Screening for Cardiac Disease Flashcards
1
Q
screen vs examination
A
SCREEN - for referral to medical practitioner for more info
EXAMINATION - for care related to previously diagnosed cardiac dysfunction
2
Q
how many deaths per year d/t CVD
A
1million deaths/yr
3
Q
how common is CVD
A
1 in 3 Americans
4
Q
what are common sx reported to PT (9)
A
- fatigue/poor exercise tolerance
- peripheral edema
- chest, shoulder, back neck, jaw, arm pain
- n/v
- DOE
- loss of body hair
- cyanosis (lips, nails, nose, earlobes)
- HA (suboccipital and temporal)
- dizziness/syncope
5
Q
why are HA a common sx of cardiac dz
A
due to HTN
6
Q
why is dizziness/syncope a common sx of cardiac dz
A
due to arrhythmias
7
Q
what are the biggest signs of cardiac dz in most general of terms
A
anything worse w exercise, better w rest, and belly up
8
Q
what are modifiable risk factors for CAD
A
HTN
HLD
smoking
obesity
stress
diabetes
inactivity
9
Q
what modifiable risk factors for CAD are part of metabolic syndrome
A
HTN
HLD
obesity
DM
10
Q
what are non-modifiable risk factors for CAD
A
age
gender
genetics / socioeconomic factors
11
Q
what risk factors seen in a woman might inc their risk of CAD at a minimum age of 35yo
A
taking birth control pills
smoking
12
Q
at ethnicities inc the risk of CAD
A
african american
mexican american
native american
pacific islander
13
Q
what are constitutional sx of CAD (8)
A
n/v
diarrhea
malaise/fatigue
fever
night sweats
pallor
diaphoresis
dizziness
14
Q
who should be screened for cardiac dz?
A
anyone w one or more risk factors
15
Q
initial steps for screening a person for cardiac dz
A
PMH
med review
VS
- HR
- bp
- RR
- temp
16
Q
activity recommendations for HR <60bpm
A
okay to exercise if not symptomatic and normal ECG
- refer to MD if sx
17
Q
activity recommendations if HR 100-150
A
100-120 - yellow flag
120-150
- precaution to initiating exercise
- refer to MD
18
Q
activity recommendations if HR >150bpm
A
contraindication to any exercise/activity
19
Q
activity recommendations for DBP <70
A
no action if not symptomatic
20
Q
at what DBP inc you risk of CAD
A
> 90
21
Q
activity recommendations for DBP >115
A
contraindication to activity/exercise
- refer to MD
22
Q
activity recommendations for SBP <90
A
no action if not sx
- refer to MD if sx
23
Q
activity recommendations if SBP 150-160
A
yellow flag
24
Q
activity recommendations if SBP >160
A
check w MD
25
activity recommendations if SBP >200
contraindication to initiating exercise
- refer to MD
26
activity recommendations if temp >100
consider deferring exercise
27
activity recommendations if temp >101
no exercise
- functional activity is one thing
- not aerobic exercise tho
28
activity recommendations if temp 100-101
yellow flag
29
what are the most common CV dx that mimic sx of NMS
MI
angina
pericarditis
AAA
30
what is the pathophysiology CAD
problem w blood supply to heart
31
when do you start seeing sx for CAD
75% occlusion of coronary artery
32
how long can angina last
1-3min
33
how is angina relieved
rest and nitroglycerine
34
what is a consideration when a pt is taking nitroglycerine
potent vasodilator
- should be sitting or laying down when taking it
35
what is the etiology behind atypical or transmittal angina
coronary spasm
- this is usually pretty rare
36
what are s/sx for angina (6)
1. gripping, vise pain or pressure substernal (80-90%)
2. neck, back, jaw, shoulder, or arm pain
3. indigestion
4. dyspnea
5. nausea
6. belching
37
what are the most concerning forms of CAD
nonocclusive and asymptomatic
- scary bc lethal
- not presenting any sx
38
what is one characteristic of MIs
more likely in the AM
- related to circadian rhythms
39
s/sx of an MI
angina w nitro not helping
angina sx and
- diaphoretic
- asystole
40
how do females typically present w an MI
more subtle sx
less chest sx than men
heaviness and weakness in arms
sx can start 1mo before event
"flu sx" - fatigue, nausea, lower belly pain
41
why is sex an important factor to consider when screening for cardiac dz
females more atypical angina sx
female MI s/sx more subtle
42
what are causes of pericarditis (4)
secondary to infection related to usually viral (bacterial is less common)
- HIV
- TB
- influenza
can be related to recent MI, chest crushing injury (MVA), open cardiac surgery
43
s/sx of pericarditis (7)
anginal pattern
difficulty swallowing
cough
LE edema (feet and ankles)
hx of fevers, chills, recent MI
pain > DB, cough, laugh, lying down, trunk movements (rotation, flexion)
pain < leaning forward, sitting up straight (trunk ext), holding breath
44
what are the 3 types of CHF
left
right
diastolic
45
what inc the risk of CHF
age
46
diastolic CHF presentation
sx are pretty similar, esp left CHF
- can't tell difference clinically without a cardiac US
47
why do you see edema in CHF
renin-angiotensin system
48
L vs R CHF
L - backs up into lungs
R - backs up into periphery
treat them differently
49
s/sx of L CHF (6)
pulmonary issues
fatigue/DOE
cough - persistent, spasmodic, worse lying down
orthopnea
tachycardia
ms weakness
edema/wt gain - 3lbs in a day
50
s/sx of R CHF (5)
can occur w L CHF
fatigue
dependent edema
pitting edema (5-10# fluid)
R UQ pain
cyanosis of nails
51
s/sx of diastolic CHF (4)
stiff heart ms
fatigue and DOE
orthopnea
edema
jugular v. distention
52
risk factors for AAA (4)
smoking
CAD
Marfans syndrome
HTN
53
when is medical screening for AAA recommended
US for men 65-75yo
>50yo and sx
54
abdominal palpation screen for AAA
b/w xiphoid process and umbilicus to left
- AAA = bounding HR
- normal = faint
55
if found an AAA during abdominal palpation screen, what is the next step
refer them back
- usually MDs won't do anything surgical, just keep an eye on it
56
flag for AAA rupture
red flag - medical emergency
57
s/sx of AAA (2)
pain in low back, hip, groin, gluts
abdominal heartbeat
58
s/sx of AAA rupture (4)
severe pain
no change in pain w positioning
BP - systolic drop <100 (not previous)
pulse changes (>100bpm)
59
why do we screen for hyperlipidemia
usually clustered w other cardiac issues
60
what are s/sx for valve dz (8)
fatigue
dyspnea
palpitations
chest pain
pitting edema
orthopnea
dizziness
syncope
61
what is the significance of having a valve dz and HF
dec CO
62
what are types of valve dz (4)
rhematic fever
endocarditis
lupus carditis
mitral valve prolapse (MVP)
63
what population do you typically see rheumatic fever in
children
64
how is rheumatic fever a valve disease
stretp infection scars valves
65
endocarditis additional sx besides general valve dz sx
MS sx
- joint and back pain
66
what is endocarditis
bacterial or viral vegetations on the heart valves
- can cause an issue for valves acutely or later
67
what is lupus carditis
related to lupus w general valve sx
68
what valve dz is the most common
MVP
69
presentation of MVP
2/3 have no sx
1/3 have sx
70
implications for other procedures if have MVP
may prescribe antibiotics
- even for routine procedures (ie teeth cleaning)
- surgery
71
what is afib's defining characteristic
irregularly irregular
72
risk factors for afib
same as cardiac
h pylori (GI)
73
sx of afib (7)
palpitations
pounding
dyspnea
anxiety
dizziness
chest pain
fatigue
74
why do you see fatigue in afib
dec CO
- losing 10-20% of atrial kick
75
what does having afib inc your risk of
blood clot migration
76
pacemaker cells lifespan
10% left at 80yo
77
s/sx of sinus tachycardia (4)
HR >100
palpitations
anxiety
chest pain
78
s/sx of sinus bradycardia (3)
HR <60
syncope
LOC
79
3 cardiac nervous system issues
afib
sinus tachy
sinus brady
80
what is a TIA
mini stroke
lasts 5-20min
stroke sx resolve quickly
81
what 3 CV disorders can a BP screen r/o
HTN - take initial BP
OH - BP drops, pulse inc
TIA
82
s/sx of arterial occlusive dz (6)
intermittent claudication
burning pain
skin color/temp changes in distal extremities
loss of hair on limbs
ulcerations
sx dec w dependent position
83
sx of a DVT (4)
leg pain (unilateral)
swelling
warmth
pain
thinking Wells criteria
84
sx of lymphedema (4)
edema on dorsum of extremities
sx inc w dependent position
heavy or full feeling
loss of motion (function)
85
sx of Raynoud's (4)
at digits
pallor
cyanosis
cold
intense redness
86
statin SE
seen in 5-18%
myalgia
rhabdomyolysis - dark urine, weakness
87
what are emerging SE of statins
ms and tendon degradation
88
how to r/o exercise induced fatigue from med related sx of statins
exercise induced - 24-48hrs to resolve
- related to ms worked
statin induced >48hrs to resolve
- not related to ms worked
89
pathophys of SE from diuretics
electrolyte imbalances -> fluid shifts -> HoTN
90
SE of diuretics (5)
ms weakness
HA
ms cramps/spasms
dizziness
nausea
91
why would a pt be taking a daily low does of ASA
preventing thromboembolism
seen in at risk pts
92
SE of ASA
bleeding and bruising risk
- careful w hands on techniques
93
what is a consideration for long term usage of statins
want to monitor over time
- monitor liver enzymes
- monitor creatinine kinase levels
94
what lab values will cause cardiac dysfunction
potassium
sodium
calcium
magnesium (less common)
95
what cardiac dysfunction do you see caused by K, Na, C, Mg imbalances
arrhythmias
- K (inc can be lethal) & Na primarily
- Ca & Mg long term
96
what electrolyte imbalances are significant for PT implications
K red flag if <3 ore >6
Na red flag if <125 or >150
97
what causes K imbalances
loss w:
- diuretics
- vomiting
- sweating
- diarrhea
inc w:
- renal and endocrine problems
- medication errors
98
what causes Na imbalances
loss w:
- water overload
- diuretics
- vomiting
- diarrhea
inc w:
- dehydration
- food intake
99
what causes Ca imbalances
loss w:
- transfusions
- renal failure
- laxative or antacid abuse
- parathyroid dz
inc less common
100
what causes Mg imbalances
less common overall
loss w:
- alcoholism
- K and Ca loss
101
what are 7 red flags for immediate medical attention
sudden intermittent claudication
- thromboembolism
DVT sx
TIA
angina if no sx dec after 3min rest
3 nitro and no relief/worsening
angina changes - worsening sx
MI
102
what patient should be referred to be soon but not necessarily urgently
doesn't fit a pattern
103
what are 5 cardiac screening questions to ask if hx of
high bp
heart problems
heart palpations
heart murmur
angina/chest pain
