Screening for Cardiovascular Disease Flashcards
List risk factors for cardiovascular disease
- advancing age
- HTN
- obesity
- sedentary lifestyle
- excessive alcohol consumption
- oral contraceptive use
- over 35+ smoking
- first-generation family history
- tobacco use
- abnormal cholesterol levels
- race
- african americans
- mexican americans
- native americans
- pacific islanders
vascular pain descriptors
- throbbing
- pounding
- pulsing
- beating
S/S of cardiovascular disease
- chest pain or discomfort
- palpitation
- dyspnea
- cardiac syncope
- fatigue
- cough
- cyanosis
- edema
- claudication
- vital signs
describe chest pain or discomfort
can be cardiac or non-cardiac in nature
- may radiate to neck, jaw, upper trap, upper back, shoulder or arms (most commonly L arm)
- radiating pain in the arm follows the ulnar nerve distribution
describe cardiac-related chest pain
- can occur secondary to:
- angina
- MI
- pericarditis
- endocarditis
- dissecting aortic aneurysm
- often accompanied by:
- N/V
- diaphoresis
- dyspnea
- fatigue
- pallor or syncope
describe non-cardiac related chest pain
- can occur secondary to:
- cervical disc disease with arthritic changes
- anxiety
- pec strain
- rib dysfunction
- trigger points
what are palpitations?
the presence of an irregular heartbeat
- described as bump, pound, jump, flop, flutter or racing sensation of the heart
- may be associated with lightheadedness or syncope
when would palpitations require more attention?
- when lasting hours with pain, SOB, fainting or severe lightheadedness require medical evaluation
- also requires immediate referral in pt with positive family history of unexplained sudden death
- more than 6 palpitations occuring in a minute should be reported to the physician
when would dyspnea require a referral?
if a pt cannot climb a single flight of stairs w/o feeling moderately to severely winded
OR
a pt who reports waking at night SOB or experiencing SOB when lying down
when would syncope require a referral?
medical referral requried for unexplained syncope
when would you need to closely monitor a pt experiencing fatigue?
when the fatigue exceeds normal expectations during or after exercises
- espeically in pts with cardiac conditions
- be sure to monitor vital signs
when is edema a red flag for CHF?
when there is a 3-lb or greater weight gain or gradual, continuous gain over several days causing swelling in ankles, abdomen and hands espeically in the presence of SOB, fatigue and dizziness
when does edema require a medical referral?
edema and other accompanying symptoms that persists with rest
- JVD and cyanosis = accompanying symptoms
what is claudication?
leg pain that occurs with PVD
when does claudication require a medical referral?
abrupt onset of ischemic resting pain or sudden worsening of claudication
abnormal vital signs responses
- HR that is too high/low
- irregular pulse rate
- SBP does not rise progressively with work level
- SBP that falls during exercise
- change in diastolic pressure greater than 10 mm Hg
what are the most common heart conditions to minimc MSK dysfunction?
- angina
- MI
- pericarditis
- dissecting aortic aneurysm
what is CAD?
Coronary Artery Disease
- narrowing or blocking of a coronary artery
- can result in ischemia, injury and infarcation to muscle supplied by the artery
- can manifest as angina pectoris and MI
list modifiable risk factors for CAD
- physical inactivity
- smoking
- hyperlipidemia
- high BP
- DM
- obesity
non-modifiable risk factors for CAD
- 65 years or older
- male
- family history
- race
- postmenopausal female
contributing factors for CAD
- response to stress
- personality
- PVD
- hormonal status
- alcohol consumption
- obesity
what S/S should PTs be aware of for pts taking statins?
- myalgia
- arthralgia
- rhabdomyolysis
- also important to screen for liver impairments
what is angina?
a symptom of obstructed or decreased blood flow to heart muscle
Clinical S/S of angina
- gripping, viselike feeling of pain or pressure behind the breast bone
- pain that may radiate to the neck, jaw, back, shoulder, or arms
- most commonly L arm in men
- toothache
- burning indigestion
- dyspnea, exercise intolerance
- nausea
- belching
- females may report extreme fatigue, lethargy, breathlessness, or weakness
when would angina be considered a red flag?
lack of objective MSK findings
- AROM does not reproduce the symptoms
- resisted motions do not reproduce symptoms
- onset of symptoms occurs withn 5-10 minutes of activity and not immediately
what is an MI?
development of ischemia and necrosis of myocardial tissue
Clinical S/S of MI
- prolonged or severe substernal chest pain or squeezing pressure
- pain radiating down one or both arms or up to throat, neck, back, jaw, shoulders, or arms
- feeling nausea or indigestion
- angina lasting for 30 mins or more
- angina unrelieved by rest, NO, or antacids
- pallor
- diaphoresis
- SOB
- weakness, numbness and feelings of faintness
what are splinter hemorrhages?
red-brown, linear streaks in nail beds
- may be sign of silent MI or pt may have hx of MI
- systemic conditions
- bacterial endocarditis
- vasculitis
- renal failure
describe atypical symptoms of heart disease in women
- unexplained, severe episodic fatigue
- weakness
- trouble sleeping
questions for women who are presenting with atypical S/S of an MI
In the past month, have you experienced any of the following:
- unusual fatigue
- sleep disturbance
- dyspnea
- indigestion or GERD
- anxiety
- heart racing
- arm weakness or heaviness
what is pericarditis?
inflammation of the pericardium
all of the following can be causes of pericarditis:
- MI
- chest injury
- chest radiation
- cardiac surgery
Clinical S/S of Pericarditis
- chest pain
- dyspnea
- increased pulse rate
- rise in temp
- malaise
- myalgia
- made worse/reproduced with coughing
- impacted by several positions
- reports pain to be sharp or cutting
list 3 items that help differentiate between angina and pericarditis
In pericarditis, the pt will:
- report symptoms made worse with coughing
- may be relieved by:
- quadruped position
- leaning forward
- sitting upright
- made worse with:
- breathing
- swallowing
- belching
- neck/trunk movement
what is an aneursym?
abnormal dilation in wall of artery, vein or heart
- designated as either venous or arterial
- described by the vessel in which they develop
list and describe 2 types of aneursyms
- Thoracic aneurysms
- invovle ascending, transverse, or descending portion of aorta from heart to top of diaphragm
- Abdominal aneurysms
- aorta below the diaphragm between the renal arterries and iliac branches
describe AAA
abdominal aortic aneurysm
- defined as vessel diameter >3 cm or more
- risk of rupture increases as diameter approaches 5-6 cm
- most are asymptomatic
- if symptoms are present → most common is a pulsating mass in abdomen
what is the most common site for an AAA?
just below the kidney immediately below the renal arteries
referring pain to TLJ
list risk factors for AAA
- age (60 and older)
- male
- history of smoking
- history of hypercholesterol and CHD
- family history of AAA
Clinical S/S of AAA
- Main symptoms
- pulsating mass in abdomen
- abdominal “heartbeat” felt when lying down
- nonmechanical properties
- may report early satiety, weight loss and nausea
- Other symptoms
- if pain present → back pain
- abdominal, hip, groin, or buttock pain also possible
- insidious onset
- sharp, intense, severe or knifelike
Clinical S/S of ruptured aneurysm
- pain described as tearing/ripping
- sudden and severe chest pain with a tearing sensation
what is CHF?
condition in which the heart is unable to pump enough blood to meet metabolic needs
failure of 1 ventricle almost always leads to failure of the other (ventricular independence)
Briefly describe how R vs L ventricular HF look different
- R ventricular failure
- edema in LE and viscera
- pitting edema
- L ventricular failure
- pulmonary congestion/edema
- problems with respiratory control
Clinical S/S of CHF
- 3-lb rule
- swelling in ankles, abdomen and hands
- pitting edema
- SOB
- fatigue and dizziness
- jugular distension
in early stages of heart valvular disease how may the pt present?
easily and early fatigue
in later stages of heart valvular disease how may the pt present?
breathless and dyspnic
what is endocarditis?
- heart infection that causes inflammation of cardiac endothelium and damages the tricuspid, aortic or mitral valves
T/F: a skin or oral infection can lead to endocarditis
TRUE
up to half of endocarditis pts initial present with _________
MSK problems
with half of these pts ONLY having MSK symptoms with no other signs of endocarditis
Clinical S/S of endocarditis
- Most prominent:
- arthralgia → proximal joints
- Other
- arthritis
- myalgias
- LBP/SI pain
- splinter hemorrhages
- constitutional symptoms
- dyspnea/chest pain
List several conditions that affect the cardiac nervous system
- Fibrillation
- irregular heartbeat
- ventricular fibrillation → potentially arrhythmia
- Tachycardia
- >100 bpm
- Bradycardia
- <60 bpm
what is the most common arrhythmia?
Atrial Fibrillation
List Cardiovascular Disorders
- HTN
- Transient Ischemic Attack
- Peripheral Arterial Disease
- Venous Disorders
- Vertebrobasilar Insufficiency (VBI)
- Cervical Arterial Dissection (CAD)
Clinical S/S of HTN
- Occipital HA
- Dizziness
- Flushed face
- Spontaneous epistaxis
- Vision changes
- Nocturnal urinary frequency
HTN guidelines
- >60 years old = 150/90
- <60 years old = 140/90
- pts >18 years old with chronic kidney disease or DM = 140/90
when would BP changes require cessation of activity an immeidate medical referral?
BP changes in the presence of:
- unstable angina
- dizziness
- nausea
- pallor
- extreme diaphoresis at rest or during activity
when would a single BP reading merit a referral?
if it occurs in the presence of the following S/S:
- HA
- dizziness
- flushed face
- spontaneous epistaxis
- vision changes
- noctural urinary frequency
List abdnormal BP reponses to physical activity/exercise
- DBP increases more than 10 with activity
- SBP does not rise or it falls (>10) with increased workload
- SBP exceeds 200
- DBP exceeds 100
what is a TIA?
- transient ischemic attack
- temporary disruption of blood supply to a part of the brain
- requires immediate medical referral
Clinical S/S of TIA
- slurred or difficulty with speech or difficulty understanding others
- sudden confusion
- temporary blindness or other dramatic visual changes
- dizziness
- sudden severe HA
- paralysis or extreme weakness usually unilaterally
- difficulty walking, LOB of loss of coordination
what is PAD?
- Peripheral Arterial Disease
- narrowing of the peripheral arteries
- most common symptoms
- intermittent claudication
- ischemic at rest
- other common complications
- ulceration
- gangrene
Clinical S/S of PAD
- intermittent claudication
- burning, ischemic pain at rest
- rest pain
- aggravated by elevated legs
- relieved by placing leg in dependent position
- decreased skin temp
- dry, scaly or shiny skin
- poor hair/nail growth
List and describe 2 types of venous disorders
- Acute Venous Disorder → DVT
- Chronic Venous Disorder → Postphletbitic syndrome
what is postphebletic syndrome?
- a chronic venous disorder
- ID by chronic swollen limbs
- thick, coarse, brownish skin around the ankles
- venous stasis ulcers
Risk Factors for DVT
- Previous hx of DVT
- Hx of cancer
- Hx of CHF
- Hx of SLE
- Receiving chemo
- major surgery
- major trauma
- immobility
- limb paralysis
- women during pregnancy
- women taking oral contraceptives, HRT
- age > 60
Clinical manifestations of DVT
- ache, tightness, tenderness
- general edema
- pitting edema
- prominent superficial venous plexus
- increased local skin temp
what is VBI?
Vertebrobasilar Insufficency
- compromise of vertebral arteries, resulting in occlusion or damage
- symptoms sudden in onset and are typically brief
- cervical rotation and extension can occlude if pathology is present
What are the 5Ds and 3Ns associated with VBI?
- 5Ds
- Dizziness
- Drop attacks
- Dysarthria
- Dysphagia
- Diplopia
- 3Ns
- Nausea
- Numbness
- Nystagmus
list additional S/S other than the 5Ds and 3Ns of VBI
vertigo, nausea, and HA
described as subtle, intermittent and chronic in nature
what is CAD?
Cervical Arterial Dissection
- tear or hematoma in wall of internal carotid or vertebral artery
- can occur sponataneously or secondary to minor trauma
- most common to occur between 35-50 years
- precipitating events could be:
- mechanical trauma
- infection
- pro-inflammatory state
describe the early clinical presentation of CAD
- Neck pain or HA
- may mimic migraine or MSK disorder
- described as unusual, different to any previously experienced
- 5Ds may be present/preceed
- symptoms worsen over hours/days
Clues to Screening for Cardiovascular Involvment
- Presentation of chest, breast, neck, jaw, back or shoulder pain
- personal/family hx of heart disease
- age >65
- postmenopausal women
- presence of cardiovascular S/S
- onset of pain in pattern associated with angina with 5-10 min lag in response to physical exertion
- upper quadrant pain induced with lower quadrant activity
- insidious onset of joint/muscle pain in pt dx with heart murmur
- throbbing pain at base of neck and/or along the back of interscapular area that increases with exertion
Chest pain of non-cardiac origin
- pain on palpation (MSK origin)
- pain alleviated or increased with body movements
- exception → pericarditis
- chest pain can occur secondary to trauma to intercostals from coughing
- reproduction of symptoms in pain pattern associated with angina that begins immediately is more likely MSK in nature
- presence of trigger point in chest wall that reproduces symptoms with palpation and symptoms are eliminated with trigger point deactivation
Guidelines for immediate medical attention
- sudden worsening of intermittent claudication
- suspicion of DVT
- anginal attack/changes in the pattern of angina
- symptoms of TIA
- S/S of MI
Guidelines for MD referral
- women with chest/breat pain w/+ cardiovascular family hx
- palpitations in pts w/hx of unexplained sudden death in family/prolonged episode of palpitations
- anyone who cannot climb a single flight of stairs w/o feeling moderate/severely winded
- 3-lb or greater weight gain or gradual, continuous gain over several days
- SOB while lying down
- Syncope w/o warning
