week 4 module 12 cardiac dx Flashcards
angina patho
pain r/t myocardial ischemia
- myocardial O2 demand > supply
angina subjective info
sub-sternal pain/pressure radiates: neck, jaw, arms: mostly left SOB fatigue sweating faintness syncope
angina objective info
tachycardic inc. RR HTN diaphoretic Co-morbidities: - COPD - xanthelasma - HTN - PAD - murmur - arrhythmia
bacterial endocarditis patho
bacterial infection of the endothelial layer of heart and valves
bacterial endocarditis subjective
fever
fatigue
sudden onset of congestive heart failure
- SOB, ankle edema
bacterial endocarditis objective
murmur
signs of neurologic dysfunction
janeway lesion: small erythematous macules on palms and soles
Osler nodes: red, painful, raised lesions on fingers or toes r/t septic emboli
left sided CHF patho
heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary circulation
- LV hypertrophy
- cardiomyopathy
…
L. side CHF subjective
fatigue
SOB
orthopnea
exercise intolerance
L side CHF objective
acute pulmonary edema or gradual onset
crackles
systolic CHF narrow pulse pressure
diastolic CHF wide pulse pressure
R. side CHF patho
heart fails to propel blood forward with usual force resulting in congestion in the systemic circulation
- Dec. CO -> dec. blood flow to tissues
R. side CHF subjective
peripheral edema, especially at end of day
weight gain
R. side CHF objective
pitting edema lower extremities
jugular venous distention
ascities
hepatomegaly
pericarditis patho
inflammation of pericardium
- often a result of viral infection
paricarditis subjective
Sharp and stabbing chest pain - heart rubbing against pericardium Pain worse with coughing, swallowing, deep breathing, lying flat, or movement Pain in back, neck, or left shoulder Diff. breathing while lying down Dry cough Anxiety Fatigue
Pericarditis objective
scratchy, grating, triphasic friction rub
friction rub heard just L. of sternum in 3rd and 4th intercostal space
Cardiac tamponade patho
excessive accumulation of effused fluids or blood between the pericardium and the heart
cardiac tamponade subjective
anxiety, restless chest pain difficulty breathing discomfort relieved by sitting upright or forward syncope, lightheaded pale, gray, or blue skin palpitations rapid breathing swelling of the abd or arms or neck veins
cardiac tamponade objective
Beck triad - jugular venous distention - hypotension - muffled heart sounds pericardium may scar and constrict -> limits cardiac filling, muffled heart sounds, hypoTN, weakened rapid pulse
Cor Pulmonale patho
enlargement of the R. ventricle secondary to chronic lung disease
Cor Pulmonale subjective
fatigue inc. RR exertional dyspnea cough hemoptysis lightheaded syncope
Cor Pulmonale objective
wheezes and crackles inc. chest diameter labored resp. efforts with chest wall retractions right heart failure and hypertrophy distended neck veins cyanosis L. parasternal systolic heave loud S2 in pulmonic region lower extremity edema
MI patho
ischemic myocardial necrosis caused by abrupt dec. in coronary blood flow to a segment of the myocardium
MI subjective
deep substernal or visceral pain - radiates to jaw, neck, left arm discomfort may be mild, esp. in older adults or pt with DM nausea fatigue SOB
MI objective
dysrhythmia comon S4 distant heart sounds soft, systolic, blowing apical murmur thready pulse blood pressure varies new ST elevation in 2 leads
VSD patho
opening between the left and right ventricles
VSD subjective
recurrent respiratory infections
VSD objective
arterial pulse is small, JV pulse unaffected
holosystolic murmur: loud, coarse, high-pitched
left peristernal lift
smaller defected causes a louder murmur and thrill
tetralogy of fallot patho
4 cardiac defects
- VSD
- pulmonic stenosis
- dextroposition of aorta (overriding)
- r. ventricular hypertrophy
tetralogy of fallot subjective
dyspnea with feeding
poor growth
exercise intolerance
paroxysmal dyspnea with loos of consciousness and central cyanosis
tetralogy of fallot objective
parasternal heave and precordial prominence
systolic ejection murmur
older children: clubbing
PDA patho
failure of the ductus arteriosus to close after birth
- blood flows from aorta through the ductus to the pulmonary artery inc. pressure in the pulmonary circulation -> inc. workload R. heart
PDA subjective
small shunt can be asymptomatic
larger: dyspnea on exertion
PDA objective
dilated and pulsatile neck vessels
wide pulse pressure
harsh, loud, continuous murmur with machine like quality
ASD patho
congenital defect in the septum dividing the left and right atria
- extra blood from L. atria can cause volume overload of the right atrium and ventricle
- can lead to shunt reversal (right to left) and heart failure
ASD subjective
often asymptomatic
HR rarely occurs in children but can in adults
ASD objective
systolic ejection murmur
- loud, high pitched, harsh. Over pulmonic area
systolic thrill may be felt, and peristernal thrust
S2 may be widely split
acute rheumatic fever patho
systemic connective tissue disease occurring after strep pharyngitis or skin infection
- may result in cardiac valvular involvement
– usually mitral or aortic valve
affected valve becomes stenotic and regurgitant
acute rheumatic fever subjective
fever swollen joints painless rash with pink margins with pale centers and a ragged edge: erythema marginatum jerky movements small, painless nodules beneath the skin chest pain palitations fatigue SOB
acute rheumatic fever objective
major and minor manifestations murmurs of mitral regurg. and aortic insuff. cardiomegaly friction rub signs of congestive HF
Jones criteria for rheumatic fever Major
carditis polyarthritis chorea erythema marginatum subcutaneous nodules
Jones criteria for rheumatic fever Minor
Clinical - previous rheumatic fever or rheumatic heart dis. - polyarthralgia - fever Labs -acute phase reaction -- ESR, c-reactive protein, leukocytosis - Prolonged PR interval
atherosclerotic heart disease Patho
narrowing of the small blood vessels that supply blood and O2 to the heart
- deposition of cholesterol, lipids, or inflammatory process
- vascular wall thickening and narrowing of lumen
atherosclerotic heart disease subjective
may be asymptomatic angina pectoris SOB palpitations Family Hx
atherosclerotic heart disease objective
dyslipidemia
dysrhythmias
signs of congestive heart failure
senile cardiac amyloidosis patho
amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart
senile cardiac amyloidosis subjective
palpitations
lower extremity edema
fatigue
reduced activity tolerance
senile cardiac amyloidosis objective
pleural effusion arrhythmia lower extremity edema dilated neck veins hepatomegaly or ascites EKG/echo: small, thickened L. ventricle, R. thickening poss.
