week 4 module 12 cardiac dx

Question 1

angina patho

Answer 1

pain r/t myocardial ischemia

- myocardial O2 demand > supply

Question 2

angina subjective info

Answer 2

sub-sternal pain/pressure
radiates: neck, jaw, arms: mostly left 
SOB
fatigue
sweating
faintness
syncope

Question 3

angina objective info

Answer 3

tachycardic
inc. RR
HTN
diaphoretic 
Co-morbidities: 
- COPD
- xanthelasma
- HTN
- PAD
- murmur
- arrhythmia

Question 4

bacterial endocarditis patho

Answer 4

bacterial infection of the endothelial layer of heart and valves

Question 5

bacterial endocarditis subjective

Answer 5

fever
fatigue
sudden onset of congestive heart failure
- SOB, ankle edema

Question 6

bacterial endocarditis objective

Answer 6

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

Question 7

left sided CHF patho

Answer 7

heart fails to propel blood forward with its usual force, resulting in congestion in the pulmonary circulation
- LV hypertrophy
- cardiomyopathy
…

Question 8

L. side CHF subjective

Answer 8

fatigue
SOB
orthopnea
exercise intolerance

Question 9

L side CHF objective

Answer 9

acute pulmonary edema or gradual onset
crackles
systolic CHF narrow pulse pressure
diastolic CHF wide pulse pressure

Question 10

R. side CHF patho

Answer 10

heart fails to propel blood forward with usual force resulting in congestion in the systemic circulation
- Dec. CO -> dec. blood flow to tissues

Question 11

R. side CHF subjective

Answer 11

peripheral edema, especially at end of day

weight gain

Question 12

R. side CHF objective

Answer 12

pitting edema lower extremities
jugular venous distention
ascities
hepatomegaly

Question 13

pericarditis patho

Answer 13

inflammation of pericardium

- often a result of viral infection

Question 14

paricarditis subjective

Answer 14

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

Question 15

Pericarditis objective

Answer 15

scratchy, grating, triphasic friction rub

friction rub heard just L. of sternum in 3rd and 4th intercostal space

Question 16

Cardiac tamponade patho

Answer 16

excessive accumulation of effused fluids or blood between the pericardium and the heart

Question 17

cardiac tamponade subjective

Answer 17

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

Question 18

cardiac tamponade objective

Answer 18

Beck triad
- jugular venous distention
- hypotension 
- muffled heart sounds 
pericardium may scar and constrict
-> limits cardiac filling, muffled heart sounds, hypoTN, weakened rapid pulse

Question 19

Cor Pulmonale patho

Answer 19

enlargement of the R. ventricle secondary to chronic lung disease

Question 20

Cor Pulmonale subjective

Answer 20

fatigue
inc. RR
exertional dyspnea
cough
hemoptysis
lightheaded
syncope

Question 21

Cor Pulmonale objective

Answer 21

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

Question 22

MI patho

Answer 22

ischemic myocardial necrosis caused by abrupt dec. in coronary blood flow to a segment of the myocardium

Question 23

MI subjective

Answer 23

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

Question 24

MI objective

Answer 24

dysrhythmia comon 
S4 
distant heart sounds
soft, systolic, blowing apical murmur
thready pulse
blood pressure varies 
new ST elevation in 2 leads

Question 25

VSD patho

Answer 25

opening between the left and right ventricles

Question 26

VSD subjective

Answer 26

recurrent respiratory infections

Question 27

VSD objective

Answer 27

arterial pulse is small, JV pulse unaffected
holosystolic murmur: loud, coarse, high-pitched
left peristernal lift
smaller defected causes a louder murmur and thrill

Question 28

tetralogy of fallot patho

Answer 28

4 cardiac defects

• VSD
• pulmonic stenosis
• dextroposition of aorta (overriding)
• r. ventricular hypertrophy

Question 29

tetralogy of fallot subjective

Answer 29

dyspnea with feeding
poor growth
exercise intolerance
paroxysmal dyspnea with loos of consciousness and central cyanosis

Question 30

tetralogy of fallot objective

Answer 30

parasternal heave and precordial prominence
systolic ejection murmur
older children: clubbing

Question 31

PDA patho

Answer 31

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

Question 32

PDA subjective

Answer 32

small shunt can be asymptomatic

larger: dyspnea on exertion

Question 33

PDA objective

Answer 33

dilated and pulsatile neck vessels
wide pulse pressure
harsh, loud, continuous murmur with machine like quality

Question 34

ASD patho

Answer 34

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

Question 35

ASD subjective

Answer 35

often asymptomatic

HR rarely occurs in children but can in adults

Question 36

ASD objective

Answer 36

systolic ejection murmur
- loud, high pitched, harsh. Over pulmonic area
systolic thrill may be felt, and peristernal thrust
S2 may be widely split

Question 37

acute rheumatic fever patho

Answer 37

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

Question 38

acute rheumatic fever subjective

Answer 38

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

Question 39

acute rheumatic fever objective

Answer 39

major and minor manifestations
murmurs of mitral regurg. and aortic insuff. 
cardiomegaly
friction rub
signs of congestive HF

Question 40

Jones criteria for rheumatic fever Major

Answer 40

carditis
polyarthritis
chorea
erythema marginatum 
subcutaneous nodules

Question 41

Jones criteria for rheumatic fever Minor

Answer 41

Clinical
- previous rheumatic fever or rheumatic heart dis. 
- polyarthralgia 
- fever
Labs
-acute phase reaction
-- ESR, c-reactive protein, leukocytosis 
- Prolonged PR interval

Question 42

atherosclerotic heart disease Patho

Answer 42

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

Question 43

atherosclerotic heart disease subjective

Answer 43

may be asymptomatic
angina pectoris
SOB
palpitations
Family Hx

Question 44

atherosclerotic heart disease objective

Answer 44

dyslipidemia
dysrhythmias
signs of congestive heart failure

Question 45

senile cardiac amyloidosis patho

Answer 45

amyloid, fibrillary protein produced by chronic inflammation or neoplastic disease, deposition in the heart

Question 46

senile cardiac amyloidosis subjective

Answer 46

palpitations
lower extremity edema
fatigue
reduced activity tolerance

Question 47

senile cardiac amyloidosis objective

Answer 47

pleural effusion 
arrhythmia
lower extremity edema dilated neck veins
hepatomegaly or ascites
EKG/echo: small, thickened L. ventricle, R. thickening poss.