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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
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2
Q

List the valvular CV diseases

A
  • Rheumatic fever
  • Endocarditis
  • Mitral valve prolapse
  • Congenital deformity
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3
Q

List the cardiac nervous system CV diseases

A
  • Arrhythmia
  • Tachycardia
  • Bradycardia
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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
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5
Q

Signs and symptoms of chest pain/discomfort

A
  • Angina, MI, pericarditis, endocarditis, mitral valve prolapse, or aortic aneurysm
  • Varies pending each condition
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6
Q

Associated signs and symptoms of CV disease

A
  • Nausea
  • Vomiting
  • Diaphoresis
  • Dyspnea
  • Fatigue
  • Pallor
  • Syncope
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7
Q

Benign causes of heart palpitations

A
  • Mitral valve prolapse
  • Athletes’ heart
  • Caffeine intake
  • Anxiety
  • Exercise
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8
Q

Severe CV conditions with heart palpitations

A
  • CAD
  • MI
  • Heart block
  • Ventricular aneurysm
  • Valvular disease
  • Mitral or aortic stenosis
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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
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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
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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
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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
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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
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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
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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
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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
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17
Q

General CV signs and symptoms

A
  • Weakness
  • Fatigue
  • Weight change
  • Poor exercise tolerance
  • Peripheral edema
  • Palpitations
  • Cold extremities
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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
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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
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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
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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
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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
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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)
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24
Q

What can angina be misdiagnosed as

A
  • TMJ
  • Heartburn
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25
Q

Red flag cluster for transport to emergency department

A
  • Substernal squeezing or crushing pain
  • SOB, pallor, diaphoresis
  • Angina >30 min
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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
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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

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)

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

Differential Diagnosis/Imaging (20 decks)

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