure (CHF)

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14
Q

diagnosis

Characterized by increased pressure load on the right ventricle with higher pulmonary vascular pressures
- produces hallmark signs of jugular vein distention and peripheral edema
- mitral valve disease or chronic lung disease (cor pulmonale)

A

right-sided heart failure

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15
Q

diagnosis

  • severe left ventricle pathology producing back up of blood into the lungs
  • increased PA pressure
  • Right ventricular pathology s/s
A

biventricular failure

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16
Q

What are associated symptoms to HF?

A
  • osteoporosis
  • myopathies
  • muscle wasting
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17
Q

What is compensated heart failure?

A

When the heart returns to functional status with reduced cardiac output and exercise tolerance

Control achieved by:
- medical therapy
- physiological compensatory mechanisms: SNS stimulation, LV hypertrophy, anaeroic metaolism, cardiac dilation, and arterial vasoconstriction

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18
Q

What is decompensated heart failure?

A

Structural or functional change in heart leads to the heart’s inability to eject and/or accommodate blood within normal physiological levels

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19
Q

Does decompensated heart failure occur abruptly or gradually?

A

Can occur abruptly or gradually

medical emergency

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20
Q

What are the s/s of right-sided HF?

A
  • dyspnea
  • fatigue
  • rales
  • peripheral edema
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21
Q

What are the color zones associated with clinical manifestations of heart failure and PT recommendations?

A
  1. Green
  2. yellow
  3. red
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22
Q

What are the s/s associated with the green zone of heart failure? What are the PT recommendations?

A
  • no s/s
  • continue activity as tolerated
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23
Q

What are the s/s associated with the yellow zone of heart failure? What are the PT recommendations?

A
  • 2 to 3 pound weight gain within 24 hours
  • increased cough
  • peripheral edema
  • SOB
  • orthopnea
  • symptoms can indicate an adjustment in medications and warrants communication with physician
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24
Q

What are the s/s associated with the red zone of heart failure? What are the PT recommendations?

A
  • SOB at rest
  • unrelieved chest pain
  • wheezing or chest tightness at rest
  • paroxysmal nocturnal dyspnea
  • weight gain/loss of 5+ pounds within 3 days
  • confusion
  • immediate medical attention is needed
  • pt must sit in a chair to sleep
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25
Q

diagnosis

elevation of blood glucose levels and accelerated atherosclerosis

A

diabetic angiopathy

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26
Q

What is a major complication of diabetic angiopathy?

A
  • neuropathy
  • neurotropic ulcers that can lead to gangrene and amputation
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27
Q

What is raynaud’s phenomenon?

A

episodic spasm of small arteries and arterioles exacerbated by coldness and/or emotional stress

28
Q

What are the s/s of Raynaud’s phenomenon?

A

tips of fingers develop pallor, cyanosis, numbness, and tingling

29
Q

Does raynaud’s phenomenon affect males or females more?

A

females

30
Q

What can varicose veins lead to?

A

varicose ulcers

31
Q

definition

Formation of blood clot in a deep vein that can lead to complications including DVT, PE, or postthrombotic syndrome

A

venous thromboembolism (VTE)

1/3 of cases experience another VTE within 10 years

32
Q

What is the mortality rate of venous thromboembolisms (VTE)?

A

10-30% within 1 month of diagnosis

33
Q

What is the chronic form of VTE?

A

postthrombotic syndrome

34
Q

What are the s/s of DVT?

A
  • TTP
  • dull ache
  • tightness
  • calf pain
  • swelling
  • warmth and redness
  • LE discoloration
  • prominent superficial veins
35
Q

(true/false) Those with early DVT can be asymptomatic.

A

true

36
Q

What is the criteria score for DVT?

A

Wells score

37
Q

When is low molecular weight heparin contraindicated?

A

Those at high risk of bleeding

38
Q

what medication is used for patients with a high risk of bleeding?

A

unfractionated heparin (UFH)

39
Q

Heparin-induced thrombocytopenia is associated with an increased risk of what?

A

venous and arterial thrombosis

40
Q

What are the s/s of PE?

A
  • abrupt onset
  • chest pain
  • dyspnea
  • diaphoresis
  • cough
  • apprehension
41
Q

What percent of patient immediately die from a PE?

A

20%

40% die within 3 months

42
Q

What diagnosis can PE lead to?

A

right heart dysfunction and failure

43
Q

diagnosis

a combination of clinical signs and symptoms that persists after an LE DVT - thrombosis resolution is incomplete

A

chronic postthrombotic syndrome

44
Q

What are the s/s of chronic postthrombotic syndrome?

A
  • pain
  • edema
  • limb heaviness
  • skin pigmentation changes
  • leg ulcers
45
Q

What causes venous valvular insufficiency?

A

Fibroelastic degneration of the valve tissue; venous dilation

46
Q

What is PAD?

A

Chronic, occlusive arterial disease of medium and large vessels caused by atherosclerosis- pulses are absent or diminished in the affected extremities

  • associated with HTN and hyperlipidemia
  • may have CAD, cerebrovascular disease, DM, metabolic syndrome, Hx of smoking
47
Q

What is the presentation of early PAD?

A
  • intermittent claudication
  • buringing/aching/tightness/cramping pain
  • relieved by rest
48
Q

What additional s/s are seen in late PAD?

A
  • pain during rest
  • muscle atrophy
  • trophic changes (hair loss, skin changes, nail changes)
49
Q

What s/s are seen with critical stenosis PAD?

A
  • resting and/or nocturnal pain
  • skin ulcers
  • gangrene
50
Q

What Wells score is indicative of likely DVT?

A

2+ points

51
Q

What is the etiology of chronic arterial insufficiency?

A
  1. atherosclerosis thrombosis
  2. emboli
  3. inflammatory process
52
Q

What is the etiology of chronic venous insufficiency?

A
  1. thrombophleitis
  2. trauma
  3. vein obstruction/clot
  4. vein incompetence
53
Q

What are the s/s of acute arterial obstruction?

A
  1. distal pain
  2. paresthesia
  3. pale
  4. pulselessness
  5. sudden onset
54
Q

definition

an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs

A

thrombophlebitis

55
Q

Where is the pain located when chronic arterial insufficiency is present?

A

calf, lower leg, or dorsum of foot

–> may occur in thigh, hip, and/or buttock

56
Q

Where is pain located when chronic venous insufficiency is present?

A

muscle compartment tenderness

57
Q

What vascular changes occur with chronic arterial insufficiency?

A
  • decreased or absent pulses
  • pallor of forefoot during elevation
  • dependent rubor
58
Q

What vascular changes occur with chronic venous insufficiency?

A
  • venous dilation or varicosity
  • moderate to severe edema
59
Q

What skin changes are observed with chronic arterial insufficiency?

A
  • pale, shiny, dry skin
  • loss of hair
  • nail changes
  • extremity coolness
60
Q

What skin changes are observed with chronic venous insufficiency?

A
  • hemosiderin staining
  • lipodermatosclerosis (fibrosing of the subcutaneous tissue)
  • possuble stasis dermatitis or cellulitis
61
Q

Where can ulcers occur with chronic arterial insufficiency? What will the tissues look like?

A
  • toes
  • feet
  • areas of trauma
  • pale, yellow, or black eschar
  • possible gangrene
  • regular borders/shape
  • “punched out” ulcer
62
Q

What causes a “punched” out ulcer?

A

chronic arterial insufficiency

63
Q

Where do ulcers occur with chronic venous insufficiency? What do the ulcers look like?

A
  • sides of ankles along the course of the veins
  • painful and shallow ulcer
  • irregular borders
  • exudate
  • granulation tissue at base of ulcer
64
Q

What are signs and symptoms of pulmonary congestion in left ventricular failure?

A
  • dyspnea
  • cough
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • pulmonary rales and/or wheezing
65
Q

What are the signs and symptoms of low cardiac output with left ventricular failure?

A
  • hypotension
  • tachycardia
  • lightheadedness
  • cerebral hypoxia
  • fatigue and weakness
  • enlarged heart on CXR
  • S3 sound (S4 is possible)
  • murmurs of mitral or tricuspid regurgitation
66
Q

What are the signs and sympotms of pulmonary congestion with right ventricular failure?

A
  • dependent edema
  • weight gain
  • ascites
  • hepatomegaly
67
Q

What are the signs and symptoms of low cardiac output with right ventricular failure?

A
  • anorexia
  • nausea
  • bloating
  • cyanosis (nail beds)
  • RUQ pain
  • jugular vein distention
  • R-sided S3 sound
  • murmurs of pulmonary or tricuspid insufficiency

NPTE (20 decks)

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