CVS Flashcards
S+S
- Chest P/discomfort
- Breathlessness
- Palpitations
- Fatigue
- Dizziness and syncope
- Sleep disturbance- can’t lie flat
- Oedema – lower limb, sacrum- reduced circulatory flow
Non cardiac causes of chest P- gastroesophageal
Perforation may be caused by forceful vomiting and disease. Sudden, severe constant P from neck to oesophagus, neck swelling
Spasm- confused with cardiac condition as its relieved with nitrates, not related to exertion (like cardiac P), swallowing extremely hot or cold substances often causes this which leads to chest P
Reflux- burning sensation, referred to as heartburn, aggravated by lying down or after meals, chronic cough or dysphagia
Non cardiac causes of chest P- pulmonary
Pleuritic in nature- P varies with respiratory cyvle, exacerbated during inspiration and coughing
Typically sharp and unilateral
Usually caused by lower resp tract infection
Spontaneous pneumothorax- results in sharp chest P, that may radiate to ipsilateral shoulder, can be caused by underlying condition, typical Px is talk, thin, male, smoker
Pulmonary embolism- acute acute of dyspnea, pleuritic chest P, severe hypoxia and risk factors such as recent surgery, underlying malignancy, bedridden/sedentary state
Non cardiac causes of chest P- MSK
Costochondritis, rib fracture, myalgia
Palpation of chest may reproduce symptoms
Non cardiac causes of chest P- herpes zoster
Burning sensation, unilateral dermatomal distribution
Physical exam findings may be lacking as P often occurs before onset of vascular lesion |(blister), making diagnosis difficult
Angina
Reduced blood flow to heart
Angina types
Stable
Unstable
Variant
Refractory
Stable angina
Most common, usually occurs during activity, relived 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, relived 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
Angina population
60+
Angina risks
Family Hx of heart disease
Aging
S+S 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
Angina prognosis
- Angina medication- glycerol tri-nitrate
- Lifestyle changes- lose wight, healthy due
- Rest
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
MI population
Male 45+
W 55
MI risks
- Age- men aged 45, women aged 55
- Tobacco use
- High blood pressure
- Obesity
- Diabetes
- Family Hx
S+S MI
- 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
MI prognosis
nc risk post first acute infarction
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
Aortic dissection population
Men 60-70
AD risks
- Turner syndrome
- Marfan syndrome
- Other connective tissue disorder
Aortic Dissection S+S
- 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
AD prognosis
- If detected early the chance of survival increases significantly
Synthetic graft to reconstruct aorta
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+
VD risks
- Older age
- Hx of certain infections
- High blood pressure
- Congenital heart disease
VD S+S
- Might not have symptoms for many years
- Heart murmur
- Chest P
- Fatigue
- Shortness of breath
- Swelling in ankles and feet
- Dizziness
VD prognosis
- Depends on type and severity of disease
- Sometimes requires surgery to repair or replace valve
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
Women
Aneurysm risks
- High blood pressure
- Size, location, growth
- Family Hx
Aneurysm S+S
- 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 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 risks
- Inherited- people with one parent with hypertrophic cardiomyopathy have a 50% chance of developing
- Should be screened
Hypertrophic S+S
- 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
Palpitation causes
- Stress
- Depression
- Strenuous exercise
- Stimulants- e.g., caffeine, nicotine, cocaine
- Hormone changes
Palpitation risks
- Stress
- Anxiety disorders or panic attacks
- Pregnancy
- Hyperthyroidism
Palpitation S+S
- 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
Dysponea risks
- Heart disease
- Respiratory infection
- Cancer, especially lung
- Asthma
- Obesity
Dysponea S+S
- Shortness of breath, intense tightening of chest
Dysponea prognosis
- 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
Children and young adults
Syncope risks
- 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 pitting oedema
Congestive heart failure, venous insufficiency, kidney disease
Blood pressure meds, NSAIDs, steroids, oestrogen (birth control), DVT
Causes of non-pitting oedema
Lymphatics
Lymphedema- lymphatic fluid builds up–> swelling. Secondary= breast cancer, etc
Myxedema- usually due to hypothyroidism–> inc accumulation of fluid in legs, feet, mouth, etc
Non-pitting oedema treatment
Resolve underlying condition
Exercise inc lymphatic flow
Elevation- inc circulation
Pitting oedema grades
Grade 1- 1-2mm, immediate rebound
2- 3-4mm, 15s rebound or less
3- 5-6mm, 60s
4- 8mm, 2-3 mins
Pitting oedema treatment
Mild- resolve on own- elevation
Severe- medicine- furosemide
Chronic- long term management of underlying condition (compression socks)
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 S+S
- 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
DVT
- 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 cause
- 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 risks
- Age (inc with age)
- Family Hx
- Obesity
- Lack of exercise
- Tobacco use
- High sodium
Hypertension S+S
- 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
Lifestyle changes- cut down on salt, fat. inc activity
Under 55- ACE inhibitors
Over 55- calcium channel blockers
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
