Screening for Cardiovascular Disease Flashcards
What are the three main known risk factors for cardiovascular disease (CVD)?
- hypertension
- smoking
- high cholesterol
What percentage of Americans have at least one of the known risk factors for CVD?
47% of Americans have at least one known risk factor for CVD.
What is the leading cause of death in industrialized nations?
Cardiovascular disease (CVD).
What are modifiable and non-modifiable risk factors for CVD?
Modifiable: Hypertension, obesity, sedentary lifestyle, excessive alcohol consumption, oral contraceptive use (in women over 35 who smoke), tobacco use, abnormal cholesterol levels.
Non-modifiable: advancing age, first-generation family history, race
What areas can cardiac pain radiate to due to multi-segmental innervation?
- neck, jaw
- upper trapezius
- shoulder
- back
- arm (following ulnar nerve distribution)
What are common symptoms that accompany cardiac pain?
- nausea
- vomiting
- fatigue
- pallor
- syncope
- sweats
What are common heart attack symptoms in women one month prior to the event?
- fatigue
- sleep disturbance
- dyspnea
- GERD
- anxiety
- racing heart
- weak/heavy arms
What is considered a normal frequency for palpitations?
Less than 6 times per minute.
Referred to a physician = Palpitations occur with other symptoms or if there is a family history of sudden cardiac death.
What is claudication and how is it assessed?
Pain in the legs due to inadequate blood flow, assessed by checking peripheral pulses.
When should a patient experiencing dyspnea be evaluated by a physician?
Anyone who cannot climb a flight of stairs without getting moderately to severely winded or who awakens with shortness of breath needs to be evaluated by a physician.
What conditions can aggravate a cough associated with cardiovascular disease?
Exercise, metabolic stress, lying supine, left ventricular dysfunction, or left-sided heart failure.
What are signs of peripheral edema that warrant physician referral?
Weight gain of more than 3 lbs over several days, swelling in the ankles, abdomen, or hands, combined with shortness of breath, fatigue, or dizziness.
What is syncope and when does it warrant a physician referral?
Fainting due to decreased oxygen to the brain, warranting referral if unexplained, or if the patient has a history of heart problems or risk factors for heart attack or stroke.
What are abnormal responses to exercise related to vital signs?
- heart rate too high or low,
- systolic blood pressure not increasing gradually,
- diastolic blood pressure changing more than 15-20 mmHg.
What are the common cardiac issues that mimic musculoskeletal dysfunction?
- angina
- myocardial infarction
- pericarditis
- dissecting aortic aneurysm
- What are the side effects of statins related to muscle symptoms = ?
- What are risk factors for statin-associated muscle symptoms = ?
Side Effects: Mild myalgia, myositis, rhabdomyolysis
Risk Factors: Older age, small body frame, alcohol abuse, excessive grapefruit juice consumption, comorbid kidney or liver disease, hypothyroidism.
What is
- angina = ?
- causes it = ?
- differences between stable and unstable = ?
- Angina: An imbalance of oxygen supply and demand to the cardiac muscle.
- Primarily caused by atherosclerosis.
- Stable angina has a predictable pattern and is alleviated by rest or medication,
- Unstable angina is non-predictable and does not respond to medication.
Describe the angina scale
- 1+ = light barely noticable
- 2+ = moderate, bothersome
- 3+ = severe, uncontrollable
- 4+ = most severe pain ever experienced
What are the three ‘P’s’ that indicate pain is not myocardial infarction (MI)?
- pleuritic pain
- pain on palpation,
- pain with changes in posture
- Women have protective effect of estrogen until around age 50
What are red flags during a patient interview for myocardial infarction?
Chest pain, previous history of CAD, hypertension, smoking, diabetes, high cholesterol (above 240 mg/dl), men over age 40, women over age 50.
What are the symptoms of pericarditis that distinguish it from MI?
- pain is relieved by leaning forward
- worsened by left side lying,
- increased with trunk movements
- May also have fever, chills, or weakness.
What are the different types of aneurysms?
- Thoracic aneurysm
- Peripheral aneurysm
- Abdominal aortic aneurysm
What are risk factors for thoracic aneurysms?
- hypertension
- male gender
- ages 40-70
What are the signs and symptoms of a peripheral aneurysm?
Increased pulse amplitude and ischemia.
What is an abdominal aortic aneurysm (AAA) and what are its risk factors?
An abnormal dilation of the aorta, risk factors include:
- trauma,
- Marfan’s syndrome,
- smoking,
- coronary artery disease
What are the symptoms of an abdominal aortic aneurysm (AAA)?
- knife-like pain
- worsening in supine position
- palpable pulsating mass in the abdomen
What are non-cardiac causes of angina?
- heartburn,
- cervical disc disease,
- gallbladder disease
What red flags during an interview suggest non-cardiac chest pain?
- Younger than 40,
- Type A personality,
- recent stressful life events
What are the guidelines for immediate medical attention in cardiovascular disease?
- worsening of intermittent claudication,
- angina not relieved by rest, nitroglycerin, or position change within 20 minutes,
- angina pattern changes (from stable to unstable)
What are the guidelines for physician referral in cardiovascular disease?
- chest pain in women with a family history of CAD,
- palpitations with a family history of sudden death,
- inability to climb stairs or shortness of breath at night,
- syncope without warning
What is deep vein thrombosis (DVT), and what percentage of patients over 40 develop DVT after major surgery?
- Deep vein thrombosis (DVT): A serious condition that occurs when a blood clot forms in a deep vein, usually in the leg.
- Approximately one-third of patients over age 40 develop DVT after major surgery or acute MI.
What is Virchow’s Triad in relation to DVT?
- venous stasis
- endothelial injury
- hypercoagulability
What are the acquired risk factors for DVT?
Immobilization, surgery, trauma, cancer, pregnancy, post-childbirth, female hormones, oral contraceptives.
What are the genetic and demographic risk factors for DVT?
Age over 50, obesity, Caucasian or African-American ethnicity, genetic mutations such as Factor V or Prothrombin mutations.
What is the significance of Wells Score in DVT screening?
The Wells Score helps categorize the risk of DVT:
- low risk (< 0),
- moderate risk (1),
- high risk (> 2).
What are the screening criteria for upper extremity DVT?
Presence of venous material such as a catheter or pacemaker, pitting edema, localized pain.
What are the common signs of a pulmonary embolism?
Shortness of breath, chest pain, fainting, cyanosis.
What red flags should prompt immediate physician referral related to cardiovascular symptoms?
Syncope, unexplained chest pain, shortness of breath, or any cardiac symptoms with a family history of heart disease.
How can you differentiate musculoskeletal pain from angina during a patient interview?
Musculoskeletal pain typically occurs immediately after activity, while angina has a delayed onset after exertion.
What cardiovascular conditions are more common in women?
Heart disease, angina, and MI are more common in women over the age of 50.
