Cardiovascular Disease Flashcards
3 key risk factors for heart disease
HTN
High cholesterol
Smoking
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
d. 35
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
c. SBP that increases progressively with workload
How might your patient describe palpitations?
“bump, jump, pound, flop, flutter, racing sensation of heart”
What would indicate the need for medial referral associated with palpitations?
Lasting for a few hours, w/SOB or syncope, or with severe lightheadedness
Family history of unexplained sudden death
What indicates the need for medical referral associated with dyspnea?
- Pt cannot climb a flight of stairs without feeling moderately to severely winded
- Reports of waking at night or observes SOB when lying down
When does syncope require medical referral?
Syncope without warning of lightheadedness, dizziness, or nausea
When is fatigue a concern for cardiac problems?
When it is provoked with minimal exertion +/- associated with dyspnea, CP, palpitations, headache
A red flag associated with a cough
Hacking cough with significant frothy, blood sputum
When is edema a red flag for heart failure?
> 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)
When does claudication warrant immediate medial referral?
Abrupt onset of ischemic rest pain or sudden worsening of intermittent claudication
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
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)
What are some contributing factors associated with coronary artery disease?
- Response to stress/exercise
- Personality
- Peripheral vascular disease
- Hormonal status
- EtOH consumption
- Obesity
- Certain bacterial exposures
- Hx of cancer treatment
- Diagonal earlobe creases
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
c. C8 distribution of L arm
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
a. Chronic stable angina
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
b. Unstable angina
Unstable angina requires what action from a PT?
Immediate medical referral
What is atypical angina?
abnormal S&S with physical or emotional exertion (toothache or earache) that subsides with rest/nitro
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?
Pain not relieved by rest or with up to 3 nitro tablets in 10-15 minute period with a non-MSK pattern.
S&S associated with angina
- 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
Angina is often mistaken for heartburn. How could you distinguish between the two?
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.
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)
Put them on an arm bike and assess pain before and after exercise. If pain increases with physical exertion - likely MI.
Signs and symptoms more commonly associated in Men with an MI
- 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
Signs and Symptoms of MI more commonly associated with women
- 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
