Differential Diagnosis/Imaging > DDx of the Cardiovascular System > Flashcards

DDx of the Cardiovascular System Flashcards

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1
Q

List the heart muscle CV diseases

A
  • CAD
  • MI
  • Pericarditis
  • CHF
  • Aneurysms
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2
Q

List the valvular CV diseases

A
  • Rheumatic fever
  • Endocarditis
  • Mitral valve prolapse
  • Congenital deformity
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3
Q

List the cardiac nervous system CV diseases

A
  • Arrhythmia
  • Tachycardia
  • Bradycardia
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4
Q

Signs and symptoms of radiating heart pain

A
  • Ulnar nerve distribution
  • Heart is supplied by C3-T4 spinal segments
  • Heart & diaphragm refer pain along the C5-C6 spinal segment
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5
Q

Signs and symptoms of chest pain/discomfort

A
  • Angina, MI, pericarditis, endocarditis, mitral valve prolapse, or aortic aneurysm
  • Varies pending each condition
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6
Q

Associated signs and symptoms of CV disease

A
  • Nausea
  • Vomiting
  • Diaphoresis
  • Dyspnea
  • Fatigue
  • Pallor
  • Syncope
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7
Q

Benign causes of heart palpitations

A
  • Mitral valve prolapse
  • Athletes’ heart
  • Caffeine intake
  • Anxiety
  • Exercise
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8
Q

Severe CV conditions with heart palpitations

A
  • CAD
  • MI
  • Heart block
  • Ventricular aneurysm
  • Valvular disease
  • Mitral or aortic stenosis
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9
Q

Signs and symptoms of heart palpitations

A
  • Patient reports bump, pound, jump, flop, flutter, or racing sensation of the heart
  • Associated symptoms may include lightheadedness or syncope
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10
Q

What palpitation conditions require medical evaluation

A
  • Palpitations lasting for hours or occurring in association with pain, shortness of breath (SOB), fainting, or severe lightheadedness require medical evaluation
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11
Q

What palpitation conditions require medical referral

A
  • Palpitation in any person with a history of unexplained sudden death in the family requires medical referral
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12
Q

Signs and symptoms of dyspnea

A
  • Shortness of breath: determine if cardiac or pulmonary, “dyspnea on exertion”
  • Paroxysmal noturnal dyspnea
  • Orthopnea: pillow sign
  • Dyspnea relieved by specific breathing patterns or by a specific body position is more likely to be pulmonary than cardiac in origin
  • Anyone who gets significantly out of breath after climbing just one flight of stairs, awakens at night, or experiences SOB when lying down should be evaluated by a physician
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13
Q

Signs and symptoms of syncope

A
  • Due to reduced O2 delivery to the brain
  • Can be caused by arrhythmia, orthostatic hypotension, poor ventricular function, CAD, or vertebral artery insufficiency
  • Syncope w/o any warning period of lightheadedness, dizziness, or nausea may be a sign of heart valve or arrhythmia problems
  • Medical referral recommended for any unexplained syncope especially in the presence of heart or circulatory problems or if the client has any risk factors for heart attack or stroke
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14
Q

Signs and symptoms of fatigue

A
  • Fatigue that goes beyond expectations during or after exercise especially in a client with a known cardiac condition must be closely monitored
  • Beta blockers prescribed for cardiac problems can also cause unusual fatigue symptoms
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15
Q

Signs and symptoms of cough/cyanosis/edema

A
  • Coughing: L ventricular dysfunction, pulmonary edema, L ventricular CHF
  • Cyanosis: bluish discoloration of the lips & nail beds of the fingers & toes
  • Edema: 3lb or more of weight gain over several continuous days in the ankles, abdomen, & hands + SOB, fatigue, dizziness = possible CHF development/exacerbation
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16
Q

Signs and symptoms of claudication

A
  • Can occur with PVD and CAD
  • More debilitating than angina/dyspnea
  • Pitting edema commonly present
  • Must differentiate b/w neurogenic claudication
  • Assess integument for trophic changes: thin, dry, hairless skin, cool to touch
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17
Q

General CV signs and symptoms

A
  • Weakness
  • Fatigue
  • Weight change
  • Poor exercise tolerance
  • Peripheral edema
  • Palpitations
  • Cold extremities
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18
Q

Integumentary, CNS, & pulmonary CV signs and symptoms

A
  • Integumentary: ulcers, loss of hair, cyanosis
  • CNS: headache, dizziness, syncope, impaired vision
  • Pulmonary: dyspnea, productive cough
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19
Q

Genitourinary, MSK, and gastrointestinal CV signs and symptoms

A
  • Genitourinary: urinary frequency, nocturia, concentrated urine, decreased output
  • MSK: chest, shoulder, back, neck, jaw, arm pain; myalgia, atrophy, edema, claudication, muscular fatigue
  • Gastrointestinal: nausea, vomiting, ascites
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20
Q

Describe the modified Borg dyspnea scale

A
  • This scale asks you to rate the difficulty of your breathing
  • 0 = breathing is causing no difficulty at all
  • 10 = breathing difficulty is maximal
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21
Q

Describe peripheral edema assessment

A
  • Associated with venous insufficiency, CHF, DVT, pulmonary HTN
  • Pitting
  • Girth measurements: >1 cm at ankles or >2 cm difference at the mid calf
  • Unilateral vs bilateral
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22
Q

Pitting edema measurement grading scale

A
  • Press on skin over tibia then move up the leg; note the point at which swelling is no longer present
  • 1+ = barely detectable impression when finger is pressed into skin
  • 2+ = slight indentation, 15 sec to rebound
  • 3+ = deeper indentation, 30 sec to rebound
  • 4+ = >30 sec to rebound
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23
Q

Characteristics of angina/cardiac chest pain

A
  • Begins 3-5 min after exertion or activity (“lag time”)
  • Moderate intensity
  • Tightness, chest discomfort
  • Usually occurs with exertion, emotion, cold, after a large meal
  • Subsides with rest or use of nitro; worse when laying down
  • Pain is related to the tone of the arteries involved (spasm)
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24
Q

What can angina be misdiagnosed as

A
  • TMJ
  • Heartburn
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25
Red flag cluster for transport to emergency department
- Substernal squeezing or crushing pain - SOB, pallor, diaphoresis - Angina >30 min
26
Describe the angina grading scale
- Class 1: ordinary activity does not cause angina, angina only with strenuous or rapid or prolonged exertion - Class 2: slight limitation of ordinary activity, angina with walking or climbing stairs rapidly - Class 3: marked limitation of ordinary physical activity, angina walking one or two blocks or one flight of stairs at a normal pace - Class 4: inability to carry out any physical activity w/o discomfort or angina at rest
27
Angina related to nitroglycerin
- Pain not relieved by rest or with up to 3 nitroglycerin tablets (take one at a time at 5 min intervals) within 10-15 min notify the physician & take client to cardiac care unit - Client should take their own nitroglycerin - Nitroglycerin dilates the coronary arteries & improves collateral cardiac circulation thus providing an increase in O2 to the heart muscle & a decrease in symptoms of angina
28
What is always a red flag when screening for chest pain
- A lack of objective MSK findings is always a red flag
29
Clinical signs & symptoms of heartburn
- Frequent "heartburn" attacks - Frequent use of antacids to relieve symptoms - Heartburn wakes the client up at night - Acidic or bitter taste in the mouth - Burning sensation in the chest - Discomfort after eating spicy foods - Abdominal bloating & gas - Difficulty in swallowing
30
Pain pattern of angina
- Left chest, neck, & jaw pain - Left shoulder and/or upper back pain - Pain along medial left arm
31
Clinical signs and symptoms of myocardial infarction (MI)
- Pain lasting 30 min to 1 hr - Sever pain (can also be painless) - Crushing pain, intolerable - Brought on with exertion or during exercise - Unrelieved by rest or nitroglycerin - Pain is related to amount of ischemia present
32
Patient interview red flags for MI
- Men >40 - Women >50 - Chest pain - PMH of CAD, HTN, DM, XOL, smoking
33
Mi symptoms in women
- One month prior: unusual fatigue, sleep disturbance, dyspnea, GERD, anxiety, heart racing, arms weak/heavy - During the MI: dyspnea, weakness, unusual fatigue, cold sweat, dizziness, nausea, arms weak/heavy
34
Slide 24 MI pain patterns
35
What are the 3 P's to rule out MI
- If present the patient is likely not experiencing a MI - Pleuritic pain (pain worse with deep breathing) - Palpitation produces pain - Posture changes pain
36
Male versus female cardiac pain patterns for MI
- Men: classic substernal (pressure/discomfort under the sternum) - Women: more subtle, nausea, abdominal pain, isolated R biceps pain, fatigue
37
Early warning signs of MI
- Pressure in center of the chest, can be crushing, >30 min - Pain in shoulders, neck, or arms - Lightheadedness or fainting - SOB - Pallor - Sweating - Nausea with or w/o chest discomfort - Angina when working with UE overhead - Sudden death often the first symptom of a heart attack
38
Define cardiac arrest
- Sudden and abrupt loss of heart function
39
Signs of cardiac arrest
- Loss of responsiveness - No response to gentle shaking - No normal breathing - Client does not take a normal breath when you check for several seconds - No signs of circulation - No movement or coughing - If working in an inpatient facility you should call a Code Blue
40
Characteristics of pericarditis
- Pain can last hours to days - Variable intensity of pain, ranges from moderate to severe - Can be asymptomatic, mimic MI, or sharp/cutting pain - Worse with breathing, swallowing, belching, neck, or trunk. movement - Relieved by kneeling on all fours, leaning forward, sitting upright, breathholding (take pressure off heart, can differentiate MI) - Pain related to inflammatory process
41
Describe a cardiac tamponade
- Rare event - Blood fills in the pericardial sac putting pressure on the heart preventing it from filling properly & reducing its pumping ability - Signs: labored breathing, venous distention, decreased BP with inhalation, fainting, elevated HR, and SOB
42
Characteristics of left ventricular failure (HFrEF)
- Pulmonary congestion - Altered by position, activity, stress - Dyspnea - Paroxysmal nocturnal dyspnea - Orthopnea - Cough - Pulmonary edema - Cerebral hypoxia - Fatigue/cramping/nocturia
43
Characteristics of right ventricular failure
- Response to L sided failure or pulmonary disease - Peripheral edema: symmetrical, dependent, pitting - Hepatosplenomegaly 2/2 venous distention: enlarged liver & spleen - Increased fatigue - RUQ pain - Cyanosis of nail beds
44
Describe diastolic heart failure (HFpEF)
- L ventricle stiffens & hypertrophies resulting in the chamber becoming restricted due to the thickened ventricle walls - Heart loses elasticity & ability to relax - Lost elasticity results in impaired filling capacity of the heart - Different than L ventricular (systolic) heart failure (thin & flabby)
45
Clinical signs of diastolic heart failure (HFpEF)
- Fatigue & dyspnea - Orthostatic - Edema & weight gain - Jugular vein distention
46
Characteristics of aneurysms
- Abnormal dilation in the wall of an artery, vein, or heart (asymptomatic) - Thoracic & peripheral: ascending, transverse, & descending aorta from heart to top of diaphragm - Abdominal (AAA): aorta from diaphragm distally - Caused by trauma/weightlifting, congenital vascular disease, infection or atherosclerosis, >risk with advanced age - Associations: Marfan syndrome, Loeys-Dietz syndrome, Turner syndrome, or vascular Ehlers-Danlos syndrome
47
Risk factors for an aortic aneurysm
- Male - Older age - Smoking - 1st degree relative with AAA - Other vascular aneurysms, CAD, cerebrovascular disease, atherosclerosis, hypercholesterolemia, HTN - 100 cigarette history/dose response relationship
48
Charateristics of valvular cardiac chest pain
- Stenosis = narrowing - Regurgitation = back flow of blood - Prolapse (mitral valve): decreased strength & stiffness of leaflets result in increased extensibility of the valve causing regurgitation - Screen patients with connective tissue disorders (Marfan syndrome, Ehlers-Danlos, Loeys-Dietz)
49
What is the triad of symptoms for prolapse (mitral valve) valvular cardiac chest pain
- Palpitations - Fatigue - SOB
50
Characteristics of mitral valve prolapse cardiac chest pain
- Pain/discomfort for minutes to hours - Rarely severe - Can be asymptomatic, not substernal discomfort, can feel a "sticking" sensation - Often occurs at rest - Unrelieved by rest or use of nitro, may be relieved by lying down - Unknown mechanism of pain - Fatigue easily - Palpitation
51
Common congenital heart defects
- Ventricular or partial septal defect (hole b/w the ventricles or atria) - Tetralogy of Fallot (combination of four defects) - Patent ductus arterioles (shunt caused by an opening b/w the aorta & the pulmonary artery) - Congenital stenosis of the pulmonary aortic & tricuspid valves
52
Describe rheumatic fever
- Infection caused by streptococcal bacteria - Affects 5-15 y/o children - Can be fatal or lead to rheumatic heart disease - Rheumatic heart disease is a chronic condition caused by scarring/deformity of the heart valves
53
Describe endocarditis
- Bacterial infection causing inflammation of the cardiac endothelium that damages the tricuspid, aortic, or mitral valve - Caused by bacteria entering the bloodstream from a remote part of the body - Injection drug users, post cardiac surgical clients (prior aortic valve) - Arthralgia in the proximal joints most common symptom (shoulder) - Constitutional symptoms, LBP/SI pain, widespread diffuse myalgias
54
Conditions affecting the cardiac nervous system
- Arrhythmias: disorder of the heart rate & rhythm - Prevalent in pt's after CVA, TBI, SCI (VITALS!!) - Fibrillation: ventricle fibrillation can result in sudden death (requires resuscitation & defibrillation) - Tachycardia/Bradycardia
55
Clinical signs of fibrillation
- Subjective report of palpitations - Sensations of fluttering, skipping, irregular beating or pounding, heaving action - Dyspnea - Chest pain - Anxiety - Pallor, fatigue - Dizziness, lightheadedness, fainting - Nervousness - Cyanosis
56
Describe diuretics
- Decrease BP by eliminating Na and H2O resulting in reduced blood volume - Electrolyte imbalances, weakness, spasm, dizziness, headache, nausea, incoordination
57
Describe beta blockers
- Block beta receptors relaxing blood vessels & heart muscles - Decrease force of contraction & reduction in HR = decrease strain on heart = less workload & less O2 consumption - RPE scale (6-20) - Bradycardia (-olol)
58
Describe alpha-1 blockers
- Dilate blood vessels resulting in decreased BP - Screen for hypotension & reflex tachycardia (-zosin)
59
Describe ACE inhibitors
- Decrease amount of vasoconstriction - Rash, persistent DRY cough (-pril)
60
Describe calcium channel blockers
- Inhibit calcium from entering blood vessel walls - LE swelling, orthostatic hypotension, headache, & nausea - Smooth muscle effects = meds that end in (-pine) - Dilation of coronary arteries/suppression of arrhythmia = verapamil & diltiazem
61
Describe nitrates
- Dilate coronary arteries - Dizziness, tachycardia, orthostatic hypotension
62
Describe statins
- Treat hypercholesterolemia - May cause myalgias - Dark urine
63
Beta blockers can be used to treat angina pectoris, arrhythmias, CHF, and/or hypertension (True/False)
- True
64
Guidelines for cardiac patients that need immediate attention
- Sudden worsening of intermittent claudication - Angina attack that does not subside: change in intensity, pattern, not relieved by nitro - Do not allow the patient to leave unaccompanied - Contact doctor or return to nursing staff
65
Guidelines for cardiac patients that need physician referral
- Women with chest pain who have family Hx of breast cancer or cardiac disease - Palpitation with Hx of unexplained sudden death in family: no more than 6 palpitations per min OR lasting hours OR with pain, SOB, fainting - Anyone who cannot climb a single flight of stairs w/o feeling moderately to severely winded - Awakened due to SOB at night - Fainting w/o warning signs - Hx of neurological impairment with new arrhythmia
66
Slide 48-51
Differential Diagnosis/Imaging
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