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
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
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
27
Q
What are red-brown linear streaks that may be a sign of silent MI or Hx of MI?
A
Splinter Hemorrhages
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)
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
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
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
61
Q
1
A
1
62
Q
1
A
1
63
Q
1
A
1
64
Q
1
A
1
65
Q
1
A
1
66
Q
1
A
1
67
Q
1
A
1
68
Q
1
A
1
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
