Cardiovascular Disease Flashcards
Cardinal Symptoms of Cardiovascular Disease
Chest, neck, and/or arm pain or discomfort Palpitation Dyspnea Syncope (fainting) Fatigue Cough Cyanosis Vascular component Edema Leg pain (claudication)
What can mimic atypical chest pain?
Cervical disk disease and arthritic changes
What spinal segment is the heart and diaphragm supplied by?
C5-C6
Dyspnea
Breathlessness or shortness of breath
What are forms of extreme dyspnea?
paroxysmal nocturnal dyspnea (PND)
orthopnea
PND
sudden unexplained episodes of shortness of breath
Will awaken a person sleeping in supine, due to amount of blood returning to heart and lungs from the Les
Frequently seen with congestive heart failure (CHF)
Orthopnea
Breathlessness that is relieved by sitting upright, using pillows to prop the head and trunk
Can occur anytime – day or night
What is dyspnea relieved by?
specific breathing pattern (pursed lip) or specific body position (leaning forward on arms to lock shoulder girdle)
Cardiac syncope
Fainting or lightheadedness
Caused by reduced oxygen to the brain
What are cardiac conditions that result in syncope?
arrhythmias, orthostatic hypotension, poor ventricular function, CAD, and vertebral artery insufficiency
Syncope without any warning period of lightheadedness, dizziness, or nausea may be sign of :
heart valve or arrhythmia and sudden death can occur
What is fatigue of a cardiac nature associated with?
dyspnea, chest pain, palpitations, or headache
What is edema a hallmark sign of?
Hallmark of right ventricular failure
Usually bilateral and dependent
What is edema accompanied by?
Accompanied by jugular venous distention (JVD), cyanosis, and abdominal distension from ascites
Claudication
Leg pain that occurs with peripheral vascular disease (PVD) (arterial or venous), often simultaneously with CAD
What is usually associated with vascular disease?
Presence of pitting edema along with leg pain
Noncardiac causes of leg pain
sciatica, anterior compartment syndrome, gout, peripheral neuropathy
Trophic changes in presence of vascular disease:
thin, dry, hairless skin
What is cool skin indicative of?
vascular obstruction
What can warm skin be a sign of?
infection or inflammation
Abrupt onset of ischemic rest pain or sudden worsening of intermittent claudication may be due
thromboembolism
Integumentary cardiac signs and symptoms
Pressure ulcers
Loss of body hair
Cyanosis (lips and nail beds)
General cardiac signs and symptoms
Weakness
Fatigue
Weight change
Poor exercise tolerance
Central Nervous System cardiac signs and symptoms
Headaches
Impaired vision
Dizziness or syncope
Respiratory cardiac signs and symptoms
Labored breathing
Productive cough
GI cardiac signs and symptoms
Nausea and vomiting
Ascites (abdominal distension)
Genitourinary cardiac signs and symptoms
Urinary frequency
Nocturia
Concentrated Urine
Decreased urinary output
Musculoskeletal cardiac signs and symptoms
Chest, shoulder, neck, jaw, or arm pain Myalgias Muscular fatigue Muscle atrophy Edema Claudication
Atherosclerosis (CAD)
Narrowing or blockage of coronary arteries
Causes myocardial infarction
More than 750,000 people annually with significant cardiac symptoms due to CAD.
Modifiable CAD risk factors:
physical inactivity, smoking, HTN, elevated cholesterol
Non-modifiable CAD risk factors
age, male sex, family Hx, race
Contributing CAD risk factors:
obesity, discriminatory medicine, response to stress, personality, diabetes, hormonal status, alcohol consumption
Clinical manifestations of CAD:
Common sequelae include peripheral vascular disease, angina pectoris, MI or heart attack, or sudden death
Heart failure, conduction disturbances, chronic arrhythmias, aneurysm, and intestinal infarction may also occur
Indications for Discontinuing or Modifying Exercise
New-onset anginal chest pain
Easily provoked angina
Increasing episodes, intensity, or duration of angina (unstable angina)
Discomfort in the upper body, including chest, arm, neck, or jaw
Fainting or lightheadedness
Severe dyspnea
Severe fatigue or muscle pain
Nausea or vomiting
Back pain during exercise
Bone or joint pain during or after exercise
Severe leg claudication
Clinical signs for discontinuing or modifying exercise:
Pallor; peripheral cyanosis; cold, moist skin
Staggering gait, ataxia
Confusion or blank stare in response to inquires
Resting heart rate > 130 beats/min, 100 degs F
Fall in systolic BP with increase in workload (specifically 10 mm Hg drop below previous BP)
Rise in systolic BP over 250 mm Hg or diastolic pressure over 120 mm Hg
Chronic stable angina
classic, exertional angina that occurs at predictable levels of physical or emotion stress and responds promptly to rest or nitroglycerin
New onset angina
angina that has developed over the last 60 days
Nocturnal angina
may awaken a person with same sensation as during exertion. Usually associated with exertion cause by increased heart rate associated with dreams or CHF
Postinfarction angina
occurs after MI when residual ischemia triggers an episode
Preinfarction or unstable angina
unpredictable and characterized by an abrupt change in the intensity and frequency of symptoms or decreased threshold of stimulus. Usually lasts longer than 15 mins and is a symptom of worsening cardiac ischemia
What pattern does angina pectoris follow?
L arm and down ulnar border of the arm to the fingers
any dermatome from C3 to T4, presenting at back of the neck, lower jaw, teeth, left upper back, interscapular area, the abdomen, and occasionally down the R arm
What intensity should CHF patients be exercised at?
moderate intensity (40-60% of VO2 max) for 2 to 6 minutes, then rest for 2 minutes
Modifiable hypertension risk factors:
high sodium intake, obesity, hypercholesterolemia and high triglycerides, smoking, chronic alcohol abuse, continuous emotional stress, sedentary lifestyle
Non modifiable hypertension risk factors:
positive family history, age (advanced), sex (male), race (black)
