Cardiovascular Disease

Question 1

3 key risk factors for heart disease

Answer 1

HTN
High cholesterol
Smoking

Question 2

Oral contraceptive use and tobacco use are risk factors for cardiovascular disease, but especially in those who are _____ years and older.
a. 20
b. 25
c. 30
d. 35

Answer 2

d. 35

Question 3

You are working on a cardiac floor with a patient who just suffered an MI. What do you expect to occur when evaluating their vitals during exercise?
a. tachycardia or bradycarida
b. Reports of symptoms like slight SOB, light CP, etc.
c. SBP that increases progressively with workload
d. DBP that increases progressively with workload

Answer 3

c. SBP that increases progressively with workload

Question 4

How might your patient describe palpitations?

Answer 4

“bump, jump, pound, flop, flutter, racing sensation of heart”

Question 5

What would indicate the need for medial referral associated with palpitations?

Answer 5

Lasting for a few hours, w/SOB or syncope, or with severe lightheadedness
Family history of unexplained sudden death

Question 6

What indicates the need for medical referral associated with dyspnea?

Answer 6

• Pt cannot climb a flight of stairs without feeling moderately to severely winded
• Reports of waking at night or observes SOB when lying down

Question 7

When does syncope require medical referral?

Answer 7

Syncope without warning of lightheadedness, dizziness, or nausea

Question 8

When is fatigue a concern for cardiac problems?

Answer 8

When it is provoked with minimal exertion +/- associated with dyspnea, CP, palpitations, headache

Question 9

A red flag associated with a cough

Answer 9

Hacking cough with significant frothy, blood sputum

Question 10

When is edema a red flag for heart failure?

Answer 10

> 3lb weight gain or gradual, continuous gain over several days with swelling in ankles, abdomen, and hands. (Even more so in the presence of SOB, fatigue, dizziness)

Question 11

When does claudication warrant immediate medial referral?

Answer 11

Abrupt onset of ischemic rest pain or sudden worsening of intermittent claudication

Question 12

You are evaluating a 78 YOF patient with general muscle weakness and tenderness. She cannot remember the names of the medicines they take, but they remember they take one for their “sugars, fat, and pressures.” The patient denied any dark urine, numbness/tingling in their hands, and asterixis was negative. You note palmar erythema and a distended firm abdomen. What is likely the cause?
a. Cancer
b. Part of the aging process for a post-menopausal woman
c. Increased pre-load causing swelling
d. Potential medication side effect

Answer 12

d. Potential medication side effect (Statin drugs can cause all her symptoms and unexplained fever/N/V, spider angiomas, and changes to nail beds/skin color)

Question 13

What are some contributing factors associated with coronary artery disease?

Answer 13

• Response to stress/exercise
• Personality
• Peripheral vascular disease
• Hormonal status
• EtOH consumption
• Obesity
• Certain bacterial exposures
• Hx of cancer treatment
• Diagonal earlobe creases

Question 14

Angina typically follows what distribution in men?
a. glove like down L arm
b. C8 distribution of R arm
c. C8 distribution of L arm
d. T1 distribution of L arm

Answer 14

c. C8 distribution of L arm

Question 15

Your patient is experiencing angina after climbing a flight of stairs. They reassure you this is normal for them. They denied any CP before starting therapy for the day. The patient requests to sit down and is asymptomatic 5 minutes later.

What type of angina does this patient have?
a. Chronic stable angina
b. Unstable angina
c. Atypical angina
d. Nocturnal angina

Answer 15

a. Chronic stable angina

Question 16

Your patient experienced an abrupt onset of angina during a treatment session. They sat for 2 minutes and stated it felt like it was getting a little worse and asked you to grab their nitro. They wind up taking 3 doses total with no relief of symptoms.
What kind of angina does your patient have?
a. Chronic stable angina
b. Unstable angina
c. Atypical angina
d. Nocturnal angina

Answer 16

b. Unstable angina

Question 17

Unstable angina requires what action from a PT?

Answer 17

Immediate medical referral

Question 18

What is atypical angina?

Answer 18

abnormal S&S with physical or emotional exertion (toothache or earache) that subsides with rest/nitro

Question 19

Your patient is experiencing angina after climbing a flight of stairs. They reassure you this is normal for them. They denied any CP before starting therapy for the day. The patient requests to sit down and is asymptomatic 5 minutes later.

When would immediate medical services/911 be warranted in this case?

Answer 19

Pain not relieved by rest or with up to 3 nitro tablets in 10-15 minute period with a non-MSK pattern.

Question 20

S&S associated with angina

Answer 20

• Gripping, vise-like feelings of pain or pressure behind sternum
• pain that radiates to neck, jaw, back, shoulder, or arms
• Toothache
• Burning indigestion
• Dyspnea, exercise intolerance
• Nausea
• Belching

Question 21

Angina is often mistaken for heartburn. How could you distinguish between the two?

Answer 21

Heartburn is often relieved with antacids and is associated with a “burning” sensation in the chest, acidic/bitter taste in mouth, abdominal bloating/gas and dysphagia. Heartburn is often preceded by spicy foods.

Question 22

What is a way in which you can rule out MI when treating a patient who has symptoms of referred pain? (Ie. shoulder/arm pain)

Answer 22

Put them on an arm bike and assess pain before and after exercise. If pain increases with physical exertion - likely MI.

Question 23

Signs and symptoms more commonly associated in Men with an MI

Answer 23

• Prolonged or severe substernal chest pain or squeezing pressure
• Pain radiating down one or both arms +/- up to throat, neck, back, jaw, shoulders, or arms.
• Nausea or indigestion
• Angina ≥30 min, not relieved by rest, nitro, or antacids
• Pain or infarct not relieved by rest or positional change.
• Nausea
• Sudden dimness or loss of vision/speech
• Diaphoresis
• SOB
• Weakness, numbness, feeling of faintness

Question 24

Signs and Symptoms of MI more commonly associated with women

Answer 24

• Classic chest discomfort
• Dyspnea
• Weakness + lethargy
• Indigestion, heartburn, stomach pain
• Anxiety/depression
• Sleep disturbance
• Sensation similar to inhaling cold air, unable to talk or breathe
• Isolated, continuous mid thoracic or interscapular back pain.
• Aching, heaviness or weakness in one or both arms.
• Symptoms may be relieved by antacids
• Older females: mental status change or confusion

Question 25

Cardiac arrest signs

Answer 25

• Sudden loss of responsiveness
• No normal breathing
• No signs of circulation
• No movement or coughing

Question 26

Pericarditis

Answer 26

Inflammation of pericardium

Question 27

Pericarditis signs and symptoms

Answer 27

• Substernal pain (“retrosternal”)
• Dysphagia
• Pain relieved by leaning forward/sitting upright or holding breath
• Pain aggravated by: movement associated with deep breathing, trunk movements, lying down.
• Fever/chills, weakness
• Cough, LE edema (esp bilaterally)

Question 28

Signs and symptoms consistent with RIGHT ventricular failure

Answer 28

• Increased fatigue
• Dependent edema (ankles > proximal)
• Pitting edema
• Edema in sacral area or the back of thighs
• Right upper quadrant pain
• Cyanosis of nail beds

Question 29

Signs and symptoms consistent with LEFT Ventricular Failure

Answer 29

• Fatigue + dyspnea after mild physical exertion or exercise
• Persistent spasmodic cough, esp when lying down or when fluid moves from extremities to the lungs.
• Paroxysmal nocturnal dyspnea
• Orthopnea
• Tachycardia
• Fatigue and muscle weakness
• Edema and weight gain
• Irritability/restlessness
• Decreased renal function or frequent urination at night

Question 30

Signs and symptoms consistent with diastolic heart failure

Answer 30

• Fatigue/dyspnea after mild physical exertion
• Orthopnea
• Edema and weight gain
• Jugular vein distention

Question 31

What are the potential types of aneurysms?

Answer 31

Thoracic, abdominal aortic, peripheral

Question 32

Thoracic aneurysm usually involved the ____________

Answer 32

ascending transverse or descending portion of the aorta from the heart to diaphragm.

Question 33

Abdominal aortic aneurysms (AAA) involve the __________

Answer 33

aorta below the diaphragm

Question 34

A dissecting AAA has signs and symptoms of

Answer 34

-Chest pain with a palpable, pulsating mass (abdomen/popliteal space) OR aorta is >3cm when palpated just above umbilicus OR abdominal “heartbeat” felt by client when lying down OR dull ache in the mid abdominal left flank or low back OR hip, groin, scrotal, buttock, +/- leg pain.
- Weakness or transient paralysis of legs
- sudden, severe CP with tearing sensation
- Pain may extend to neck, shoulders, between scapulae, low back or abdomen.
- Pain is not relieved by a change in position,
- Pulsating abdominal mass
- Cold, pulseless LEs
- BP changes (more than 10 mmHg difference in DBP between arms or SBP <100mmHg)
- Pulse rate >100 bpm
- Ecchymosis in flank/perianal area
- Light-headedness/nausea

Question 35

Peripheral arterial aneurysms affect what arteries?

Answer 35

femoral and politeal

Question 36

Risk factors for aneurysm

Answer 36

• Hx of smoking
• Known congenital heart disease
• Sx to repair/replace aortic valve before age 70 years
• Recent infection
• Atherosclerosis
• Predisposing genetic conditions
• Active Older Adults