Common Cardiac Complaints Flashcards
what are the most common cardiac complaints?
Chest pains Palpitations Shortness of breath Swelling Syncopal Episode
if a pt presents with a cardiac complaint & there is low suspicion for ACS, what are some possible differential diagnoses?
non-cardiac: pulmonary & GI -GERD -pneumonia -pulmonary embolism
skin
-shingles d/t neuropathic pain
MSK
- pleurisy
- costochondritis
what is the most common symptom assoc. with CAD & why is it dangerous?
chest pain
-Leading cause of mortality in men and women
Black ethnicity is highest
1 in every 7 deaths
True or False:
Chest discomfort does not mean chest pain.
False.
Chest discomfort described as tightness & pressure = chest pain
what are the classic exertional symptoms in chest pain?
pain
pressure
tightness
what are some atypical symptoms that can be used to describe chest pain?
Cramping grinding burning ripping tearing
what is the most concerning differential diagnosis assoc. w/ chest pain?
ACS
- acute MI
- unstable angina
- STEMI
- NSTEMI
True or false:
A CXR showing cardiomegaly is pertinent in assessing for ACS.
False
What should be ordered when ACS is suspected?
EKG CXR Labs: >CBC: r/o infection/anima > CMP: electrolyte abnormalities > cardiac enzymes
what is the true definition of palpitations?
Awareness of heartbeat
what are descriptors of palpitations?
Pounding
Skipping
Racing
Fluttering
what differential diagnoses should be considered when a pt presents w/ palpitations?
Arrhythmia >> Atrial Fibrillation >> PAC/PVC Anxiety Hyperthyroidism Medication Side effects Recreational Drugs
if a pt presents w/ palpitations, what should you look for upon inspection of the neck?
thyroid abnormalities such as nodules & goiters
-hyperthyroidism
if there is a suspicion for drug side effects in a pt w/ palpitations, what should you inspect for?
HEENT -pupils > dilation -mucus membranes -nasal mucosa > ulcerations w/ cocaine use
What should be ordered when working up palpitations?
EKG CXR -> only if indicated Labs: CBC Chemistry Panel Thyroid panel Cardiac Enzyme -> will reflect damage of the heart in afib, cocaine use
what rhythm abnormalities are associated with a regularly irregular rhythm?
trigeminy- every 3 beats
bigeminy- couplets
what rhythm abnormalities are associated with an irregular rhythm?
sinus arrhythmias
PAC
PVC
what rhythm abnormalities are associated with a irregularly irregular rhythm?
afib
atrial flutter
what is dyspnea?
uncomfortable awareness of breathing that is inappropriate for the level
of exertion
what is orthopnea & when s it noticeable?
dyspnea that occurs when patient is supine
-improves when
patient sits up
what is paroxysmal nocturnal dyspnea?
Sudden dyspnea and orthopnea that awaken the
patient from sleep
True or False: A patient that experiences paroxysmal nocturnal dyspnea will start with orthopnea
False
what systems should be considered when a pt c/o SOB?
cardiac, pulmonary, GI, psychiatric causes
which type of CHF is associated with SOB?
left sided heart failure
-d/t lack of blood from from left side of the heart
if a pt c/o SOB, what differentials should be considered?
CHF (left sided heart failure) PE PTX Anxiety COPD Asthma Anemia
if a pt c/o SOB and you suspect CHF, what other findings do you expect to find on exam?
pitting edema in the lower extremities
what should be ordered when evaluating a pt with SOB?
EKG
Imaging: CXR vs VQ scan vs CT chest
Labs: ? CBC, cardiac enzymes, d-dimer
if you have a high suspicion for a pt having a PE, what is the best test to order?
VQ scan
|»_space; D-Dimer is better to evaluate for blood clots
in a pt that has pitting edema on exam, how much fluid is accumulated in the extravascular interstitial space?
> 5L fluid
in a pt with R sided CHF, what is the first symptom they will present with?
peripheral edema/leg swelling
in a pt with L sided CHF, what is the first symptom they will present with?
SOB
what conditions can cause build up of edema?
Right or left ventricular dysfunction Pulmonary HTN COPD Nutritional Positional (dependent) Nephrotic syndrome Liver disease Metastatic disease autoimmune issues
how does right sided heart failure cause swelling?
dysfunction of the right atrium/ventricle ->
prohibits blood from returning to the heart = back up of blood in periphery
how does left sided heart failure cause swelling?
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
what is the most common cause of R sided heart failure?
left sided heart failure
what should be ordered for a pt when heart failure is suspected?
EKG ECHO CXR Labs: ?CBC CMP -> LFTs UA -> protein urea
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.
True
-Echo should be ordered instead
what is syncope?
Transient loss of consciousness, followed by recovery
what is the most common cause of syncope?
neuro-cardiogenic -> vasovagal
why do vasovagal syncopes occur?
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)
what pathology can cause syncope?
Cardiac arrhythmias
