Week 5- Screening For Cardiovascular Disease Flashcards
1
Q
PART 1: RISK FACTORS AND S/Sx
A
PART 1: RISK FACTORS AND S/Sx
2
Q
Heart disease remains the leading cause of death, __/__ Americans have some form of cardiovascular disease.
A
1/3
3
Q
What are the risk factors for CV Disease? (9)
A
- Age
- HTN
- Obesity
- Sedentary lifestyle
- High cholesterol levels
- Alcohol/Tobacco
- Oral contraceptive (>35 and smoking)
- 1st gen family Hx
- Race (AA, MA, NA, PI)
4
Q
What are some vascular pain descriptors? (4)
A
- Throbbing
- Pounding
- Pulsing
- Beating
5
Q
What are the S/Sx of CV Disease? (10)
A
- Chest Pain
- Palpitation
- Dyspnea
- Cardiac Syncope
- Fatigue
- Cough
- Cyanosis
- Edema
- Claudication
- Vital Signs
6
Q
Chest Pain or Discomfort:
- Can be _______ or ___-_______ in nature.
- Where can it radiate to? Which is most common?
- Radiating pain in the arm follows the ______ nerve distribution.
- Is non-cardiac or cardiac related chest pain often accompanied by N/V, diaphoresis, dyspnea, fatigue, pallor, or syncope?
A
- cardiac or non-cardiac
- Can radiate to neck, jaw, upper trap, upper back, shoulder, or arms. L arm is most common (secondary to heart supplied by C3-T4)
- ulnar nerve distribution
- cardiac related
7
Q
Palpitation:
- Presence of an irregular heartbeat is described as bump, pound, jump, flop, flutter, or racing sensation and may be associated with ________/_______.
- When do palpitations require immediate referral?
- > __ palp/1m should be reported to physician.
A
- lightheadedness/syncope
- When lasting hours with pain, SOB, fainting, lightheadedness OR in pt with + family Hx of sudden death.
- 6/min
8
Q
Dyspnea:
- Could also be indicative of a __________ pathology.
- When does dyspnea require medical referral?
A
- pulmonary
- When pt cannot climb 1 flight of stairs without feeling mod-sev winded OR report of SOB at night or lying down.
9
Q
Cardiac Syncope:
- ________ due to cardiac condition.
- Syncope that occurs without warning of lightheadedness, dizziness, or nauseas.
- When does cardiac syncope require referral?
A
- fainting
- When syncope is unexplained
10
Q
Fatigue:
- Provoked by _______ ______ may indicate cardiac origin.
- Often accompanied by dyspnea, chest pain, palpitations, or HA.
- Fatigue that exceeds normal expectations during or after exercises require close monitoring (especially in cardiac patients). Be sure to monitor _____ signs.
- What meds commonly prescribed for cardiac problems can also cause unusual fatigue?
A
- minimal exertion
- vital signs
- beta-blockers
11
Q
Cough:
- Most commonly associated with _______ conditions.
- LV dysfunction resulting in __________ _____ or L ventricular CHF may cause cough.
- Cough is described as hacking and may produce frothy, blood-tinged sputum.
A
- pulmonary
- pulmonary edema
12
Q
Cyanosis:
- Bluish discoloration of lips/nailbeds secondary to inadequate ________ levels.
- Most often accompanies _______/________ conditions.
A
- blood O2
- cardiac/pulmonary
13
Q
Edema:
- __lb or greater weight gain or gradual, continuous gain over several days causing swelling in ankles, abdomen, and hands especially in the presence of SOB, fatigue, and dizziness = red flag symptoms of _____.
- When does edema require medical referral?
- What are a few accompanying symptoms?
A
- 3lb or >, CHF
- When edema and other accompanying symptoms persist with rest.
- JVD and cyanosis
14
Q
Claudication:
- ____ pain that occurs with PVD.
- Common to also have _____ _____ and _________/_________.
- When does claudication require medical referral? Why?
A
- leg pain
- pitting edema and skin discoloration/trophic changes
- When there is abrupt onset of ischemic resting pain or sudden worsening of claudication. (increased risk for thromboembolism)
15
Q
Vital Signs:
- HR/BP should be taken at ____ for all patients to establish a baseline.
- Everyone with __________ should be monitored.
- What are some abnormal responses?
A
- IE
- heart disease
- HR too high/low. irregular HR, SBP that does not rise progressively with work, SBP that falls during exercise, change in DBP >10mmHg
16
Q
What may be done if we note a cluster of S/Sx for CV disease?
A
Cardiovascular Review of Systems
17
Q
PART 2
A
PART 2
18
Q
Cardiac Disease can affect what 3 parts of the heart? What are some specific conditions associated with each?
A
Heart Muscle
- Coronary Artery Disease (CAD)
- MI
- Pericarditis
- Aneurysms
- CHF
Heart Valve
-Endocarditis
Cardiac Nervous System
- Arrhythmias
- Tachycardia
- Bradycardia
19
Q
Conditions Affecting the Heart Muscle:
- What are the MOST COMMON conditions to mimic MSK dysfunction?
- Referral patterns include the _____, ____, ________, ______, and/or ____ pain.
A
- Angina, MI, Pericarditis, Dissecting Aortic Aneurysm
- jaw, neck, shoulder, chest, and/or back
20
Q
CAD (Coronary Artery Disease):
- What is CAD?
- Can result in ischemia, injury, and infarction to muscle supplied by the artery.
- Can manifest as _________ and _____.
A
- narrowing/blocking of a coronary artery
- angina pectoris (obstructed/decreased blood flow) and MI
21
Q
CAD Modifiable Risk Factors. (6)
A
- Physical inactivity
- Smoking
- Hyperlipidemia
- High BP
- Diabetes
- Obesity
22
Q
CAD Non-Modifiable Risk Factors. (5)
A
- > 65yo
- Male
- Family Hx
- Race
- Postmenopausal
23
Q
CAD (Coronary Artery Disease):
- What is one of the primary risk factors for CAD?
- What medication is used for this?
- What are some side effects of this drug that we should be aware of?
A
- Hyperlipidemia
- Statins
- Myalgia, Arthralgia, Rhabdomyolysis, Excessive muscle soreness after exercise (persist after days of rest), liver screening
24
Q
Angina S/Sx. (8)
A
- Pain/pressure behind breast bone
- Pain radiate to jaw, neck, shoulders, back, or arms
- Toothache
- Severe indigestion
- Dyspnea; exercise intolerance
- Nausea
- Belching
- Females report of extreme fatigue, lethargy, breathlessness, or weakness
25
Angina:
- Pain not relieved by ____ or up to __ nitroglycerin tablets in ___-___ minutes requires sending patient to ED and notifying MD.
- Does the PT administer nitroglycerin?
- What would be a red flag for angina?
- rest or up to 3 nitroglycerin tablets in 10-15 minutes
- No
- Lack of objective MSK findings
26
MI S/Sx:
- Prolonged/severe ______ pain or squeezing pressure.
- Pain radiating to ____, _____, ____, ________, or _____.
- Feeling of nausea or indigestion.
- Angina >___ minutes
- Angina unrelieved by _____, _________ or antacids
- Pallor
- Diaphoresis
- SOB
- Weakness, numbness, and feelings of faintness
- chest
- jaw, neck, back, shoulders, or arms
- angina >30m
- angina unrelieved by rest, nitroglycerin, or antacids
27
What are red-brown linear streaks that may be a sign of silent MI or Hx of MI?
Splinter Hemorrhages
28
Women and Heart Disease:
- Symptoms are more "______".
- Unexplained, severe episodic ________, _______, and trouble _______.
- _______ poses greatest risk in women.
- What are the pain locations for "atypical" MI?
- "atypical"
- fatigue, weakness, and trouble sleeping
- diabetes
- upper abdominal/epigastric, neck/jaw/tooth, interscapular and mid-low thoracic, R arm pain (biceps isolation possible)
29
Pericarditis:
- What is pericarditis?
- Be alert to possibility of pericarditis in a patient presenting to PT with new onset of ______, _____, or ________ pain with Hx of recent pericarditis.
- Inflammation of the pericardium.
| - chest, neck, or L shoulder pain
30
Pericarditis S/Sx:
- Chest pain
- Dyspnea
- Increased HR
- Malaise
- Myalgia
- Made worse/reproduced with ________
- Maybe relieved by _________, __________ or _______
- Made worse with _______, ______, _______, or ______/_____ movement
- Reports pain to be sharp or cutting
- coughing
- kneeling on all 4s, leaning forward, sitting upright
- breathing, swallowing, belching, or neck/trunk movement
31
Aneurysm:
- What is an aneurysm?
- ________ Aneurysm = Involve ascending, transverse, or descending portion of aorta from heart to top of diaphragm.
- ________ Aneurysm = Aorta below the diaphragm between the renal arteries and iliac branches.
- Abnormal dilation in wall of artery, vein, or heart.
- Thoracic Aneurysm
- Abdominal Aneurysm
32
Abdominal Aortic Aneurysm (AAA):
- AAA is defined ass vessel diameter >__cm.
- Risk of rupture increases as diameter approached __-__cm.
- Most AAAs are __________.
- The most common symptom is what?
- >3cm
- 5-6cm
- asymptomatic
- pulsating mass in abdomen
33
What are the risk factors for AAA? (5)
- Age >60
- Male
- Hx smoking
- Hx hypercholesterol and CHD
- Family Hx of AAA
34
AAA S/Sx:
- ________ _____ in abdomen.
- Abdominal "__________" felt when lying down.
- If pain present, most likely ____ pain.
- Abdominal, hip, groin, or buttock pain also possible.
- ___________ properties.
- _______ onset.
- May report early ______, _________, and nausea.
- Described as sharp, intense, severe, or knifelike.
- pulsating mass
- "heartbeat"
- back pain
- nonmechanical
- insidious onset
- early satiety, weight loss, and nausea
35
Ruptures Aneurysm pain is described as ________/_______.
tearing/ripping
36
- How do we palpate for AAA?
| - What is an abnormal finding?
- With patient supine, palpate for aortic pulse superior and left of umbilicus. Place palms on abdomen with index fingers on each side of the aorta.
- Abnormal finding is pulse width >3cm and exquisite tenderness/referred back pain.
37
- How do we auscultate for AAA?
| - What is an abnormal finding?
- With patient in supine, apply firm pressure but no dent beginning at level of renal arteries and move towards umbilicus.
- Abnormal finding is presence of bruit (blowing/swishing sounds).
38
Combination of palpation and auscultation for AAA improves the value of these techniques as a screening tool for _____ patients with aneurysms >__cm.
- thin
| - >5cm
39
Congestive Heart Failure (CHF):
- What is CHF?
- Does a properly functioning heart depend on both ventricles?
- RV Failure = Edema in ____ and _______
- LV Failure = _________ edema
- Heart is unable to pump enough blood to meet metabolic needs.
- Yes, failure of one almost always will lead to failure of the other.
- RV Failure = Edema in LE and viscera
- LV Failure = Pulmonary edema
40
CHF S/Sx. (5)
- 3lb or > weight gain or gradual, continuous gain over several days causing:
- swelling in ankles, abdomen, and hands
- SOB
- Fatigue and dizziness
- JVD
41
Conditions Affecting the Heart Valves:
- Occur secondary to impairment of ______ due to disease, congenital deformity, or infection.
- In early stages patients report that they _______ easily.
- In later stages patients report ________ or ________.
- What is (1) condition that affects the heart valves?
- valves
- fatigue
- breathlessness or dyspnea
- endocarditis
42
Endocarditis:
- What is endocarditis?
- Can occur as a result of _____ or _____ cavity infection.
- 45% of patients initially present with ______ symptoms.
- Heart infection that causes inflammation of cardiac endothelium and damages the tricuspid, aortic, or mitral valves.
- skin or oral infection
- MSK symptoms
43
Endocarditis S/Sx. (7)
- Arthralgia (proximal joints)
- Arthritis
- Myalgias
- Low back/SI pain
- Splinter hemorrhages
- Constitutional symptoms
- Dyspnea/chest pain
44
Conditions Affecting the Cardiac Nervous System:
- Failure of the heart's nervous system to conduct normal electrical impulses resulting in _________.
- ______ fibrillation is a potentially arrhythmia.
- Tachycardia = _____bpm
- Bradycardia = ____bpm
- arrhythmias
- ventricular arrhythmias
- Tachycardia = >100bpm
- Bradycardia = <60bpm
45
PART 3: CARDOVASCULAR DISORDERS
PART 3: CARDOVASCULAR DISORDERS
46
List some CV Disorders. (6)
- HTN
- Transient Ischemic Attack (TIA)
- Peripheral Arterial Disease (PAD)
- Venous Disorders
- Vertebrobasilar Insufficiency (VBI)
- Cervical Artery Dissection (CAD)
47
HTN:
- What is HTN?
- HTN is a major _____ risk factor.
- Consistently elevated DBP, SBP or both measured over a period of time.
- CV risk factor
48
HTN S/Sx. (6)
- Occipital HA
- Dizziness
- Flushed face
- Spontaneous epistaxis (nose bleed)
- Vision changes
- Nocturnal urinary frequency
49
Hypertensive Guidelines:
- ≥60 years old= ___/___ mm Hg considered hypertensive
- <60 years old= ___/___ mm Hg considered hypertensive
- Patients ≥ 18 years old with chronic kidney disease or diabetes= ____/____ mm Hg considered hypertensive
- ≥60 years old= 150/90 mm Hg considered hypertensive
- <60 years old= 140/90 mm Hg considered hypertensive
- Patients ≥ 18 years old with chronic kidney disease or diabetes= 140/90 mm Hg considered hypertensive
50
What are the (2) instances where we should terminate activity and a referral is warranted in regard to BP?
- BP changes in presence of unstable angina, dizziness, nausea, pallor, or extreme diaphoresis at rest.
- BP >140-90 on antihypertensives
51
One high BP reading is not cause for medical referral usually. In what instance is one high BP warranted for referral?
Single high BP reading in presence of other S/Sx
52
Abnormal BP Responses to Exercise:
- DBP increase more than ___mmHg with activity.
- SBP doesn't _____ or it _____ with increasing workload.
- SBP exceeds ____mmHg or DBP exceeds ____mmHg. (upper limit, judge based off patient age, health, and condition).
- >10mmHg
- rise or it falls (>10mmHg)
- 200mmHg, 100mmHg
53
Can we use a automatic BP cuff to measure during activity?
No, use a manual cuff during physical activity.
54
Transient Ischemic Attack (TIA):
- What is it?
- Ischemic episode may last from __-__ minutes or up to 24 hours.
- When does TIA require referral?
- Temporary disruption of blood supply to a part of the brain.
- 5-20 minutes
- In any patients with S/Sx of TIA.
55
TIA S/Sx:
- _____/______ speech or difficulty understanding
- Sudden ________
- Temporary ________ or other dramatic visual changes
- Dizziness
- Sudden severe _____
- _______/_______ on one side of the body
- Difficulty walking, LOB, or coordination
- slurred/difficult speech
- sudden confusion
- blindness
- HA
- paralysis/weakness
56
Peripheral Arterial Disease (PAD):
- What is PAD?
- What are the (2) most common symptoms?
- Narrowing of peripheral arteries
| - Intermittent claudication, ischemic rest pain
57
PAD S/Sx:
- _______ ________
- Burning, _______ _____ at rest
- Rest pain aggravated by _______ legs, relieved by the opposite.
- ______ skin temperature
- Dry, scaly, or shiny skin
- Poor hair/nail growth
- intermittent claudication
- ischemic pain at rest
- elevating legs
- decreased skin temp
58
Venous Disorders:
- What is an acute venous disorder?
- What is a chronic venous disorder and how is it identified?
Acute
-DVT
Chronic
-Postphlebitic syndrome (chronic swollen limbs, thick/ coarse/brownish skin around ankles, venous stasis ulcers)
59
DVT Risk Factors:
- Previous Hx
- Hx of _______, ____, ____
- Receiving chemotherapy
- Major _______/_______
- Immobility
- Limb paralysis
- Women during pregnancy
- Women taking oral contraceptives/hormone replacement
- Age >___ years
- Hx of cancer, CHF, SLE
- major surgery/trauma
- Age >60 years
60
DVT Clinical Manifestations. (5)
- Ache, tightness, tenderness
- General/pitting edema
- Prominent superficial venous plexus
- Increased local skin temp
61
1
1
62
1
1
63
1
1
64
1
1
65
1
1
66
1
1
67
1
1
68
1
1
69
Vertebrobasilar Insufficiency:
- What is it?
- Symptoms sudden in onset typically are ______ in duration.
- Cervical _____/______ can occlude if pathology present.
- What are (3) other symptoms other than the 5 D's and 3 N's?
- Compromise of the vertebral arteries resulting in occlusion or damage.
- brief
- rotation/extension
- vertigo, nausea, HA
70
What are the 5 D's and 3 N's of VBI?
- Dizziness
- Drop Attacks
- Diplopia
- Dysarthria
- Dysphagia
- Nausea
- Numbness
- Nystagmus
71
Cervical Arterial Dissection (CAD):
- What is it?
- Can occur _________ or secondary to _____ trauma.
- Most common age ___-___.
- What is the early clinical presentation of CAD?
- How is the pain described?
- Tear or hematoma in wall of internal carotid or vertebral artery.
- spontaneously or secondary to minor trauma
- 35-50 years
- Neck pain/HA that often worsen over hours/days
- Described as unusual pain that is different to any previously experienced.
72
Clues to Screening for CV Involvement:
- ____, _____, _____, _____, ______, ______ pain
- >__yo and _________ women
- Presence of CV S/Sx
- Onset of pain in pattern associated with angina with __-__ lag in response to physical exertion
- ____ pain induced with ___ activity
- _______ onset of joint/muscle pain in patient diagnosed with heart murmur
- Throbbing pain at base of neck and/or along the back to interscapular area that increases with exertion
- jaw, neck, chest, back, shoulder, arm pan
- >65yo and postmenopausal women
- 10-15 minute lag
- UQ pain induced with LQ activity
- Insidious
73
What are some ways we can distinguish chest pain of non-cardiac origin?
- Pain on palpation
- Pain alleviated/increased with body movements (EXCEPTION: pericarditic relieved by leaning forward, sitting upright, leaning on all 4s)
- Chest pain can occur secondary to trauma to intercostals from coughing
- Reproduction of symptoms in pain pattern associated with angina that begins immediately more likely MSK
- Presence of TrP in chest wall that reproduces symptoms with palpation and symptoms are eliminated with TrP deactivation
74
What are the guidelines for immediate medical attention? (3)
- Sudden worsening of intermittent claudication
- Anginal attacks/changes in angina pattern
- Symptoms of TIA, DVT, MI
75
Guidelines for MD Referral:
- Women with _____ pain + CV family Hx
- Palpitations in patients with Hx of unexplained sudden death in family/ prolonged episodes of palpitations
- Anyone who cannot climb flight of stairs without mod-sev winded
- >3lb weight gain or continuous over several days
- SOB at ______
- _______ without warning
- chest
- rest
- syncope
