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
