Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Differential Diagnosis/Imaging > DDx of the Cardiovascular System > Flashcards

DDx of the Cardiovascular System Flashcards

1
Q

List the heart muscle CV diseases

A
  • CAD
  • MI
  • Pericarditis
  • CHF
  • Aneurysms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List the valvular CV diseases

A
  • Rheumatic fever
  • Endocarditis
  • Mitral valve prolapse
  • Congenital deformity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

List the cardiac nervous system CV diseases

A
  • Arrhythmia
  • Tachycardia
  • Bradycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs and symptoms of radiating heart pain

A
  • Ulnar nerve distribution
  • Heart is supplied by C3-T4 spinal segments
  • Heart & diaphragm refer pain along the C5-C6 spinal segment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Signs and symptoms of chest pain/discomfort

A
  • Angina, MI, pericarditis, endocarditis, mitral valve prolapse, or aortic aneurysm
  • Varies pending each condition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Associated signs and symptoms of CV disease

A
  • Nausea
  • Vomiting
  • Diaphoresis
  • Dyspnea
  • Fatigue
  • Pallor
  • Syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Benign causes of heart palpitations

A
  • Mitral valve prolapse
  • Athletes’ heart
  • Caffeine intake
  • Anxiety
  • Exercise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Severe CV conditions with heart palpitations

A
  • CAD
  • MI
  • Heart block
  • Ventricular aneurysm
  • Valvular disease
  • Mitral or aortic stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Signs and symptoms of heart palpitations

A
  • Patient reports bump, pound, jump, flop, flutter, or racing sensation of the heart
  • Associated symptoms may include lightheadedness or syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What palpitation conditions require medical evaluation

A
  • Palpitations lasting for hours or occurring in association with pain, shortness of breath (SOB), fainting, or severe lightheadedness require medical evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What palpitation conditions require medical referral

A
  • Palpitation in any person with a history of unexplained sudden death in the family requires medical referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Signs and symptoms of dyspnea

A
  • Shortness of breath: determine if cardiac or pulmonary, “dyspnea on exertion”
  • Paroxysmal noturnal dyspnea
  • Orthopnea: pillow sign
  • Dyspnea relieved by specific breathing patterns or by a specific body position is more likely to be pulmonary than cardiac in origin
  • Anyone who gets significantly out of breath after climbing just one flight of stairs, awakens at night, or experiences SOB when lying down should be evaluated by a physician
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Signs and symptoms of syncope

A
  • Due to reduced O2 delivery to the brain
  • Can be caused by arrhythmia, orthostatic hypotension, poor ventricular function, CAD, or vertebral artery insufficiency
  • Syncope w/o any warning period of lightheadedness, dizziness, or nausea may be a sign of heart valve or arrhythmia problems
  • Medical referral recommended for any unexplained syncope especially in the presence of heart or circulatory problems or if the client has any risk factors for heart attack or stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Signs and symptoms of fatigue

A
  • Fatigue that goes beyond expectations during or after exercise especially in a client with a known cardiac condition must be closely monitored
  • Beta blockers prescribed for cardiac problems can also cause unusual fatigue symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Signs and symptoms of cough/cyanosis/edema

A
  • Coughing: L ventricular dysfunction, pulmonary edema, L ventricular CHF
  • Cyanosis: bluish discoloration of the lips & nail beds of the fingers & toes
  • Edema: 3lb or more of weight gain over several continuous days in the ankles, abdomen, & hands + SOB, fatigue, dizziness = possible CHF development/exacerbation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs and symptoms of claudication

A
  • Can occur with PVD and CAD
  • More debilitating than angina/dyspnea
  • Pitting edema commonly present
  • Must differentiate b/w neurogenic claudication
  • Assess integument for trophic changes: thin, dry, hairless skin, cool to touch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

General CV signs and symptoms

A
  • Weakness
  • Fatigue
  • Weight change
  • Poor exercise tolerance
  • Peripheral edema
  • Palpitations
  • Cold extremities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Integumentary, CNS, & pulmonary CV signs and symptoms

A
  • Integumentary: ulcers, loss of hair, cyanosis
  • CNS: headache, dizziness, syncope, impaired vision
  • Pulmonary: dyspnea, productive cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Genitourinary, MSK, and gastrointestinal CV signs and symptoms

A
  • Genitourinary: urinary frequency, nocturia, concentrated urine, decreased output
  • MSK: chest, shoulder, back, neck, jaw, arm pain; myalgia, atrophy, edema, claudication, muscular fatigue
  • Gastrointestinal: nausea, vomiting, ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Describe the modified Borg dyspnea scale

A
  • This scale asks you to rate the difficulty of your breathing
  • 0 = breathing is causing no difficulty at all
  • 10 = breathing difficulty is maximal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe peripheral edema assessment

A
  • Associated with venous insufficiency, CHF, DVT, pulmonary HTN
  • Pitting
  • Girth measurements: >1 cm at ankles or >2 cm difference at the mid calf
  • Unilateral vs bilateral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pitting edema measurement grading scale

A
  • Press on skin over tibia then move up the leg; note the point at which swelling is no longer present
  • 1+ = barely detectable impression when finger is pressed into skin
  • 2+ = slight indentation, 15 sec to rebound
  • 3+ = deeper indentation, 30 sec to rebound
  • 4+ = >30 sec to rebound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Characteristics of angina/cardiac chest pain

A
  • Begins 3-5 min after exertion or activity (“lag time”)
  • Moderate intensity
  • Tightness, chest discomfort
  • Usually occurs with exertion, emotion, cold, after a large meal
  • Subsides with rest or use of nitro; worse when laying down
  • Pain is related to the tone of the arteries involved (spasm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What can angina be misdiagnosed as

A
  • TMJ
  • Heartburn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Red flag cluster for transport to emergency department

A
  • Substernal squeezing or crushing pain
  • SOB, pallor, diaphoresis
  • Angina >30 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the angina grading scale

A
  • Class 1: ordinary activity does not cause angina, angina only with strenuous or rapid or prolonged exertion
  • Class 2: slight limitation of ordinary activity, angina with walking or climbing stairs rapidly
  • Class 3: marked limitation of ordinary physical activity, angina walking one or two blocks or one flight of stairs at a normal pace
  • Class 4: inability to carry out any physical activity w/o discomfort or angina at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Angina related to nitroglycerin

A
  • Pain not relieved by rest or with up to 3 nitroglycerin tablets (take one at a time at 5 min intervals) within 10-15 min notify the physician & take client to cardiac care unit
  • Client should take their own nitroglycerin
  • Nitroglycerin dilates the coronary arteries & improves collateral cardiac circulation thus providing an increase in O2 to the heart muscle & a decrease in symptoms of angina
28
Q

What is always a red flag when screening for chest pain

A
  • A lack of objective MSK findings is always a red flag
29
Q

Clinical signs & symptoms of heartburn

A
  • Frequent “heartburn” attacks
  • Frequent use of antacids to relieve symptoms
  • Heartburn wakes the client up at night
  • Acidic or bitter taste in the mouth
  • Burning sensation in the chest
  • Discomfort after eating spicy foods
  • Abdominal bloating & gas
  • Difficulty in swallowing
30
Q

Pain pattern of angina

A
  • Left chest, neck, & jaw pain
  • Left shoulder and/or upper back pain
  • Pain along medial left arm
31
Q

Clinical signs and symptoms of myocardial infarction (MI)

A
  • Pain lasting 30 min to 1 hr
  • Sever pain (can also be painless)
  • Crushing pain, intolerable
  • Brought on with exertion or during exercise
  • Unrelieved by rest or nitroglycerin
  • Pain is related to amount of ischemia present
32
Q

Patient interview red flags for MI

A
  • Men >40
  • Women >50
  • Chest pain
  • PMH of CAD, HTN, DM, XOL, smoking
33
Q

Mi symptoms in women

A
  • One month prior: unusual fatigue, sleep disturbance, dyspnea, GERD, anxiety, heart racing, arms weak/heavy
  • During the MI: dyspnea, weakness, unusual fatigue, cold sweat, dizziness, nausea, arms weak/heavy
34
Q

Slide 24 MI pain patterns

A
35
Q

What are the 3 P’s to rule out MI

A
  • If present the patient is likely not experiencing a MI
  • Pleuritic pain (pain worse with deep breathing)
  • Palpitation produces pain
  • Posture changes pain
36
Q

Male versus female cardiac pain patterns for MI

A
  • Men: classic substernal (pressure/discomfort under the sternum)
  • Women: more subtle, nausea, abdominal pain, isolated R biceps pain, fatigue
37
Q

Early warning signs of MI

A
  • Pressure in center of the chest, can be crushing, >30 min
  • Pain in shoulders, neck, or arms
  • Lightheadedness or fainting
  • SOB
  • Pallor
  • Sweating
  • Nausea with or w/o chest discomfort
  • Angina when working with UE overhead
  • Sudden death often the first symptom of a heart attack
38
Q

Define cardiac arrest

A
  • Sudden and abrupt loss of heart function
39
Q

Signs of cardiac arrest

A
  • Loss of responsiveness
  • No response to gentle shaking
  • No normal breathing
  • Client does not take a normal breath when you check for several seconds
  • No signs of circulation
  • No movement or coughing
  • If working in an inpatient facility you should call a Code Blue
40
Q

Characteristics of pericarditis

A
  • Pain can last hours to days
  • Variable intensity of pain, ranges from moderate to severe
  • Can be asymptomatic, mimic MI, or sharp/cutting pain
  • Worse with breathing, swallowing, belching, neck, or trunk. movement
  • Relieved by kneeling on all fours, leaning forward, sitting upright, breathholding (take pressure off heart, can differentiate MI)
  • Pain related to inflammatory process
41
Q

Describe a cardiac tamponade

A
  • Rare event
  • Blood fills in the pericardial sac putting pressure on the heart preventing it from filling properly & reducing its pumping ability
  • Signs: labored breathing, venous distention, decreased BP with inhalation, fainting, elevated HR, and SOB
42
Q

Characteristics of left ventricular failure (HFrEF)

A
  • Pulmonary congestion
  • Altered by position, activity, stress
  • Dyspnea
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Cough
  • Pulmonary edema
  • Cerebral hypoxia
  • Fatigue/cramping/nocturia
43
Q

Characteristics of right ventricular failure

A
  • Response to L sided failure or pulmonary disease
  • Peripheral edema: symmetrical, dependent, pitting
  • Hepatosplenomegaly 2/2 venous distention: enlarged liver & spleen
  • Increased fatigue
  • RUQ pain
  • Cyanosis of nail beds
44
Q

Describe diastolic heart failure (HFpEF)

A
  • L ventricle stiffens & hypertrophies resulting in the chamber becoming restricted due to the thickened ventricle walls
  • Heart loses elasticity & ability to relax
  • Lost elasticity results in impaired filling capacity of the heart
  • Different than L ventricular (systolic) heart failure (thin & flabby)
45
Q

Clinical signs of diastolic heart failure (HFpEF)

A
  • Fatigue & dyspnea
  • Orthostatic
  • Edema & weight gain
  • Jugular vein distention
46
Q

Characteristics of aneurysms

A
  • Abnormal dilation in the wall of an artery, vein, or heart (asymptomatic)
  • Thoracic & peripheral: ascending, transverse, & descending aorta from heart to top of diaphragm
  • Abdominal (AAA): aorta from diaphragm distally
  • Caused by trauma/weightlifting, congenital vascular disease, infection or atherosclerosis, >risk with advanced age
  • Associations: Marfan syndrome, Loeys-Dietz syndrome, Turner syndrome, or vascular Ehlers-Danlos syndrome
47
Q

Risk factors for an aortic aneurysm

A
  • Male
  • Older age
  • Smoking
  • 1st degree relative with AAA
  • Other vascular aneurysms, CAD, cerebrovascular disease, atherosclerosis, hypercholesterolemia, HTN
  • 100 cigarette history/dose response relationship
48
Q

Charateristics of valvular cardiac chest pain

A
  • Stenosis = narrowing
  • Regurgitation = back flow of blood
  • Prolapse (mitral valve): decreased strength & stiffness of leaflets result in increased extensibility of the valve causing regurgitation
  • Screen patients with connective tissue disorders (Marfan syndrome, Ehlers-Danlos, Loeys-Dietz)
49
Q

What is the triad of symptoms for prolapse (mitral valve) valvular cardiac chest pain

A
  • Palpitations
  • Fatigue
  • SOB
50
Q

Characteristics of mitral valve prolapse cardiac chest pain

A
  • Pain/discomfort for minutes to hours
  • Rarely severe
  • Can be asymptomatic, not substernal discomfort, can feel a “sticking” sensation
  • Often occurs at rest
  • Unrelieved by rest or use of nitro, may be relieved by lying down
  • Unknown mechanism of pain
  • Fatigue easily
  • Palpitation
51
Q

Common congenital heart defects

A
  • Ventricular or partial septal defect (hole b/w the ventricles or atria)
  • Tetralogy of Fallot (combination of four defects)
  • Patent ductus arterioles (shunt caused by an opening b/w the aorta & the pulmonary artery)
  • Congenital stenosis of the pulmonary aortic & tricuspid valves
52
Q

Describe rheumatic fever

A
  • Infection caused by streptococcal bacteria
  • Affects 5-15 y/o children
  • Can be fatal or lead to rheumatic heart disease
  • Rheumatic heart disease is a chronic condition caused by scarring/deformity of the heart valves
53
Q

Describe endocarditis

A
  • Bacterial infection causing inflammation of the cardiac endothelium that damages the tricuspid, aortic, or mitral valve
  • Caused by bacteria entering the bloodstream from a remote part of the body
  • Injection drug users, post cardiac surgical clients (prior aortic valve)
  • Arthralgia in the proximal joints most common symptom (shoulder)
  • Constitutional symptoms, LBP/SI pain, widespread diffuse myalgias
54
Q

Conditions affecting the cardiac nervous system

A
  • Arrhythmias: disorder of the heart rate & rhythm
  • Prevalent in pt’s after CVA, TBI, SCI (VITALS!!)
  • Fibrillation: ventricle fibrillation can result in sudden death (requires resuscitation & defibrillation)
  • Tachycardia/Bradycardia
55
Q

Clinical signs of fibrillation

A
  • Subjective report of palpitations
  • Sensations of fluttering, skipping, irregular beating or pounding, heaving action
  • Dyspnea
  • Chest pain
  • Anxiety
  • Pallor, fatigue
  • Dizziness, lightheadedness, fainting
  • Nervousness
  • Cyanosis
56
Q

Describe diuretics

A
  • Decrease BP by eliminating Na and H2O resulting in reduced blood volume
  • Electrolyte imbalances, weakness, spasm, dizziness, headache, nausea, incoordination
57
Q

Describe beta blockers

A
  • Block beta receptors relaxing blood vessels & heart muscles
  • Decrease force of contraction & reduction in HR = decrease strain on heart = less workload & less O2 consumption
  • RPE scale (6-20)
  • Bradycardia (-olol)
58
Q

Describe alpha-1 blockers

A
  • Dilate blood vessels resulting in decreased BP
  • Screen for hypotension & reflex tachycardia (-zosin)
59
Q

Describe ACE inhibitors

A
  • Decrease amount of vasoconstriction
  • Rash, persistent DRY cough (-pril)
60
Q

Describe calcium channel blockers

A
  • Inhibit calcium from entering blood vessel walls
  • LE swelling, orthostatic hypotension, headache, & nausea
  • Smooth muscle effects = meds that end in (-pine)
  • Dilation of coronary arteries/suppression of arrhythmia = verapamil & diltiazem
61
Q

Describe nitrates

A
  • Dilate coronary arteries
  • Dizziness, tachycardia, orthostatic hypotension
62
Q

Describe statins

A
  • Treat hypercholesterolemia
  • May cause myalgias
  • Dark urine
63
Q

Beta blockers can be used to treat angina pectoris, arrhythmias, CHF, and/or hypertension (True/False)

A
  • True
64
Q

Guidelines for cardiac patients that need immediate attention

A
  • Sudden worsening of intermittent claudication
  • Angina attack that does not subside: change in intensity, pattern, not relieved by nitro
  • Do not allow the patient to leave unaccompanied
  • Contact doctor or return to nursing staff
65
Q

Guidelines for cardiac patients that need physician referral

A
  • Women with chest pain who have family Hx of breast cancer or cardiac disease
  • Palpitation with Hx of unexplained sudden death in family: no more than 6 palpitations per min OR lasting hours OR with pain, SOB, fainting
  • Anyone who cannot climb a single flight of stairs w/o feeling moderately to severely winded
  • Awakened due to SOB at night
  • Fainting w/o warning signs
  • Hx of neurological impairment with new arrhythmia
66
Q

Slide 48-51

A

Differential Diagnosis/Imaging (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions