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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 SBP)

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 metabolic 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. biventricular 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, anaerobic metabolism, 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
# diagnosis elevation of blood glucose levels and accelerated atherosclerosis
diabetic angiopathy
26
What is a major complication of diabetic angiopathy?
- neuropathy - neurotropic ulcers that can lead to gangrene and amputation
27
What is raynaud's phenomenon?
episodic spasm of small arteries and arterioles exacerbated by coldness and/or emotional stress
28
What are the s/s of Raynaud's phenomenon?
tips of fingers develop pallor, cyanosis, numbness, and tingling
29
Does raynaud's phenomenon affect males or females more?
females
30
What can varicose veins lead to?
varicose ulcers
31
# definition Formation of blood clot in a deep vein that can lead to complications including DVT, PE, or postthrombotic syndrome
venous thromboembolism (VTE) ## Footnote 1/3 of cases experience another VTE within 10 years
32
What is the mortality rate of venous thromboembolisms (VTE)?
10-30% within 1 month of diagnosis
33
What is the chronic form of VTE?
postthrombotic syndrome
34
What are the s/s of DVT?
- TTP - dull ache - tightness - calf pain - swelling - warmth and redness - LE discoloration - prominent superficial veins
35
(true/false) Those with early DVT can be asymptomatic.
true
36
What is the criteria score for DVT?
Wells score
37
When is low molecular weight heparin contraindicated?
Those at high risk of bleeding
38
what medication is used for patients with a high risk of bleeding?
unfractionated heparin (UFH)
39
Heparin-induced thrombocytopenia is associated with an increased risk of what?
venous and arterial thrombosis
40
What are the s/s of PE?
- abrupt onset - chest pain - dyspnea - diaphoresis - cough - apprehension
41
What percent of patient immediately die from a PE?
20% | 40% die within 3 months
42
What diagnosis can PE lead to?
right heart dysfunction and failure
43
# diagnosis a combination of clinical signs and symptoms that persists after an LE DVT - thrombosis resolution is incomplete
chronic postthrombotic syndrome
44
What are the s/s of chronic postthrombotic syndrome?
- pain - edema - limb heaviness - skin pigmentation changes - leg ulcers
45
What causes venous valvular insufficiency?
Fibroelastic degneration of the valve tissue; venous dilation
46
What is PAD?
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
What is the presentation of early PAD?
- intermittent claudication - burnging/aching/tightness/cramping pain - relieved by rest
48
What additional s/s are seen in late PAD?
- pain during rest - muscle atrophy - trophic changes (hair loss, skin changes, nail changes)
49
What s/s are seen with critical stenosis PAD?
- resting and/or nocturnal pain - skin ulcers - gangrene
50
What is the etiology of chronic arterial insufficiency?
1. atherosclerosis thrombosis 2. emboli 3. inflammatory process
51
What is the etiology of chronic venous insufficiency?
1. thrombophleitis 2. trauma 3. vein obstruction/clot 4. vein incompetence
52
What are the s/s of acute arterial obstruction?
1. distal pain 2. paresthesia 3. pale 4. pulselessness 5. sudden onset
53
# definition an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs
thrombophlebitis
54
Where is the pain located when chronic arterial insufficiency is present?
calf, lower leg, or dorsum of foot --> may occur in thigh, hip, and/or buttock
55
Where is pain located when chronic venous insufficiency is present?
muscle compartment tenderness
56
What vascular changes occur with chronic arterial insufficiency?
- decreased or absent pulses - pallor of forefoot during elevation - dependent rubor
57
What vascular changes occur with chronic venous insufficiency?
- venous dilation or varicosity - moderate to severe edema
58
What skin changes are observed with chronic arterial insufficiency?
- pale, shiny, dry skin - loss of hair - nail changes - extremity coolness
59
What skin changes are observed with chronic venous insufficiency?
- hemosiderin staining - lipodermatosclerosis (fibrosing of the subcutaneous tissue) - possible stasis dermatitis or cellulitis
60
Where can ulcers occur with chronic arterial insufficiency? What will the tissues look like?
- toes - feet - areas of trauma - pale, yellow, or black eschar - possible gangrene - regular borders/shape - "punched out" ulcer
61
What causes a "punched" out ulcer?
chronic arterial insufficiency
62
Where do ulcers occur with chronic venous insufficiency? What do the ulcers look like?
- sides of ankles along the course of the veins - painful and shallow ulcer - irregular borders - exudate - granulation tissue at base of ulcer
63
What are signs and symptoms of pulmonary congestion in left ventricular failure?
- dyspnea - cough - orthopnea - paroxysmal nocturnal dyspnea - pulmonary rales and/or wheezing
64
What are the signs and symptoms of low cardiac output with left ventricular failure?
- hypotension - tachycardia - lightheadedness - cerebral hypoxia - fatigue and weakness - enlarged heart on CXR - S3 sound (S4 is possible) - murmurs of mitral or tricuspid regurgitation
65
What are the signs and symptoms of pulmonary congestion with right ventricular failure?
- dependent edema - weight gain - ascites - hepatomegaly
66
What are the signs and symptoms of low cardiac output with right ventricular failure?
- anorexia - nausea - bloating - cyanosis (nail beds) - RUQ pain - jugular vein distention - R-sided S3 sound - murmurs of pulmonary or tricuspid insufficiency
67
What kind of P wave does A-flutter have?
Saw tooth ## Footnote If a pt is asymptomatic, decrease intensity If a pt is symptomatic, stop exercise
68
What kind of P wave does A-fib have?
unrecognizable (looks like a squiggle) | stop exercise and refer to physician
69
What kind of P wave does A-tach have?
Shape of P-wave is not changed, however, it will have short duration due to tachycardia
70
Rank the following based on range of HR from high to low: A-flutter A-tach A-fib
1. A-Fib (350-400 bpm) 2. A-flutter (200-400 bpm) 3. A-tach (150-250 bpm)
71
What does the QRS complex look like when V-tach is present?
mountains | medical emergency
72
What does the QRS complex look like with V-fib?
scribble | unrecognizable rhythm components; medical emergency
73
What does the QRS complex look like with PVC?
Inverted or reverse "s" shape

NPTE (22 decks)

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