Cardiovascular System Flashcards
Review signs and symptoms of CVS disease
- Chest P/discomfort
- Breathlessness
- Palpitations
- Fatigue
- Dizziness and syncope
- Sleep disturbance- can’t lie flat
- Oedema – lower limb, sacrum- reduced circulatory flow
Angina
Reduced blood flow to heart
Angina types
Stable
Unstable
Variant
Refractory
Stable angina
Most common
Usually occurs during activity
Relieved by rest or medication
Predictable, short term episodes
Occurs due to mismatch between blood supply and metabolic demand, causes regional wall abnormalities
Unstable angina
Unpredictable
Medical emergency, occurs at rest
More severe symptoms
Inc duration (20 mins)
Heart starved of O2= potential heart attack
Variant angina
Not due to CAD
Caused by spasm in coronary arteries that temporarily reduces blood flow
Tends to occur in cycles, typically rest
Relieved by medicine
Refractory angina
Episodes are frequent despite medication + lifestyle changes
Angina causes
- Caused by dec blood flow to heart
- Symptom of CAD
- Can be result of aortic stenosis
Population affected by angina
60+
Angina risk factors
Family Hx of heart disease
Aging
Clinical presentation of angina
- Often described as squeezing, pressure, heaviness, tightness or P in chest
- May feel like heavy weight on chest
- P may be felt in arms, neck, jaw, shoulders and back
- Dizziness, fatigue, nausea, shortness of breath, sweating
Prognosis of angina
- Angina medication- glycerol tri-nitrate
- Lifestyle changes- lose wight, healthy due
- Rest
DDX angina
- Acute myocarditis
- Severe pulmonary hypertension
Myocardial infarction
- Heart attack occurs when flow of blood to heart is reduced or blocked
- Myocardial cells don’t have a blood supply, requires lots of O2 as in constant use
Population affected by myocardial infarction
Male 45+
Risk factors of myocardial infarction
- Age- men aged 45, women aged 55
- Tobacco use
- High blood pressure
- Obesity
- Diabetes
- Family Hx
Clinical presentation of myocardial infarction
- Variable
- Chest P- pressure, tightness, P, squeezing or aching
- Cold sweat
- Fatigue
- Heartburn or indigestion
- Dizziness
- Shortness of breath
- Women can have silent infarctions= no symptoms
Prognosis of myocardial infarction
Inc risk post first acute infarction
DDX myocardial infarction
- Stable angina
- Myocarditis
- Aortic stenosis
- Aortic dissection
Pericarditis types
Acute
Recurrent
Incessant
Chronic constrictive
Acute pericarditis
Begins suddenly, doesn’t last longer than 3 weeks, future episodes can occur
Recurrent pericarditis
Occurs about 4-6 weeks after episode with no symptoms in between
Incessant pericarditis
Lasts about 4-6 weeks but less than 3 months, continuous symptoms
Chronic constrictive pericarditis
Usually develops slowly and lasts longer than three months
Pericarditis causes
- Swelling and irritation of thin, saclike tissue surrounding heart (pericardium)
- Often result of viral infection that causes chest cold or pneumonia
Pericarditis population
Men 20-50
Risk factors of pericarditis
- Previous heart attack
- Autoimmune disease
- Trauma
- Viral infection
Clinical presentation of pericarditis
- Chest P most common
- Usually feels sharp or stabbing
- Some people have dull, achy or pressure-like chest P
- Spreads to left shoulder + neck
- Get worse when coughing, lying down and taking deep breath
- Fatigue and general feeling of weakness
- Leg swelling
- Specific symptoms depend on type
Prognosis of pericarditis
- Px with acute idiopathic or viral pericarditis generally have good long-term prognosis
DDX pericarditis
- Myocardial infarction
- Pulmonary embolism
- Congestive heart failure
- Pneumonia
- Vasculitis
Aortic dissection
- Serious condition in which tear occurs in layer of aorta
- Blood rushes through tear causing inner and middle layers of aortic to dissect
Aortic dissection causes
- Uncontrolled high blood pressure
- Atherosclerosis
- Aortic aneurysm
Population aortic dissection
Men 60-70
Risk factors aortic dissection
- Turner syndrome
- Marfan syndrome
- Other connective tissue disorder
Weaken vessels, predispose to aneurysms (linked to dissection)
Aortic dissection clinical presentation
- Feeling of tearing P followed by sudden low back P
- Loss of consciousness
- Shortness of breath
- Weak pulse in one arm or thigh compared with other
- Leg P
- Difficulty walking
Prognosis of aortic dissection
- If detected early the chance of survival increases significantly
DDX aortic dissection
- Cardiac tamponade
- Cardiogenic shock
- Myocardial infarction
- Pulmonary embolism
Valvular heart disease
- One or more valve doesn’t work properly
- Causes poor blood flow through the heart to the body
Valvular disease cause
- Congenital
- Infection
- Degenerative conditions
- Stenosis- thickened valves or calcified obstructs flow
Valvular disease population
+65
Valvular disease risk factors
- Older age
- Hx of certain infections
- High blood pressure
- Congenital heart disease
Valvular disease presentation
- Might not have symptoms for many years
- Heart murmur
- Chest P
- Fatigue
- Shortness of breath
- Swelling in ankles and feet
- Dizziness
Prognosis of valvular disease
- Depends on type and severity of disease
- Sometimes requires surgery to repair or replace valve
DDX of valvular disease
Hypertrophic obstructive cardiomyopathy
Congestive heart failure
- Chronic, progressive condition that affects pumping power of your heart muscle
- CHF specifically refers to stage in which fluid builds up within heart and causes it to pump inefficiently
Congestive heart failure cause
- Develops when ventricles cant pump enough blood to the body
- Eventually, blood and other fluids can back up inside lungs, abdomen, liver, lower body
Population congestive heart disease
45-64
Risk factors of congestive heart failure
- CAD
- Diabetes
- High blood pressure
- Obesity
- Valvular heart disease
Congestive heart failure clinical presentation
- Primary- fatigue, swelling in ankles/lower limb, weight gain, inc need to urinate
- Worsening- irregular heartbeat, cough that develops from congested lungs, wheezing, shortness of breath
- Severe- chest P that radiates into upper arm, rapid breathing, skin appears blue, fainting
Congestive heart failure prognosis
- Can be life threatening, needs urgent medical attention
- Congestive heart failure drugs
- ACE inhibitors- open narrowed blood vessels to improve flow
Aneurysm
- Abnormal bulge in wall of blood vessel
- Can rupture, causing internal bleeding (fatal)
- Aortic, abdominal aortic, thoracic aortic, brain, peripheral aneurysm
Aneurysm cause
- High blood pressure/hypertension over many years damage/weakening of blood vessels
- Atherosclerosis- weakens blood vessels
Aneurysm population
30-60
More common in women
Aneurysm risk factors
- High blood pressure
- Size, location, growth
- Family Hx
Aneurysm presentation
- Dependent on location
- Brain- can lurk without symptoms, can rupture and leak (haemorrhagic stroke- medical emergency), most don’t rupture, severe headache, nausea, blurred/double vision, seizure, photosensitivity. Unruptured- P above/behind eye, dilated pupil, change in vision, numbness of one side of face
- Aortic- back P, cough, weak/scratchy voice, shortness of breath, tenderness in chest
- Abdominal- dizziness, P in lower back, sweaty/pale/clammy skin, fast heartbeat, shortness of breath
- Peripheral- pulsating lump that can be felt, leg P/cramping with exercise, ulcers of toes/fingers, radiating P, gangrene/tissue death
Aneurysm prognosis
- Some have below risk of rupture
- Doctor required to identify size/risk of rupture
- Rupture= fatal (especially in brain)
Hypertrophic changes
- Heart muscles become thickened
- Makes it harder for blood to be pumped around body
Hypertrophic changes cause
- Genetic mutation that causes muscle thickening
- Typically affects septum, can block blood flow between chambers
Hypertrophic changes population
- Can be diagnosed at any age
- Hypertrophy may be present at birth or in childhood, however much more common to appear normal
Hypertrophic risk factors
- Inherited- people with one parent with hypertrophic cardiomyopathy have a 50% chance of developing
- Should be screened
Hypertrophic clinical presentation
- Often goes undiagnosed due to lack of symptoms
- Shortness of breath, chest P, changes to hearts electrical system life-threatening irregular heart rhythm/sudden death
- Chest P during exercise
- Fainting post exercise
- Heart murmur
- Sense of palpitations
- Shortness of breath
Hypertrophic prognosis
- Multiple complications (e.g., heart failure, syncope, mitral valve disease, blocked blood flow)
- No prevention but important to identify condition early to start treatment ASAP
Atrial fibrillation
- Irregular and often very rapid heart rhythm
- Can lead to irregular blood clots
- Inc risk of stroke, heart failure and other complications
- 100-175 BPM (normal- 60-100)
Types of atrial fibrillation
Occasional
Persistent
Long standing persistent
Permanent
Occasional atrial fibrillation
come and go, usually lasting for a few mins to hours, symptoms can last up to a week and episodes can happen repeatedly, symptoms may go away on own
Persistent atrial fibrillation
normal rhythm not regained independently, meds, cardioversion treatment may be used to restore
Long standing persistent atrial fibrillation
continues and lasts longer than 12 months
Permanent atrial fibrillation
regular rhythm cant be restored, medications needed to control HR and prevent clots
Causes of atrial fibrillation
- CAD
- Heart attack
- Congenital defect
- Heart valve problem
- High blood pressure
- Previous heart surgery
Risk factors of atrial fibrillation
- Age- older= higher risk
- Heart disease
- High blood pressure
- Thyroid disease- trigger irregular rhythm
- Excessive alchol- inhibits fibrillation
- Obesity
- Family Hx
Clinical presentation of atrial fibrillation
- Some asymptomatic
- Sensations of fast, fluttering or pounding heartbeat
- Chest P
- Dizziness
- Fatigue
- Shortness of breath
Prognosis of atrial fibrillation
- A-fib isn’t usually life-threatening, but it is serious and needs treatment to prevent stroke
- Medication, therapy to reset rhythm, catheter blocks faulty heart signals
- Prevention- healthy lifestyle choices reduces risk of heart disease
Palpitation causes
- Stress
- Depression
- Strenuous exercise
- Stimulants- e.g., caffeine, nicotine, cocaine
- Hormone changes
Risk factors of palpitations
- Stress
- Anxiety disorders or panic attacks
- Pregnancy
- Hyperthyroidism
Palpitation clinical presentation
- Feeling of fast-beating, fluttering or pounding
- May be felt in throat or neck as well as chest
- Can occur during rest or activity
Palpitation prognosis
- Usually harmless, rarely a symptom of a more serious condition
Dysponea
- Left ventricle failure results in dysponea due to oedema in lungs, alveoli and intestinal fluid lungs become stiff more respiratory effort required for proper ventilation
Causes shortness of breath
Dysponea risks
- Heart disease
- Respiratory infection
- Cancer, especially lung
- Asthma
- Obesity
Dysponea clinical presentation
- Shortness of breath, intense tightening of chest
Dysponea progonsis
- Bronchodilators can open airways
- Steroids reduce swelling
- P medication
Syncope
- Occurs when you faint because your body overreacts to certain triggers, such as sight of blood
- Triggers HR and blood pressure to drop suddenly
- Leads to reduced blood flow to the brain brief loss of consciousness
Syncope cause
- Occurs when part of nervous system that regulates HR and blood pressure malfunctions to a trigger
- HR slows and blood vessels in legs dilate
- Allows blood to pool in legs, which lowers blood pressure
- Combined drop in blood pressure and slowed HR quickly reduces blood flow to your brain fainting
- Common triggers- heat exposure, standing for long period of time, seeing blood, having blood drawn, fear of bodily injury
Syncope population
- Most common in children and young adults
Syncope risk factors
- Over heating
- Dehydration
- Heavy sweating
- Sudden changes of body position- blood pooling in legs
Syncope presentation
- Pale skin
- Light-headedness
- Tunnel/blurred vision
- Nausea
- Feeling warm
- Cold, clammy sweat
- During episode- dilated pupils, slow, weak pulse, and jerky movements
Syncope prognosis
- Usually harmless and requires no treatment
- Potential to injure yourself during syncope episode
- Doctor may recommend tests to rule out more-serious causes, such as heart disease
- Cant prevent- lie down and lift legs if feeling faint
Oedema
- Excess fluid in interstitial space
Causes of oedema
- Non-pitting- due to lymphatic blockage, cant get rid of excess water, typically cancer or lymphatics
- Pitting- venous, typically CV, kidney or liver
- Unilateral- deep vein thrombosis, soft tissue infection, trauma, immobility, lymphatic obstruction
- Bilateral- heart failure, chronic venous insufficiency, drugs (e.g., NSAIDs), inferior vena cava obstruction, immobility
- Pregnancy
Oedema population
- Older adults
- Pregnant women
Oedema risks
- Being pregnant
- Certain medication
- Having long-lasting illness, e.g., congestive heart failure
- Having surgery that involves a lymph node
Oedema presentation
- Swollen lower limbs (can affect anywhere in body)
- Pitting- leaves dimple
- Puffiness
- Stretched or shiny skin
- If left too long legs may turn brown, haemosiderin- toxin in blood comes to surface to try and be removed
Oedema prognosis
- See a doctor if shortness of breath, irregular heartbeat, chest P
- Mild usually goes away- compression socks, raising affected arm/leg higher than heart
Claudication
- Too little blood flow to muscles during exercise, causes P due to lack of exercise
- Most often this P occurs in legs after walking at a certain pace
Claudication cause
- Symptom of disease, most often peripheral artery disease (narrowing of arteries in limbs that restricts blood flow)
- Damage to peripheral arteries usually due to atherosclerosis (plaque blocks arteries)
Claudication population
- Diabetics
- Older people
Claudication risks
- Family Hx of atherosclerosis
- 50+ if smoke or have diabetes
- 70+
- Diabetes
- High blood pressure
- High cholesterol
Claudication presentation
- P, ache, discomfort or fatigue in muscles during exercise
- P likely in calves, thighs, buttocks, hips or feet
- P relived after rest
- Can develop over time and cause P at rest as well as cool skin, skin discolouration, wounds that don’t heal
Claudication prognosis
- Speak to doctor
- Identify underlying condition
Deep vein thrombosis
- Occurs when blood clot forms in one or more deep veins in body, usually legs
DVT cause
- Anything that prevents blood from flowing or properly clotting
- Damage to vein from surgery or inflammation and damage due to infection or injury
DVT population
- Over 40
- People with Hx of DVT/blood clots
DVT risks
- Age- 60+
- Lack of movement
- Injury or surgery
- Pregnancy
- Birth control
- Obesity
DVT presentation
- Leg swelling
- Leg P, cramping or soreness that often starts in calf
- Change in skin colour of leg- such as red or purple
- Warmth
DVT prognosis
- Complications include pulmonary embolism, phospholipidic syndrome and treatment complications
- See a doctor if shortness of breath, feeling lightheaded, fainting, rapid breathing, coughing up blood
Hypertension
- High blood pressure
- Heart needs to work harder to pump blood
- 130/80 mm Hg or higher
- Normal- 120/80
- Elevated- 120-129/below 80
- Stage 1 hypertension- 130-139/80-89
- Stage 2- 140 or higher/90 or higher
- Above 180/120 mm Hg is hypertensive emergency or crisis
- Need 3 months of consistent readings to diagnose
Hypertension causes
- Primary- no identifiable cause, develops gradually over many years, plaque builds up in arteries
- Secondary- underlying condition, tends to appear suddenly and cause higher blood pressure than primary (adrenal gland tumour, congenital heart defect, kidney disease, etc)
Hypertension population
- Older people
- Obese people
Hypertension risk factors
- Age (inc with age)
- Family Hx
- Obesity
- Lack of exercise
- Tobacco use
- High sodium
Hypertension presentation
- Most asymptomatic
- Headaches
- Shortness of breath
- Nose bleeds
Hypertension prognosis
- Untreated can lead to inc risk of heart attack, stroke, and other serious health problems
Stroke
- Occurs when blood supply to brain is interrupted or reduced
- Prevents brain tissue from getting oxygen and nutrients
- Brain cells die in minutes
Stroke cause
- Ischemic- blocked artery- most common
- Haemorrhagic- leaking or bursting of vessel- result of other condition such as uncontrolled high blood pressure, overtreatment with blood thinners, trauma
- Transient ischemic attack- mini stroke, doesn’t cause permanent damage, temporary block of blood supply
Stroke population
- 55+
- African Americans
- Men
- Hormones- birth control
Stroke risk
- Obesity
- Physical inactivity
- Heavy or binge drinking
- High blood pressure
- High cholesterol
- Diabetes
Stroke presentation
- Trouble speaking
- Paralysis of numbness of face, arm or leg
- Problems seeing in one or both eyes
- Headache
- Trouble walking
Stroke prognosis
- Seek immediate attention
- FAST- face, arms, speech, time
Peripheral vascular disease
- Narrowed arteries reduce blood flow to arms or legs
- Not enough blood received to keep up with demand
- Can cause leg P when walking
- Usually sign of build up of fatty deposits
Peripheral vascular disease cause
- Usually due to atherosclerosis
- Blood vessel inflammation
- Injury to arms or legs
- Radiation exposure
- Changes in muscles or ligaments
Peripheral vascular disease population
- Older age
- Obese
Peripheral vascular disease risk
- Family Hx
- High blood pressure
- High cholesterol
- Increasing age (65+)
- Obesity (BMI over 30)
Peripheral vascular disease presentation
- Mild or no symptoms- mainly leg P whilst walking
- Coldness in lower leg or foot
- Numbness or weakness
- P cramping in one or both hips, thighs, calf muscles after certain activities
- Shiny skin on legs
- Skin colour changes
- Hair loss/slow growth on legs
- Sores on toes, feet or legs that won’t heal
Peripheral vascular disease
- Inform doctor if in P, numbness or other symptoms of PVD
- Complications are critical limb ischemia (causes tissue death, symptoms are open sores on limbs that don’t heal) and stroke/heart attack
- Prevention- don’t smoke, healthy/active lifestyle, low saturated fat diet
Vasculitis
- Inflammation of blood vessels
- Causes walls of blood vessel to thicken, reducing pathway through vessel, restricting blood flow to tissues leading to damage
Vasculitis cause
- Not fully understood
- Some related to genetics
- Infections- e.g., hep C + B
- Blood cancers
- Immune system diseases- e.g., RA, lupus, scleroderma
- Reactions to certain drugs
Vasculitis risks
- Age- giant cell arthritis rarely occurs before 50
- Family Hx- Behcet’s disease, granulomatosis
- Lifestyle- smoking, use of recreational drugs
- Medication- e.g., minocycline, allopurinal, etc
- Infections- hep B + C
- Sex- women
Vasculitis presentation
- Fever
- Headache
- Fatigue
- Weight loss
- General aches and P
- Other parts of body which may be affected:
1. Digestive system- P after eating
2. Ears- ringing
3. Eyes- red appearance with itch/burn
4. Hands or feet- numbness and weakness
5. Lungs- shortness of breath
6. Skin- bleeding under skin can show up as red spots
Vasculitis prognosis
- Complications can lead to organ damage, blood clots and aneurysms, vision loss and blindness, infections
