Orientation Week Flashcards
Peripheral Vascular Symptoms
- Diseases that involve arteries, veins, lymphatic
- Can be assessed via pulses
Peripheral venous Insufficiency
- The body can’t get blood from the extremities back to the heart (DVT).
- Stasis ulceration, painless, occurs at ankle area or lower leg just above the medial malleolus
Peripheral arterial insufficiency
- Intermittent claudication
- Decreased or absent pulses
- Pale color when elevated, red when lowered, cool temp.
- No or mild edema, thin shiny , loss hair over foot/toes, nail thickening.
- Ulceration on toes or areas of trauma on feet, painful ulcers, gangrene may develop, compression not used
Asymptomatic Arterial Narrowing
- Asymptomatic
- Not presenting with any clinical problems
- May suffer from atherosclerotic plaques etc
Symptomatic Arterial narrowing
- Predictable
- Relieved by rest
Intermittent Claudication
- Pain in the leg muscles that occurs during exercise and is relieved by rest.
- Especially calf but if issue more proximal also thigh.
- Condition seen in peripheral arterial disease
Critical Limb Ischaemia
- Increasingly severe symptoms
- Onset of symptoms with less exertion
- Pain at rest
Claudication Distance
Distance pt can walk before onset of symptoms
Acute Limb Ischaemia
- Complete Arterial Occlusion
- Present with 6 Ps
What are the 6 P’s?
- pale
- pulseless
- painful
- paralysed
- paraesthetic
- perishing with cold
Clarifying Symptoms
- Speed of onset
- Duration and frequency of symptoms
- Severity (1-10)
- Character of pain.
- How do they experience pain
- Radiation (where does pain go to)
- Has pain changed
- Associated symptoms (vomiting, collapsing, shortness of breath)
- Aggravating and relieving symptoms
- Effect on QofL (impact on family life, employment etc)
Non-modifiable risk factors
- Age
- Ethnicity
- Sex
- Personal/Family History of CVD
- Low Birth Weight
Modifiable risk factors
- Hypertension
- Hyperlipidaemia
- Diabetes
- Obesity
- Smoking
- Sedentary lifestyle
Past Medical History
- Medical conditions
- Visits to the Dr
- Investigations
- Procedures
- Operations
- Any problems On-going/fully-resolved/managed by medication
Diabetes
- Managing blood sugar is not everything, will only marginally lower CVD risk.
- Also have to look at cholesterol etc.
What is the most common cause of secondary hypertension?
Renal Disease
What is Hypertension?
- Abnormally high blood pressure
- Asymptomatic
- Affects heart, kidneys and other organs
Primary hypertension
- No known cause
- Most common
Secondary hypertension
High blood pressure caused by the effects of another disease (e.g., kidney disease)
Hyperthyroidism
- A disorder caused by a thyroid gland that is faster than normal and overly productive
- Results in a rapid pulse, nervousness, and loss of weight
Hypercholesterolaemia
Too much cholesterol in blood can lead to atherosclerosis
What is a True allergy?
Any med that causes a rash, itching, swelling, or difficulty breathing, otherwise it is an adverse reaction
List 5 Chest Pain Causes?
- Cardiovascular
- Respiratory - cancer, embolus
- Upper GI - oesophageal disease
- Musculoskeletal - trauma (broken rib)
- Other - Herpes Zoster
Stable angina
- Chest pain or pressure precipitated by activities such as exercise or emotional stress which increase myocardial oxygen demand
- NOT an acute coronary syndrome
- Predictable in onset
- Reproducible
- Relieved by rest/GTN
Examples of Acute Coronary Syndromes
- Unstable Angina
- Acute MI (NSTEMI & STEMI)
Coronary Artery Spasm
- Variant Angina
- Occurs during rest, often at night
Costochondritis
An inflammation of the cartilage that connects a rib to the sternum
Angina
Narrowing of coronary arteries so that when heart rate increases there is not enough blood flow to meet the O2 demands of heart muscle
GTN
- Glyceryl Trinitrate Spray
- Used as vasodilator for treatment of angina
Acute Myocardial Infarct
- Can differentiate from unstable angina through tests
- Blood test will show troponin release
- ECG have to look at ST elevation
Pericarditis
- Inflammation of pericardium
- Viral/MI/TB/uraemia/malignany etc
- Sharp/retrosternal pain
- Relieved by sitting forwards
Aortic Dissection
- Sudden and severe
- Tearing of the inside of the aorta causing deep pain
- Radiates to left shoulder/back
Dyspnoea
- Shortness of breath
- Acute, chronic or acute-on-chronic
- 2 types in cardiac failure: orthopnoea/PND
- Venous return is higher when lying down so get leaky pulmonary vessels resulting in fluid build up in lung tissues.
Orthopnoea
- Shortness of breath (dyspnea) from lying flat.
- Relieved by patient being propped up in bed or sitting in a chair.
Paroxysmal Nocturnal dyspnoea
- Awakening from sleep with dyspnoea and needing to be upright to achieve comfort.
- Feel like they’re suffocating.
Palpitations
- Feeling a heart-racing, pounding, or fluttering sensation in the chest
- Uncomfortable sensations in the chest related to cardiac arrhythmias, such as premature ventricular contractions (PVCs)
- Ask the pt to tap it out
Arrhythmia
- Abnormal heart rhythm
- NOT all pts experience palpitations!
Extrasystoles
- Extra beats of the heart
- Ventricular or atrial
- Heart jumps or ‘flutters’
Atrial fibrillation
- May be unnoticed
- Heart jumping about or racing
- Associated breathlessness
Supraventricular Tachycardia
- Heart racing or fluttering
- Associated polyuria
Ventricular Tachycardia
- Heart racing or fluttering
- Associated breathlessness
- May be present as syncope rather than palpitations
- A very rapid heartbeat that begins within the ventricles
Dizziness and Syncope
- Postural hypotension
- Neurocardiogenic (vasovagal)
- Micturition syncope
- Cardiac arrhythmias
- Mechanical obstruction to cardiac output
Oedema
- Abnormal accumulation of fluid in interstitial spaces
- Uni/Bilateral
Pitting oedema
Oedema thats demonstrated by applying pressure to the skin causing a lasting indentation.
Fatigue
- Lots of different causes
- Side effect of beta blockers
Axillary Nodes
- Lymphatic drainage of breast and other structures superficial to the thoracic wall
Pec Major
- Clavicle, costal cartilage and sternum to intertubercular groove of humerus
- Shoulder flexion and adduction
Pec Minor
- Ribs 3, 4, 5 to the coracoid process
- Stabilises scapula
- Landmark for axillary artery and brachial plexus
Latissimus Dorsi
- Iliac Crest, lower thoracic and lumbar vertebral spines to humerus
- Shoulder extension and adduction
Serratus anterior
- Upper 8 ribs to medial border of scapula
- Scapular protraction and rotation in shoulder abduction
Breast
- Mammary gland in females
- Glandular tissue in fibro-fatty stroma
- 16 or so ducts converging on nipple
- Lie opposite to ribs 2-6
- Tail extending into axilla
- Blood supply from axillary and internal thoracic arteries
- Lymph drainage to axillary and internal thoracic nodes
Tumour Spread
- Breast lymph drainage described in 3 levels of severity for tumour spread into the axillary nodes Level 1: anterior or pectoral group Level 2: central group Level 3: Apical group - Can also spread to internal nodes
Functions of thoracic wall
- Respiratory movements: ribs, costal cartilages and intercostal movements, diaphragm
- Protects major organs
- Connects neck to upper limbs and abdomen
Pump Handle Inspiration
Rib elevation to push the sternum up and forward to increase thoracic anteriorposterior diameter
Bucket Handle inspiration
When additional increase in lateral diameter by rib eversion is required during enforced inspiration
Intercostal Muscles
- Between ribs
- Raise the ribs in inspiration but some may act in forced expiration to help lower the ribs
- Intercostal neurovascular bundle at the lower edge of the rib (important for chest drain insertion)
Thoracic Inlet
- T1, 1st ribs and costal cartilages and manubrium
- Slopes antero-inferiorly
Apex of lung
Extends upwards to the level of T1 and neck of 1st rib
Structures that cross 1st rib
- Brachial plexus
- Subclavian artery and vein
Structures that pass through the thoracic inlet?
Pass between the thorax and the upper limb From anterior to posterior: -Subclavian vein (scalenus anterior) -Subclavian artery -Inferior trunk of the brachial plexus
Pass between the thorax and neck
- Vessels that supply and drain the head and neck
- Trachea
- Oesophagus
- Nerves (right and left vagus, recurrent laryngeal, right and left phrenic nerves)
Thoracic outlet syndrome
- Compression of the neurovascular bundle as it exits the thoracic outlet
- Clincians call inlet the outlet as vessels move out of it
Dysplastic first rib
- Can cause chronic trauma to the subclavian artery resulting in dissection and aneurysm
- Trauma can then cause embolisation to the forearm
Thoracic Outlet
- Closed by diaphragm
- T12
- 12th and 11th ribs
- Costal cartilages of ribs 10, 9, 8 ,7
- Xiphoid cartilage
Structures passing through diaphragm
"I ATE 10 eggs at 12" T8 caval opening: -IVC -Right phrenic nerve T10 oesophageal opening: -Oesophagus -Vagal trunks -Left gastric vessels T12 aortic hiatus: -Aorta -Azygos vein -Thoracic duct
Body Cavitities
Lined by serous membranes with miniscule layer of fluid, lubricated potential space, friction free
Parietal and visceral layer
Thorax:
- lungs and chest wall lined by pleura
- Heart surrounded by pericardium
Abdomen and pelvis lined by peritoneum
Allows movement, expansion, contraction of organs
Pleura
- Subdivided into mediastinal, diaphragmatic, costal and apex
- Extends all the way down to 10th rib
Costodiaphragmatic recess
- The lower area of the pleural cavity into which the lung expands on inspiration
- Potential space between lung and diaphragm