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S7- Differential Diagnosis > Week 5- Screening For Cardiovascular Disease > Flashcards

Week 5- Screening For Cardiovascular Disease Flashcards

1
Q

PART 1: RISK FACTORS AND S/Sx

A

PART 1: RISK FACTORS AND S/Sx

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2
Q

Heart disease remains the leading cause of death, __/__ Americans have some form of cardiovascular disease.

A

1/3

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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)
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4
Q

What are some vascular pain descriptors? (4)

A
  • Throbbing
  • Pounding
  • Pulsing
  • Beating
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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
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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
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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
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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.

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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

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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
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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

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12
Q

Cyanosis:

  • Bluish discoloration of lips/nailbeds secondary to inadequate ________ levels.
  • Most often accompanies _______/________ conditions.
A
  • blood O2

- cardiac/pulmonary

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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
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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)
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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
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16
Q

What may be done if we note a cluster of S/Sx for CV disease?

A

Cardiovascular Review of Systems

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17
Q

PART 2

A

PART 2

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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
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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

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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

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21
Q

CAD Modifiable Risk Factors. (6)

A
  • Physical inactivity
  • Smoking
  • Hyperlipidemia
  • High BP
  • Diabetes
  • Obesity
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22
Q

CAD Non-Modifiable Risk Factors. (5)

A
  • > 65yo
  • Male
  • Family Hx
  • Race
  • Postmenopausal
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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
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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
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25
Q

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?
A
  • rest or up to 3 nitroglycerin tablets in 10-15 minutes
  • No
  • Lack of objective MSK findings
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26
Q

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
A
  • chest
  • jaw, neck, back, shoulders, or arms
  • angina >30m
  • angina unrelieved by rest, nitroglycerin, or antacids
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27
Q

What are red-brown linear streaks that may be a sign of silent MI or Hx of MI?

A

Splinter Hemorrhages

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28
Q

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?
A
  • “atypical”
  • fatigue, weakness, and trouble sleeping
  • diabetes
  • upper abdominal/epigastric, neck/jaw/tooth, interscapular and mid-low thoracic, R arm pain (biceps isolation possible)
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29
Q

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.
A
  • Inflammation of the pericardium.

- chest, neck, or L shoulder pain

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30
Q

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
A
  • coughing
  • kneeling on all 4s, leaning forward, sitting upright
  • breathing, swallowing, belching, or neck/trunk movement
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31
Q

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.
A
  • Abnormal dilation in wall of artery, vein, or heart.
  • Thoracic Aneurysm
  • Abdominal Aneurysm
32
Q

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?
A
  • > 3cm
  • 5-6cm
  • asymptomatic
  • pulsating mass in abdomen
33
Q

What are the risk factors for AAA? (5)

A
  • Age >60
  • Male
  • Hx smoking
  • Hx hypercholesterol and CHD
  • Family Hx of AAA
34
Q

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.
A
  • pulsating mass
  • “heartbeat”
  • back pain
  • nonmechanical
  • insidious onset
  • early satiety, weight loss, and nausea
35
Q

Ruptures Aneurysm pain is described as ________/_______.

A

tearing/ripping

36
Q
  • How do we palpate for AAA?

- What is an abnormal finding?

A
  • 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
Q
  • How do we auscultate for AAA?

- What is an abnormal finding?

A
  • 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
Q

Combination of palpation and auscultation for AAA improves the value of these techniques as a screening tool for _____ patients with aneurysms >__cm.

A
  • thin

- >5cm

39
Q

Congestive Heart Failure (CHF):

  • What is CHF?
  • Does a properly functioning heart depend on both ventricles?
  • RV Failure = Edema in ____ and _______
  • LV Failure = _________ edema
A
  • 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
Q

CHF S/Sx. (5)

A
  • 3lb or > weight gain or gradual, continuous gain over several days causing:
  • swelling in ankles, abdomen, and hands
  • SOB
  • Fatigue and dizziness
  • JVD
41
Q

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?
A
  • valves
  • fatigue
  • breathlessness or dyspnea
  • endocarditis
42
Q

Endocarditis:

  • What is endocarditis?
  • Can occur as a result of _____ or _____ cavity infection.
  • 45% of patients initially present with ______ symptoms.
A
  • Heart infection that causes inflammation of cardiac endothelium and damages the tricuspid, aortic, or mitral valves.
  • skin or oral infection
  • MSK symptoms
43
Q

Endocarditis S/Sx. (7)

A
  • Arthralgia (proximal joints)
  • Arthritis
  • Myalgias
  • Low back/SI pain
  • Splinter hemorrhages
  • Constitutional symptoms
  • Dyspnea/chest pain
44
Q

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
A
  • arrhythmias
  • ventricular arrhythmias
  • Tachycardia = >100bpm
  • Bradycardia = <60bpm
45
Q

PART 3: CARDOVASCULAR DISORDERS

A

PART 3: CARDOVASCULAR DISORDERS

46
Q

List some CV Disorders. (6)

A
  • HTN
  • Transient Ischemic Attack (TIA)
  • Peripheral Arterial Disease (PAD)
  • Venous Disorders
  • Vertebrobasilar Insufficiency (VBI)
  • Cervical Artery Dissection (CAD)
47
Q

HTN:

  • What is HTN?
  • HTN is a major _____ risk factor.
A
  • Consistently elevated DBP, SBP or both measured over a period of time.
  • CV risk factor
48
Q

HTN S/Sx. (6)

A
  • Occipital HA
  • Dizziness
  • Flushed face
  • Spontaneous epistaxis (nose bleed)
  • Vision changes
  • Nocturnal urinary frequency
49
Q

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
A
  • ≥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
Q

What are the (2) instances where we should terminate activity and a referral is warranted in regard to BP?

A
  • BP changes in presence of unstable angina, dizziness, nausea, pallor, or extreme diaphoresis at rest.
  • BP >140-90 on antihypertensives
51
Q

One high BP reading is not cause for medical referral usually. In what instance is one high BP warranted for referral?

A

Single high BP reading in presence of other S/Sx

52
Q

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).
A
  • > 10mmHg
  • rise or it falls (>10mmHg)
  • 200mmHg, 100mmHg
53
Q

Can we use a automatic BP cuff to measure during activity?

A

No, use a manual cuff during physical activity.

54
Q

Transient Ischemic Attack (TIA):

  • What is it?
  • Ischemic episode may last from __-__ minutes or up to 24 hours.
  • When does TIA require referral?
A
  • Temporary disruption of blood supply to a part of the brain.
  • 5-20 minutes
  • In any patients with S/Sx of TIA.
55
Q

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
A
  • slurred/difficult speech
  • sudden confusion
  • blindness
  • HA
  • paralysis/weakness
56
Q

Peripheral Arterial Disease (PAD):

  • What is PAD?
  • What are the (2) most common symptoms?
A
  • Narrowing of peripheral arteries

- Intermittent claudication, ischemic rest pain

57
Q

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
A
  • intermittent claudication
  • ischemic pain at rest
  • elevating legs
  • decreased skin temp
58
Q

Venous Disorders:

  • What is an acute venous disorder?
  • What is a chronic venous disorder and how is it identified?
A

Acute
-DVT

Chronic
-Postphlebitic syndrome (chronic swollen limbs, thick/ coarse/brownish skin around ankles, venous stasis ulcers)

59
Q

DVT Risk Factors:

  • Previous Hx
  • Hx of _______, ____, ____
  • Receiving chemotherapy
  • Major _______/_______
  • Immobility
  • Limb paralysis
  • Women during pregnancy
  • Women taking oral contraceptives/hormone replacement
  • Age >___ years
A
  • Hx of cancer, CHF, SLE
  • major surgery/trauma
  • Age >60 years
60
Q

DVT Clinical Manifestations. (5)

A
  • Ache, tightness, tenderness
  • General/pitting edema
  • Prominent superficial venous plexus
  • Increased local skin temp
69
Q

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?
A
  • Compromise of the vertebral arteries resulting in occlusion or damage.
  • brief
  • rotation/extension
  • vertigo, nausea, HA
70
Q

What are the 5 D’s and 3 N’s of VBI?

A
  • Dizziness
  • Drop Attacks
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Nausea
  • Numbness
  • Nystagmus
71
Q

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?
A
  • 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
Q

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
A
  • jaw, neck, chest, back, shoulder, arm pan
  • > 65yo and postmenopausal women
  • 10-15 minute lag
  • UQ pain induced with LQ activity
  • Insidious
73
Q

What are some ways we can distinguish chest pain of non-cardiac origin?

A
  • 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
Q

What are the guidelines for immediate medical attention? (3)

A
  • Sudden worsening of intermittent claudication
  • Anginal attacks/changes in angina pattern
  • Symptoms of TIA, DVT, MI
75
Q

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
A
  • chest
  • rest
  • syncope

S7- Differential Diagnosis (15 decks)

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