Chapter 6 Flashcards
The most common symptoms of the vascular component of a cardiovascular condition is
Edema and leg pain
The cardinal symptoms of cardiac disease usually include
Chest, neck arm pain or discomfort, dyspnea, palpitation, syncope, cough, diaphoresis and cyanosis
Heart is innervated by
C3-T4
Fluttering sensations in the neck are usually
Caused by anxiety, random muscle fasciculations or minor muscle strain or overuse
Less than ___ palpitations a minute is considered normal
6
Palpitation in any person with a history of unexplained sudden death in the family needs
Immediate physician referral
Caffeine sensitivity can cause palpitation like feelings because
Causes an overactive thyroid
Why does paroxysmal nocturnal dyspnea wake people up
The amount of blood returning to the heart and lungs from the lower extremities when lying down
People with CHF usually have these two things
PND and unexplained episodes of shortness of breath
Those with CHF breathe easier when
Standing and when later in the day due to gravity
Anyone who cannot climb a single flight of stairs without feeling moderately or severely winded or who awakens at night or has sob lying down needs
Physician referral
When is dyspnea more likely to be of pulmonary origin
When it is relieved by specific breathing patterns or positional changes like leaning forward
Syncope that occurs with no warning period of symptoms may be a sign of
Heart valve or arythmia problems
What is pseudoclaudication
Claudication from lumbar stenosis
Statins are used to
Decrease LDLs
What is the most common mycotoxin event associated with statins
Myalgia
What is myositis
Muscle symptoms with increased CK levels
Risk factors for statin side effects
Age over 80, small body frame, kidney or liver disease, excessive grapefruit juice consumption, use of other medications and alcohol abuse
Signs and symptoms of statin induced side effects
Myalgia, fever, nausea, vomiting, liver impairment symptoms
One of the most important primary signs of CAD in women
Unexplained, severe episodic fatigue and weakness associated with decreased ability to carry out normal ADLs
What is Prinzmetal’s angina
Coronary artery spasms that squeeze arteries shut and keep the blood from reaching the heart
Prinzmetal’s angina typically occurs
At rest and at the same time everyday
Women with signs of CAD may have isolated pain in the
Mid thoracic spine or right bicep
Why does cardiac pain refer to the jaw
Inter nuncial fibers from the cervical spinal cord posterior horns to the spinal nucleus of the trigeminal nerves
80 to 90% of clients experience angina in this location
Retrosternal or slightly left of the sternum
The duration of angina as a direct result of myocardial ischemia is typically
1-3 minutes and no longer than 3 to 5 minutes
If angina like pain is not relieved with rest or up to ___ nitro tablets notify the physician and take the client to cardiac care unit
3
Signs and symptoms of angina
Gripping vise like feeling of pain or pressure behind Breast bone, radiating pain, toothache, burning indigestion, dyspnea, nausea, belching
Most common cause of MI
Coronary thrombosis
What is the first symptom of heart attack in half of men
Sudden death
MIs typically occur at what time of day
Morning (40% higher likelihood)
Why do MIs pose a greater risk in the morning
The body’s clotting system is more active at this time, BP surges, increased HR from rest and reduced BF to heart
Hormone effect on having an MI in the morning
Stress hormone which can induce vasoconstriction increase in the morning
Warning signs of MI - classic ones
Chest pain that is unrelieved by rest of nitro tablets and lasts over 30 minutes, pain radiates for hours, pallor, sweating, nausea, vomiting
When working with _____ it can increase the pain associated with MI
Arms overhead
Most common symptom of MI in men
Feeling of pressure or discomfort in the sternal region or across the chest
Chest pain is less common in ____ during MI
Women
In women _____ may relieve the symptoms of MI
Antacids
Most common symptom in women one month before heart attack
Unusual fatigue
What is pericarditis
Inflammation of the pericardium
Chest pain from pericarditis mimics
Chest pain of an MI
How can you differentiate MI from pericarditis with position changes
MI pain will be unaffected by position,, breathing or movement whereas pericarditis may be relieved by kneeling on all fours , leaning forward or sitting upright
Pericardital chest pain is often worse with
Breathing, swallowing, belching or neck or trunk movements especially side bending and rotation
The chest pain in pericarditis may be described as
Sharp or cutting and possibly in bursts with a change in body position
What may reduce pericarditis pain?
Holding the breath
What is ventricular interdependence
The ventricles both need to be functioning, if one fails it almost always leads to failure of the other
Right sided ventricular failure leads to
Congestion of peripheral tissues and viscera, liver enlargement, ankle swelling and ascites (fluid buildup in abdomen)
What are the most common signs and symptoms of CHF
Breathlessness, exhaustion and LE edema
Why is cough a common symptom of left ventricular failure
A large amount of fluid is trap,led in the pulmonary tree, irritating lung mucosa
Why is fatigue and muscle weakness a symptom of left ventricular failure
Inadequate CO leads to hypoxic tissue and slowed removal of metabolic waste products causing them to tire easily
Nocturia is possible in both and r and l sided heart failure but more common in
Left
What is one of the early signs of right ventricular failure
Dependent edema - symmetric edema in the dependent parts of the body where venous pressure is highest
Clinical signs and symptoms of right sided heart failure q
Increased fatigue, dependent edema, pitting edema, edema in sacral area or back of thighs, right upper quadrant pain and cyanosis of nail beds
What is a dissecting aortic aneurysm
Splits and penetrates the arterial wall creating a false vessel
Thoracic aneurysms occur most frequently in
Men with hypertension ages 40-70
What is the most common site of peripheral arterial aneurysms
Popliteal space
Abdominal aortic aneurysms occur _ times as often than thoracic aneurysms
4
The most common site for abdominal aortic aneurysms is
Just below the kidney with referred Omani to the thoracic lumbar junction
Most AAAs are asymptomatic or symptomatic?
Asymptomatic - find out with exams
The most common symptom of an AAA is
A pulsating mass in the abdomen with or without pain, followed by abdominal pain and back pain
Palpating the width of the abdominal aorta should
Have a uniform pulse from midline out
The abdominal aorta passes posterior to diaphragm at what level
T12
The abdominal aorta bifurcates at this level
L4
The BP and HR values that may indicate shock
Systolic under 100 and HR over 100
What is stenosis
A narrowing or constriction that prevents the valve from opening fully and may be caused by growths, scars, or abnormal deposits on leaflets
What is insufficiency
Regurgitation, occurs when The valve does not close properly and causes blood flow to back into the heart chamber
Prolapse…
Involves only the mitral valve, and occurs when enlarged valve leaflets bulge backward into the left atrium
Signs and symptoms of valvular disease
Easy fatigue, dyspnea, palpitation, chest pain, pitting edema, Orthopnea and paroxysmal dyspnea, dizziness and syncope
What is rheumatic fever caused by
Stretoloccocal bacteria
Why is it called rheumatic fever
The two more common symptoms are fever and joint pain
Most typical presentation of rheumatic fever in children and young adults
Cold or sore throat followed two to three weeks later by painful joints and fever, with palpitations and fatigue
What is endocarditis
Inflammation of the cardiac endothelium and damages either the tricuspid, mitral or aortic valves
Endocarditis is caused by
Bacteria, abnormal growths on the closure lines of previously damaged valves or artificial valves
Two groups most at risk for endocarditis
Injection drug users and post cardiac surgical patients
Up to 45% of individuals with endocarditis Inititally have
Musculoskeletal symptoms including arthralgia, arthritis, low back pain and myalgia
The most common musculoskeletal symptom of endocarditis is
Arthralgia, generally in proximal joints
Most common site of arthralgia in endocarditis
Shoulder
If a patient is suspected of RA due to symmetric arthralgia in knees and ankles, how could you differentiate
If they have morning stiffness, it would be RA, this is not present in those with endocarditis
Endocarditis may produce destructive changes in the
Sacroiliac joint
Endocarditis induced low back pain mimics symptoms of someone with
Herniated lumbar disk
How do you differentiate endocarditis low back pain and herniated disk
Neurological deficits aren’t present in endocarditis
Systemic lupus erythematosus releases
Broad spectrum of autoantibodies into the circulation
The most common cardiac lesion associated with SLE
Pericarditis
Usually symptoms of mitral valve prolapse are due to
Dysautonomia
There is a high incidence of mitral valve prolapse in those with
Fibromyalgia
The triad of symptoms for mitral valve prolapse
Fatigue, dyspnea and palpitations
The therapist should monitor pulse carefully before, during and after exercise in anyone who has had a
Stroke
Explain a fib and possible complication
Disorganization of atrial activity without effective atrial contraction, the chambers quiver rather than contract causing pooling of blood and clots to form increasing risk for a stroke
Which bacteria is of concern may cause A fib
H. Pylori in the stomach, confirm with high concentration of c reactive protein
Sinus tachycardia is defined as
More than 100 bpm
Bradycardia is less than
60bpm
What is pulse pressure
Systolic minus diastolic
A widened pulse pressure usually results from
Stiffening of the aorta secondary to atherosclerosis
If the pulse pressure widens this will increase
Stroke volume
Primary hypertension is also called ______ and makes up ____ of all hypertensive clients
Idiopathic, 95%
Secondary hypertension results from
Diseases that cause it
What is labile or borderline hypertension
When there is intermittent elevation of BP interspersed with normal readings
What is isolated systolic hypertension and what does it increase the risk for
Systolic rises but diastolic is normal and it increases the risk for stroke and death
This important mineral deficiency is known to contribute to hypertension
Potassium
Clinical signs and symptoms of hypertension
Occipital headache, vertigo, flushed face, spontaneous epistaxis, vision changes and nocturnal urinary frequency
How long do transient ischemic attacks last
5 to 20 minutes usually but can last up to 24 hours
An untreated TIA is likely to result in stroke in 10-20% of patients within
3 months
Signs and symptoms of TIAs
Slurred speech, difficulty with speech, or difficulty understanding others, sudden confusion, loss of memory, even loss of consciousness, temporary blindness or other dramatic visual changes, dizziness, severe headache, paralysis or weakness usually one sided, symptoms typically lasting a few minutes
Orthostatic hypotension is
SBP drops 20 mmHg or a drop of 10 mmHg or more of both systolic and diastolic BP upon an erect position with a 10-20% decrease in HR
DM is an insect or direct risk factor for heart disease
Indirect, it’s the combination of what it effects that increases the risk
The first sign of vascular occlusive disease may be
The loss of hair on the toes
The most common lesion of vascular occlusive disease is the
Superficial femoral artery causing pain in the calf and lower thigh
What is Raynaud’s phenomenon
Intermittent episodes during which small arteries or arterioles in extremities contrict, causing temporary pallor and cyanosis of the digits and changes in skin temperature
Unilateral Raynaud’s may be a sign of
Hidden neoplasm
Secondary Raynaud’s is known To be caused by these things
Connective tissue or collagen vascular disease like sclerderma, polymyositis/dermatomyositis, systemic lupus erthmatosus or RA
Raynaud’s disease is
A primary vaso spastic or vaso motor disorder caused by hypersensitivity to cold, release of serotonin and congenital predisposition to vaso spasm
80% of those with Raynaud’s disease are
Women between 20-49
Acute venous disorders are due to
Formation of thrombi which obstruct venous flow
DVT is more common in men or women and children or adults?
Women and adults
The most significant risk factors for a DVT are
Age over 70 and previous thromboembolism
Thrombus formation is attributed to what three things
Venous stasis, hypercoagulability, injury to the venous wall
What is venous stasis caused by
Prolonged immobilization or absence of the calf muscle pump
Women on progestogen only pills are at little or no increased risk of
Blood clots
Lymphadema is
An excessive accumulation of fluid in the tissue spaces.
Potassium levels should be monitored for those taking
Dieretics
Med in particular that lowers potassium
Digitalis
What are the cardiac effects of too much potassium
Ventricular arythmias and a systole or flat line
Magnesium deficits often accompany these deficits
Potassium and calcium
NSAIDs have the ability to decrease the effectivness of
ACE inhibitors
___ and ___ is combo with NSAIDs will
Exacerbate the effects of NSAIDs
Diuretics work by
Lowering BP by eliminating sodium and water and thus reducing blood volume
Beta blockers work by
Relaxing the blood vessels and the heart muscle by blocking the beta receptors on the SA node and myocardial cells producing a decline in the force of contraction and a reduction in heart rate
Alpha 1 blockers…
Lower BP by dilating blood vessels
Alpha 1 blocker medications all end with
“Zocin”
Ace inhibitors also
Vaso dilate
Calcium does what to blood vessels
Constricts
Calcium channel blocking Meds end with
Pine
Angina does ___ occur immediately after physical activity
Not
