Diff Dx - Cardio

Question 1

Abdominal Aortic Aneurysm

Answer 1

Risk Factors: -smoking -CAD -recent infection -age -heredity Signs and Symptoms -Aneurysm: -back pain, left lower quadrant, flank pain -syncope -LE motor/sensory loss -awareness of pulse in abdomen -ruptured aneurysm: -acute, stabbing pain -cold, pulseless legs -drop in BP with sudden tachycardia -lightheaded, nausea

Question 2

Cardiovascular Disease

Answer 2

-Heart dx is the leading cause of death in industrialized countries -1 in 3 americans have some form of CVD (half of deaths are unexpected and sudden Risk Factors: -advancing age -HTN -obesity -sedentary lifestyle -excessive alcohol consumption -oral contraceptives -first generation family history -tobacco use -race

Question 3

Follow Up Questions for Cardio:

Answer 3

1. Angina - discomfort in chest, jaw or shoulder? 2. Endocarditis - bouts of rapid heart action, irregular heartbeats or palpitations after visit to dentist? 3. Rheumatic fever/endocarditis - skin rash on chest within the last 3 weeks? 4. Cardiac Ischemia - waking up FROM pain at night 5. Psychogenic stress induced - waking WITH pain 6. Has a physician ever told you that you have heart trouble?

Question 4

Heart Palpitations are a concern when:

Answer 4

-last for hours -more than 6 in a min -post menopausal women -personal family history of heart dx or sudden death -presence of other symptoms (SOB, chest pin, dizzy, lightheadedness)

Question 5

Cardinal s/s for Cardiovascular Dysfunction

Answer 5

1. chest, neck, and/or arm pain or discomfort -radiating pain to neck, jaw, upper trap, upper back, shoulder or arms (left arm) 2. accompanied by constitutional s/s 3. Palpitations 4. Dyspnea - CHF, PND, Orthopnea 5. Syncope 6. Fatigue 7. Diaphoresis 8. Cyanosis 9. Edema (greater than 3lb weight gain) 10. Leg pain/claudication

Question 6

Coronary Artery Disease

Answer 6

1. Atherosclerosis 2. Thrombosis 3. Spasm (intermittent constriction) Modifiable Risk Factors: -physical inactivity -tobacco -elevated serum levels -high BP -diabetes -obesity

Question 7

Women and Heart Disease

Answer 7

-women are 10x more likely to die of CVD than cancer (1:2.5 deaths) -S/s: -unexplained, severe episodic fatigue and weaknes associated with decreased ability to carry out normal activities of daily living -fatigue, weakness, trouble sleeping -nausea -classic pain for CAD = crushing, heavy, squeezing sensation -signs may not appear until 75% of narrowing of coronary artery

Question 8

Types of Angina

Answer 8

*Primary cause is CAD -Chronic Stable Angina: occurs w/ predictable physical or emotional stress, no p! at rest, p! is consistent over time -Resting Angina: chest p! that occurs at rest in supine position and frequently at same time of day, p! not brought on by exertion nor relieved by rest -Unstable Angina: crescendo, an abrupt change in the intensity and frequency of symptoms with decreased threshold of stimulus such as onset while at rest, duration 20-30 min -unrelieved by rest or nitroglycerin report to MD -Nocturnal Angina: weakness at night, assoc w/ CHF -Atypical Angina: unusual s/s related to physical/emotional stress, subside with NG and rest -MI

Question 9

Signs/Symptoms of Angina

Answer 9

-clenched fist against sternum -gripping, viselike feeling of pressure behind breast bone -described as squeezing, burning, pressing, choking, aching - can be confused with heartburn or burning indigestion -radiates commonly to L shoulder and down ulnar distribution -refers to neck, jaw, teeth, upper back, possibly down R arm and occasionally abdomen -dyspnea -belching -women complain of weaknes, breathing in cold air, lethargy and SOB

Question 10

Myocardial Infarction: Cardiac Arrest

Answer 10

-strikes suddenly without warning -sudden loss in responsiveness -no normal breathing -no signs of circulation -call for help, begin CPR, use AED if available

Question 11

Myocardial Infarction - Typical

Answer 11

-may be silent, smokers/diabetics -sudden cardiac death -prolonged and severe substernal chest pain -p! possibly radiating down one or both arms and/or up to the throat, neck, back, jaw, shoulders, arms -nausea, indigestion -angina >30 min, unrelieved by NG, rest, antacids -sudden dimness or loss of vision/speech -pallor, diaphoresis -SOB -weakness, numbness and feeling faint

Question 12

Myocardial Infarction in Women

Answer 12

-does not follow classic patterns -chest discomfort -mental status changes or confusion -dyspnea -weakness/lethargy interferes with ADLs -indigestion, heart burn, stomach pain (mis dx for GERD) -anxiety or depression -sleep disturbance -sensation of inhaling cold air -isolated, continuous mid thoracic or interscapular pain -aching, heaviness or weakness in both arms -sx relieved by antacids - sometimes better than NG

Question 13

Pericarditis

Answer 13

-previous infection -presence of new onset chest, neck or L shoulder p! -substernal pain that may radiate to neck, upper back, upper trap, left supraclavicular, down L arm, costal margins -dif with swallowing -***pain relieved by sitting upright -***pain relieved/reduced by holding breath -aggravated by deep breathing, trunk movements and laying down -h/o fever, chills, weakness, heart disease -cough -LE edema

Question 14

Endocarditis

Answer 14

Risk Factors: valve damage, IV drug users, post cardiac surg, heart disease, aortic stenosis, valve replacement Signs/Symptoms -arthralgias -arthritis -MS problems - LBP/SI -myalgias -constitutional s/s -cold painful extremities

Question 15

CHF - L Sided Heart failure -L Ventricular Failure causes pulmonary congestion/disturbance

Answer 15

L Sided heart failure: -fatigue/dyspnea after mild exertion -persistent spasmodic cough (lying down) -paroxysmal nocturnal dyspnea -orthopnea -tachycardia -muscle weakness -edema -decreased renal function or frequent urination

Question 16

CHF - R Sided Heart Failure - occurs in response to L CHF or as result of PE

Answer 16

-increased fatigue -dependent edema -pitting edema -right upper quadrant pain -cyanosis of nail beds

Question 17

Diastolic Heart Failure - L ventricle stiffens and hypertrophies = Decreased Filling of heart

Answer 17

-fatigue and dyspnea after mild exertion -orthopnea -edema -jugular vein distention

Question 18

Systolic Heart Failure - L ventricle becomes weak or flabby = decreased contractility = decreased pumping to organs and tissues

Answer 18

-low ejection fraction <35% with symptoms is suggestive of heart failure

Question 19

Cardiovascular Medications

Answer 19

Angina pectoris -organic nitrates -beta blockers -calcium channel blockers Arrhythmias -sodium channel blockers -beta blockers -calcium channel blockers -agents prolonging depolarization CHF -cardiac glycosides (digitalis) -diuretics -ACE inhibitors -vasodilators HTN -diuretics -beta blockers -ACE inhibitors -vasodilators -calcium channel blockers -alpha 1 blockers

Question 20

Cardiovascular Signs and Symptoms that Require Immediate Medical Attention

Answer 20

1. Sudden worsening of intermittent claudication may be due to thromboembolism 2. Symptoms of TIAs in any individual especially those with a history of heart dx, HTN, tobacco use 3. Onset of Anginal attack which requires immediate cessation of exercise - symptoms associated with angina may be reduced immediately and should subside within 3-5 min with cessation of activity 4. Clients taking nitroglycerin should administer meds themselves - relief should be within 1-2 min, if anginal p! is not relieved within 20 minutes or presence of constitutional s/s - immediate med intervention is needed 5. Changes in the pattern of angina 6. Client should not be advised to leave unaccompanied

Question 21

Pt presents with chest, breast, neck, jaw, back or shoulder p! look for the following clues:

Answer 21

-personal or family history or heart disease -age (post menopause or over 65) -ethnicity (black women) -other s/s such as pallor, unexplained perspiration, inability to talk, n/v, sense of impending doom -3 p’s (pleuritic, position, palpation) -chest p! brought on by excessive coughing -angina is activated by exertion, emotional stress, large meal, or exposure to cold and has a lag time of 5-10 min -angina does not occur immediately after physical activity (more likely MS, TOS, psychologic) -upper quad p! than can be effected by lower quad activity -insidious onset of jt/ms p! in pt w/ heart murmur may be bacterial endocarditis (w/ morning stiff = rheumatoid arthritis) -symptoms from vascular claudication are relieved by rest -throbbing p! at base of neck/intrascapular area that increases with exertion - check vitals/ palpate for AAA

Question 22

The 3 P’s

Answer 22

-Pleurtic Pain = Pulmonary or Cardiac -relief or reduction of p! with valsalva for p! exacerbated by respiratory movements involving the diaphragm -Pain on Palpation = Musculoskeletal -Pain with changes in position = Musculoskeletal or Pulmonary -p! that is worse when lying down and that improves when sitting up or leaning forward is often pleuritic in origin

Question 23

Important Points - Cardiac

Answer 23

-RED FLAG = fatigue beyond expectation -be on alert for cardiac risk factors -systolic BP may be low with CHF -cervical disk dx/arthritis can mimic atypical chest pain -if pt uses NG be sure to have on site -Elevated BP common side effect with NSAIDs and ACE inhibitors -Beta blockers may not allow HR to increase - monitor with return to resting within 2 min -No smoking or eating immediately before exercise -RED FLAG = 3lb or greater weight gain + SOB/dizzy -Pericardium is adjacent to diaphragm and p! is experienced in the shoulder because they are both supplied by C5-6 spinal segment -watch for muscle pain, cramps, stiffness, spasms, and weakness that cannot be explained by arthritis, exercise, fever, recent fall or other common causes in patients taking STATINS

Question 24

ACSM Risk Factors for Cardio

Answer 24

1. Family hx of CVD - MI, coronary revascularization or sudden death - before age 55 in father or 1st degree relative - before age 65 in mother or 1st degree relative 2. Cigarette Smoking - current or quit within last 6 mo 3. Hypertension - SBP >/= to 140 or DBP 90 or HTN meds 4. Dyslipidemia - LDL > 130 - HDL < 40 - Total cholesterol >200 mg/dL 5. Fasting Glucose - >/= 100 on 2 separate occasions 6. Obesity - BMI > 30 kg/m2 7. Sedentary lifestyle - persons not meeting the PA guidelines of accumulating 30 min of mod activity most days of the week.

Question 25

Recommendations for Medical Clearance and exercise testing

Answer 25

low risk = men 45 women >55 2 or more risk factors High Risk = known CVD, pulmonary, or metabolic dx s/s of CVD