Week 8: The Cardiovascular System Flashcards
The Primary Health role of the Chiropractor / Health Professional.
Also the heart case history you will ask a patient
Screening for Hypertension
Patient education on risk factors for stroke and CVD, lifestyle modification advice
Case history:
- chest pain
- palpitations
- shortness of breath
- cyanosis, pallor, difficulty breathing
- clubbing (lung cancer)
- dyspnea
- orthopnea
- paroxysmal nocturnal dyspnea (PND)
- bipedal oedema
- syncope
Essential terminology for cardiovascular know it :
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
Dyspnea : Shortness of breath, breathlessness. Normal with physical exertion but not good if its in unexpected situations
Orthopnea :Shortness of breath while laying down.
Paroxysmal nocturnal dyspnea (PND): Paroxysmal nocturnal dyspnea (or PND) refers to attacks of severe shortness of breath and coughing that generally occur at night.[1] It usually awakens the person from sleep, and may be quite frightening.
Angina Pectoris – presentation and treatment
Angina is medical term used to describe the temporary chest discomfort that occurs when the heart isn’t getting enough blood.
It’s not a heart attack. It may be a warning sign of one though. Arteries which serve the heart may be narrowed from plaque etc.
Symptoms:
-pain or discomfort in middle of chest
-pain may be accompanies by breathlessness and sweating pressure of a feeling of tightness in chest
-radiating pain in neck, jaw and left arm, sometimes radiating pain in upper back and shoulders.
Treatment: Aspirin: reduces risk of blood clots Nitrates: ease pain Drugs to lower cholesterol Drugs to Lower blood pressure Lifestyle changes Surgery
Heart attack
Angina: Chest pain or discomfort in the center of the chest; also described as a heaviness, tightness, pressure, aching, burning, numbness, fullness or squeezing feeling that lasts for more than a few minutes or goes away and comes back. It is sometimes mistakenly thought to be indigestion or heartburn.
Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach
Difficulty breathing or shortness of breath
Sweating or “cold sweat”
Fullness, indigestion, or choking feeling (may feel like “heartburn”)
Nausea or vomiting
Light-headedness, dizziness, extreme weakness or anxiety
Rapid or irregular heart beats
Measuring heart size on x-ray – what is normal?
Don’t m
Echocardiography – what is this and how does it work?
How does the echocardiogram work?
The transducer that’s placed on your chest sends sound waves toward the heart. Like the sonar on a submarine, the sound waves bounce off the heart,and are collected by by the transducer.
These returning sound waves are processed by a computer, assembled into a two-dimensional image of the beating heart, and displayed on a TV screen (which you will be able to see if you wish). By aiming the transducer, the technician will be able to image most of the important cardiac structures.
Key features of peripheral vascular disease:
Symptoms
Skin:
○ Colour change
○ Temperature change
○ Trophic or nutritional changes – ulcers, flaky skin, shiny skin, hair loss, nonhealing wounds
○ Pain or tenderness
Claudication
Oedema (swelling)
Disorders of the PVS
Venous Thrombosis & Deep vein Thrombosis (DVT)
Leading to thrombo-embolism > pulmonary embolism, MI or stroke
Diabetes Mellitus Types 1 & 2
Venous & arterial insufficiency
Leg ulcers
Oedema
From cardiovascular disease / heart failure
Arterial insufficiency:
Atheroma & arteriosclerosis
Aneurysm:
Aortic aneurysm
Other
Vasculitis:
Autoimmune
Signs and symptoms of PVD
Claudication ➡ Pain, weakness, or cramping in muscles due to decreased blood flow
Noticeable change in color ➡ (cyanosis, pallor or rubor) or temperature (coolness) when compared to the other limb
Diminished hair and nail growth on affected limb and digits (atrophic)
Sores, wounds, or ulcers that heal slowly or not at all
Chronic Arterial vs. Venous Insufficiency
Slide 13
Signs of arterial occlusion
Stages of PVD
Check out images on 15,16,17,18
Signs of arterial occlusion
Slide 14
The 4 P’s: Pain Pallor Pulselessness Paresthesia
Stages of PVD (arterial)
I: mild pain on walking (“claudication”);
II: severe pain on walking relatively shorter distances (intermittent claudication);
III: pain while resting (rest pain);
IV: tissue loss (gangrene);
What are the causes of PVD?
Smoking:
-increase 10 fold in relative risk for PVD in dose related effect
Diabetes mellitus:
-between two and four times increased risk of PVD
Dyslipidemia:
-elevation of total cholesterol, LDL cholesterol, and triglyceride levels each have been correlated with accelerated PVD
Hypertension: elevated blood pressure gives increased risk for PVD, as well as in associated coronary and cerebrovascular events (heart attack, stroke)
Hypertension
Elevated blood pressure is correlated with?
Other risk factors?
Risk of PVD also increases if the patient is?
Elevated blood pressure is correlated with an increase in the risk of developing PVD, as well as in associated coronary and cerebrovascular events (heart attack and stroke).
Other risk factors:
Inflammatory mediators such as C-reactive protein and fibrinogen.
Risk of PVD also increases if the patient is:
Over the age of 50; African American
Male; Obese
Personal history of cardiovascular disease
What are the signs and symptoms of PVD? Oedema
Difference between pitting oedema and non-pitting oedema?
Pitting oedema: usually cardiovascular or peripheral vascular causes: -cardiac failure -kidney disease -peripheral vascular disease
Non-pitting oedema:
Usually lymphatic causes:
-lymphedema
-pretibial myxedema of hyperthyroidism
Describe the mechanics of oedema?
Pictures 23 and 24
Defined as a palpable swelling produced by increased interstitial fluid volume.
Mechanisms:
-pitting (eg cardiac failure, renal or PV disease) change in interstitial fluid due to sodium/ H20 retention.
-non-pitting (eg lymphedema) ➡no change on consistency of interstitial fluid, but rather stasis (a drainage disorder)
Dependant oedema-pitting, chronic oedema influenced by gravity
; in ankles or legs; in a bed bound patient sacral oedema
Further research:
Aortic aneurysm- causes and presentation
- enlargement of the aorta greater than 1.5 times normal size
- caused from underlying weakness in the wall of the aorta at that location (atherosclerotic or degenerative disease)
- independent causes:smoking, fam history of them, chronic obstructive pulmonary disease, coronary artery disease, high cholesterol levels, hypertension
- may cause pain, which is a sign of impeding rupture, when rupture occurs massive internal haemorrhage results ➡death unless treated immediately
Presentation:
- usually asymptomatic untill they expand or rupture
- patients may experience I impressive back, flank, abdominal or groin pain for some time prior to rupture
- isolated groin pain particularly (occurs coz retro peritoneal expansion pressing on femoral nerve)
Further research
Deep vein thrombosis causes and presentation
Causes:
- blood is meant to flow, if it becomes stagnant there is a potential for it to clot.
- the blood in veins is constantly forming microscopic clots that are routinely broken down by body (if this balance is altered, significant clotting can occur)
- can occur I’d you are prolonged travel and sitting, hospitalisation, surgery, pregnancy, obesity
- trauma to vein, bruised leg
Presentation:
Inflammation of the vein and surrounding skin causes the symptoms of any other type of inflammation like: redness, warmth, tenderness, and swelling
-often the affected vein can be palates As a firm thickened cord
-pain
Further research
Diabetes type 1and 2
In Diabetes Type 1 the body is not producing insulin, while in Diabetes Type 2 the cells are not responding properly to the insulin, and/or there is not enough insulin being produced.
Should know this
Peripheral vascular disease is?
-reduced circulation of the blood to a body part other than the brain or heart. Caused by a narrowed or blocked blood vessel. Risk factors are diabetes obesity, and lack of physical activity.
Main cause is atherosclerosis (build up of fatty deposits) usually an artery.
Symptoms:
-intermittent leg pain, which may feel like cramps, muscle fatigue or heaviness (usually in legs)
-worsening pain during exercise (usually in legs) easing during rest
-coldness of the affected body part
-numbness
-pins and needles
-muscular weakness
-blue or purple tinge to the skin
Causes:
- diabetes: high blood sugar damages and weakens blood vessels, causing them to narrow
- obstruction: a blood clot (thrombus) may lodge within the blood vessel
- infection-can cause scarring and narrowing of the blood vessel
Smoking: smoking damages the blood vessels throughout the body including extremities leads to PVD
Lymphoedema definition and causes
Is the swelling of certain parts of the body, especially arms and legs, caused by problems with the lymphatic system. It can happen after surgery, particularly cancer-related surgery where radiotherapy has been used.
Causes:
- cancer surgery
- radiotherapy
- infections (may damage tissue around lymph nodes or vessels
- inflammatory conditions
- cardiovascular disease
- injury and trauma
Compartment syndrome definition, presentation, causes
Def: is a limb- and life-threatening condition which occurs after injury, when there isn’t sufficient blood to supply the muscles and nerves with oxygen and nutrients because of the raised pressure sitting the compartment such as arm, leg, any enclosed space within the body and leads to nerve damage because lack of blood supply.
Causes:
- muscles contained in thick fibrous bands of tissue or fascia.
- because of injury, pressure can increase within that compartment to swelling or bleeding.
- when these high compartment pressures arise, blood can’t circulate to the muscles and nerves to supply the, with oxygen and nutrients.
- as muscles lose their blood and O2 supply, they use anaerobic metabolism and begin to die
- if nerve cells that are damaged fail causing numbness or weakness, individual may need amputation :/
Presentation:
- typically present with pain whose severity appears out of proportion to the injury
- pain often described as burning, deep and aching in nature and worsened by passive stretching muscles involved
- numbness (early unreliable complaint)
- 2 point discrimination test is better
- high velocity injuries are not good sign
- possibly caused from vigorous exercise
Vascular claudication definition and causes
Def: claudication is pain or cramping in the lower leg due to inadequate blood flow to muscles. Pain usually causes someone to limp. It’s typically felt while walking and subsides when rested
Causes:
-peripheral artery disease ➡ generally caused by atherosclerosis (hardening of arteries)
-especially common at branching points of arteries in the legs
-blockages of the arteries from these plaques cause low blood flow to the muscles in the legs
-increased blood needed when exercising thus the pain occurs then most
Become familiar with the ones on slide 26. Can’t be assed right now
J
Presenting symptoms of cardiovascular disease
Chest pain Palpitations Shortness of breath Bipedal Oedema- body retains too much salt causing body to retain water) Syncope- black outs/ fainting
