pathophysiology Flashcards
pertinent positives
specific symptoms that raise the physician’s suspicion for a particular disease
pertinent negatives
specific symptoms that are not present which lower physicians suspicion for a particular DDx
pathophysiology
the physiological processes causing the symptoms
what is the triple threat?
hypertension, hyperlipidemia, diabetes (high glucose)
effects of chronically high blood glucose
diabetic retinopathy, CVA, renal failure, cardia disease, peripheral vascular disease, neuropathy
effects of chronically high blood pressure
retinopathy, CVA, cardiac disease, CHF, renal failure
effects of chronically high cholesterol
CVA, cardiac disease, pancreatitis
arterial atherosclerosis
accumulation of cholesterol in the blood vessels causes thickening and hardening of vessel walls
describe the pathophysiology of CAD
etiology: narrowing of the coronary arteries causing reduced blood flow to the heart muscle
risk factors: HTN, HLD, DM, smoking, family hx of CAD/MI <55%
chief complaint: angina, modifying factors: worse w exertion, improved w rest and/or nitroglycerin (NTG)
assoc. sx: shortness of breath
meds: NTG to manage angina, acetylsalicylic acid (ASA) to decrease the chance of a blockage
diagnosed by: cardiac catheterization (CAD cannot be diagnosed in the ED)
* a patient has CAD if they have a PMHx of angina, MI, CABG, cardiac stents, or angioplasty
angina
exertional chest pain or chest pressure specifically caused by decreased blood flow to the heart
describe the pathophysiology of MI
etiology: acute blockage the coronary arteries causing ischemia or infarct to the heart muscle
risks: CAD, HTN, HLD, DM, smoking, FHx of CAD <55%
chief complaint: chest pain or chest pressure, modifying factors: worse w exertion, improved w rest or NTG
assoc. sx: diaphoresis, N/V, shortness of breath
meds: aspirin or ASA, NTG, thrombolytic (heparin)
diagnosed by: STEMI - diagnosed by EKG or Non-STEMI - diagnosed by elevated troponin
*note ED arrival time, EKG time, ASA time, cath lab departure time, STEMI pt must get to cath lab w/in 90 min of arrival
describe the pathophysiology of CHF (congestive heart failure)
etiology: heart becomes enlarged, inefficient, and congested with excess fluid
risk factors: Hx of CHF, HTN, HLD, DM, kidney disease, smoking
chief complaint: shortness of breath, modifying factors: worse w lying flat (orthopnea), worse w exertion (dyspnea on exertion), and episodically worse at night (paroxysmal nocturnal dyspnea (PND))
assoc. sx: bilateral lower extremity swelling, fatigue, cough
meds: diuretics (lasix/furosemide)–> urinate extra fluid
PE: rales (crackles) in lungs, jugular vein distention (JVD), pedal edema
diagnosed by: CXR and elevated BNP (B-type natriuretic peptide)
*if pt has FHx of CHF, document current dosage of lasix, search echo and document the cardiac output (EF or ejection fraction) and cardiac valve function
describe the pathophysiology of atrial fibrillation (A Fib)
etiology: electrical abnormalities in the “wiring” of the heart causes atria to quiver abnormally
risk factors: paroxysmal A Fib, chronic A Fib, alcoholism
chief complaint: palpitations (fast, pounding, irregular)
assoc. sx: global weakness, fatigue, lightheadedness
meds: coumadin/warfarin (blood thinner) and digoxin (slows HR)
PE: irregularly irregular rhythm
diagnosed by: ECG/EKG
*ED concern is rapid ventricular response (RVR) which is Afib with a rate greater than 100bpm. pt who have Afib are at increased risk for blood clots and often take a blood thinner
describe the pathophysiology of pulmonary embolism (PE)
etiology: a blood clot becomes lodged in the pulmonary artery and blocks blood flow to the lungs
risk factors: known DVT, PMHx of DVT or PE, recent surgery, cancer, AFib, immobility, pregnancy, BCP (birth control pills), smoking
chief complaint: chest pain; modifying factor: worse w deep breaths (pleuritic)
assoc. sx: shortness of breath, pt often hypoxic (low oxygen saturation), tachycardic (high HR)
diagnosed by: screening tool - D-Dimer; diagnostic tool - CTA chest (CT chest w/ IV contrast)
**DVT is a blood clot in an extremity (not lungs). sx of DVT include extremity pain and swelling and has same risk factors as PE. A DVT is diagnosed by an ultrasound of that extremity
