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Physical Diagnosis & Assessment > Common Cardiac Complaints > Flashcards

Common Cardiac Complaints Flashcards

1
Q

what are the most common cardiac complaints?

A 
Chest pains  
Palpitations 
Shortness of breath 
Swelling 
Syncopal Episode
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2
Q

if a pt presents with a cardiac complaint & there is low suspicion for ACS, what are some possible differential diagnoses?

A 
non-cardiac: 
pulmonary & GI 
-GERD
-pneumonia
-pulmonary embolism

skin
-shingles d/t neuropathic pain

MSK

  • pleurisy
  • costochondritis
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3
Q

what is the most common symptom assoc. with CAD & why is it dangerous?

A

chest pain
-Leading cause of mortality in men and women
 Black ethnicity is highest
1 in every 7 deaths

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4
Q

True or False:

Chest discomfort does not mean chest pain.

A

False.

Chest discomfort described as tightness & pressure = chest pain

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5
Q

what are the classic exertional symptoms in chest pain?

A

pain
pressure
tightness

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6
Q

what are some atypical symptoms that can be used to describe chest pain?

A 
Cramping
grinding
burning
ripping
tearing
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7
Q

what is the most concerning differential diagnosis assoc. w/ chest pain?

A

ACS

  • acute MI
  • unstable angina
  • STEMI
  • NSTEMI
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8
Q

True or false:

A CXR showing cardiomegaly is pertinent in assessing for ACS.

A

False

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9
Q

What should be ordered when ACS is suspected?

A 
EKG
CXR
Labs: 
 >CBC: r/o infection/anima
 > CMP: electrolyte abnormalities
 > cardiac enzymes
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10
Q

what is the true definition of palpitations?

A

Awareness of heartbeat

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11
Q

what are descriptors of palpitations?

A

 Pounding
 Skipping
 Racing
 Fluttering

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12
Q

what differential diagnoses should be considered when a pt presents w/ palpitations?

A 
 Arrhythmia
 >> Atrial Fibrillation
 >> PAC/PVC 
 Anxiety 
 Hyperthyroidism 
 Medication Side effects 
 Recreational Drugs
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13
Q

if a pt presents w/ palpitations, what should you look for upon inspection of the neck?

A

thyroid abnormalities such as nodules & goiters

-hyperthyroidism

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14
Q

if there is a suspicion for drug side effects in a pt w/ palpitations, what should you inspect for?

A 
HEENT
-pupils 
 > dilation
-mucus membranes
-nasal mucosa 
 > ulcerations w/ cocaine use
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15
Q

What should be ordered when working up palpitations?

A 
 EKG 
 CXR -> only if indicated
 Labs:
 CBC
 Chemistry Panel
 Thyroid panel
 Cardiac Enzyme -> will reflect damage of the heart in afib, cocaine use
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16
Q

what rhythm abnormalities are associated with a regularly irregular rhythm?

A

trigeminy- every 3 beats

bigeminy- couplets

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17
Q

what rhythm abnormalities are associated with an irregular rhythm?

A

sinus arrhythmias
PAC
PVC

18
Q

what rhythm abnormalities are associated with a irregularly irregular rhythm?

A

afib

atrial flutter

19
Q

what is dyspnea?

A

uncomfortable awareness of breathing that is inappropriate for the level
of exertion

20
Q

what is orthopnea & when s it noticeable?

A

dyspnea that occurs when patient is supine
-improves when
patient sits up

21
Q

what is paroxysmal nocturnal dyspnea?

A

Sudden dyspnea and orthopnea that awaken the

patient from sleep

22
Q

True or False: A patient that experiences paroxysmal nocturnal dyspnea will start with orthopnea

A

False

23
Q

what systems should be considered when a pt c/o SOB?

A

cardiac, pulmonary, GI, psychiatric causes

24
Q

which type of CHF is associated with SOB?

A

left sided heart failure

-d/t lack of blood from from left side of the heart

25
Q

if a pt c/o SOB, what differentials should be considered?

A 
 CHF (left sided heart failure) 
 PE 
 PTX 
 Anxiety 
 COPD 
 Asthma 
 Anemia
26
Q

if a pt c/o SOB and you suspect CHF, what other findings do you expect to find on exam?

A

pitting edema in the lower extremities

27
Q

what should be ordered when evaluating a pt with SOB?

A

 EKG
 Imaging: CXR vs VQ scan vs CT chest
 Labs: ? CBC, cardiac enzymes, d-dimer

28
Q

if you have a high suspicion for a pt having a PE, what is the best test to order?

A

VQ scan

|&raquo_space; D-Dimer is better to evaluate for blood clots

29
Q

in a pt that has pitting edema on exam, how much fluid is accumulated in the extravascular interstitial space?

A

> 5L fluid

30
Q

in a pt with R sided CHF, what is the first symptom they will present with?

A

peripheral edema/leg swelling

31
Q

in a pt with L sided CHF, what is the first symptom they will present with?

A

SOB

32
Q

what conditions can cause build up of edema?

A 
Right or left ventricular dysfunction 
 Pulmonary HTN 
 COPD 
 Nutritional 
 Positional (dependent) 
 Nephrotic syndrome 
 Liver disease 
 Metastatic disease
 autoimmune issues
33
Q

how does right sided heart failure cause swelling?

A

dysfunction of the right atrium/ventricle ->

prohibits blood from returning to the heart = back up of blood in periphery

34
Q

how does left sided heart failure cause swelling?

A

dysfunction of left atrium/ventricle

  • prohibits blood from returning to the heart from the lungs
  • pt w/ L CHF will still develop SOB first then swelling as it progresses
35
Q

what is the most common cause of R sided heart failure?

A

left sided heart failure

36
Q

what should be ordered for a pt when heart failure is suspected?

A 
 EKG 
 ECHO 
 CXR 
 Labs: 
?CBC
CMP -> LFTs 
UA -> protein urea
37
Q

True or False:

A pt w/ a known hx of CHF presents w/ increased swelling in the legs. An EKG is not necessary to order.

A

True

-Echo should be ordered instead

38
Q

what is syncope?

A

Transient loss of consciousness, followed by recovery

39
Q

what is the most common cause of syncope?

A

neuro-cardiogenic -> vasovagal

40
Q

why do vasovagal syncopes occur?

A

reflex withdrawal of sympathetic tone and increased vagal tone causing drop in blood pressure and heart rate
ex) blood drawn, trauma/injury/ emotional issues, immunization (HPV)

41
Q

what pathology can cause syncope?

A

Cardiac arrhythmias

Physical Diagnosis & Assessment (7 decks)

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