Lecture One (Cardio)-Exam 1 Flashcards
What is stable angina? Is it common or uncommon? What has not changed?
Stable angina chest pain with stress and activity. It is the most common type of angina in the United States. It follows a pattern that has been consistent for at least 2 months. That means the following factors have not changed:
* How often your angina events occur
* What causes or triggers your angina
* How long your angina events last
* How well your angina responds to rest or medicines
What is Unstable Angina?
does not follow a pattern. It may be new or occur more often and be more painful than stable angina. Unstable angina can occur with or without physical exertion. Rest or medicine may not relieve the pain
Vasospastic Angina (aka Prinzmetal angina)
* What is it characterized by?
* Attributed to what?
* What happens?
* What can it be to?
- Characterized by chest discomfort/pain at rest with transient EKG changes and a prompt response to nitrates
- Attributed to coronary artery spasm
- Transient decrease in the blood supply to the heart
- Can happen due to exposure to cold, exercise. Cocaine use
What are all the causes of Chest pain? (5 groups)
- Cardiac: angina, MI, pericarditis
- Musculoskeletal: costochondritis, rib problem, muscle strain
- Thoracic problem: pleuritis, pneumonia, pulmonary embolism, pneumothorax
- GI: GERD, esophageal contraction disorders, ulcer
- Other: panic attack, anxiety, shingles
Dyspnea
* What is it?
* What are the two types?
Dyspnea – an uncomfortable awareness of breathing, difficult or labored breathing
* Exertional Dyspnea (Most common): Requires the increased demand of exertion to precipitate symptoms
* Dyspnea at rest: Suggests severe cardiac disease
Paroxysmal nocturnal dyspnea
* What is it?
* What is it caused by?
* Suggests what?
Paroxysmal nocturnal dyspnea (Second most common)
* Patient awakening after being asleep or recumbent for 1 hour or more
* Caused by redistribution of body fluids from the lower extremities into the vascular space and back to the heart, resulting in volume overload
* Suggests a more severe condition
Different than sleep apnea
Orthopnea
* What is this?
* What does it increase?
* What does it suggest?
* Documented based on what?
- Dyspnea that occurs immediately on assuming the recumbent position
- Mild increase in venous return before any redistribution
- Suggests even more severe disease
- Documented based on how many pillows used at night
Syncope and Presyncope (described as lightheadedness and/or dizziness)
* What does it indicate?
Indicates a reduction in cerebral blood flow.
* could also be CNS dx, metabolic conditions, dehydration, inner-ear, orthostatic hypotension, arrhythmia, aortic stenosis, HOCM, vasovagal
Syncope and Presyncope (described as lightheadedness and/or dizziness)
* Usually need to ask more what?
Usually need to ask more questions about what precipitated the symptoms:
* Syncope associated with an arrhythmia is usually sudden
* Syncope from AS or orthostatic hypotension could be experienced upon standing from a seated position quickly
* Syncope from inner ear could be changing overall positions
* Syncope from vasovagal would be from bearing down
Edema (Fluid Retention)
* What can peripheral edema be caused by? (3)
- Congestive heart failure
- Valvular heart disease
- Venous insufficiency: Creates issues with lower extremity wounds, ambulation
Edema (Fluid Retention)
What can be cause Abdominal edema/ascites/bloating?
- Valvular heart disease
- Congestive heart failure
- Liver disease : Edema can create abdominal pain, enlarged liver, decreased appetite, diarrhea, jaundice, gut and hepatic dysfunction due to fluid engorgement (hepatic congestion)
When it comes to edema, what is important to ask patients?
Weight gain- important to ask patients about weight gain. How much and over what amount of time?
In order to know which kind of edema, what does it require you to ask?
◦ Timing?
◦ Position changes?
◦ Unilateral (DVT) or bilateral?
◦ Generalized edema or in one area? Onset acute or chronic?
◦ Medication history?
◦ Systemic disease?
What do you need to be worried about with position changes?
* When will edema not improve?
- Dependent edema caused by venous insufficiency improves with elevation or compression hose
- Edema associated with decreased plasma oncotic pressure (malabsorption, liver failure, nephrotic syndrome) does not change with dependency and will only improve once underlying condition addressed
Palpitations
* What is this?
* What cannot be appreciated?
- a subjective sensation of an irregular or abnormal heartbeat
- Normal resting cardiac activity usually cannot be appreciated
Palpitations:
* What does the patient feel?
* What is more and less common causes?
Perceived heart stopping transiently (pausing) or the occurrence of isolated forceful beats or both:
* More commonly caused by premature ventricular contractions PVC’s or PACs
* Pt feels either the compensatory pause or the resultant more forceful subsequent beat or both
* Less commonly caused by SVT or AF ( a sensation of a rapid heart rate that may be regular or irregular)
What is an hpi? What does it start with?
- Chronology of the events leading up to the patient’s current complaints.
- Start with chief complaint (CC) and then ask pertinent questions
Cardiac History:
* What is it important to assess?
Important to assess Cardiac/Atherosclerotic risk factors
* Atherosclerotic cardiovascular disease is the most common form of heart disease in industrialized nations
* Presenting signs and symptoms can range from unimpressive and minimal to sudden death.
What are the risk factors for cardiac disease? (8)
- Early FH of atherosclerotic disease, Men <55 years old, women <65
- DM, uncontrolled. Duration of time with DM
- Lipid disorders (especially elevated LDL)
- HTN, controlled vs uncontrolled
- Smoking
- Functional status: Lack of exercise
- high stress levels
- Obesity
Inspection for cardio:
* What do you need to look at for general appearance
* What are the two different chest wall deformities?
General appearance:
* distress? Skin (temperature, color), nails (splinter hemorrhages, Janeway lesions)
Chest wall deformities:
* Pectus excavatum – sternum sinks into the chest, concave
* Pectus carinatum- sternum projects forward, convex
Inspection for cardio:
* What may not be visible?
* What is used to estimate RA filling pressures? What can it be seen with?
PMI (point of maximal impulse) – may not be visible (feel like a pulse)
* You feel it if heart is enlarged and in HF
JVP – used to estimate RA filling pressures
* Can be seen with right sided HF, pericardial tamponade, PE
Palpations of cardio:
* What does the PMI give an estimate of?
* What is the location?
- Gives estimate on size of the heart
- Location: 4-5th intercostal space (nipple level) in mid clavicular line
Palpation: Thrills
* What is it?
* What does it signify?
* Cen be felt when?
Thrills – palpable murmur (Feels like a vibration, cat purring)
* Signifies at least a grade IV/VI murmur
* Can be felt in disease peripheral arterial vessels as well