Chapter 6- Screening for Cardiovascular disease

the aorta & cerebral vascular area

two most common places for aneurysms

arrhythmias, orthostatic hypotension, poor ventricular function, CAD, vertebral artery insufficiency

causes of cardiac syncope?

- neurologically unstable pts from CVA, head trauma, SCI, or other CNS insult - environmental factors - abnormal thyroid function - meds

potential causes of arrhythmias

Although cyanosis can accompany hematologic or CNS disorders, most often, visible cyanosis accompanies cardiac & pulmonary problems

potential causes of cyanosis?

- may be CV in origin - secondary to pulmonary pathologic condition - fever - certain meds - allergies - poor physical conditioning - obesity

potential causes of dyspnea?

-fever - hypotension - thyrotoxicosis - anemia - anxiety - exercise - hypovolemia - pulmonary emboli - MI - CHF -shock

potential causes of sinus tachycardia

vasovagal syncope

a common physiological response consisting of slow heart rate and low blood pressure that sometimes occurs in people with blood/illness/injury phobias

- Cervical disc disease, and arthritic changes - anxiety - cocaine - anemia - trigger points - thing multisegment innervation, direct pathways, and embryological tissues learn more in chapter 17

examples of non cardiac related chest pain?

· For exercise-related muscle fatigue --> muscle fatigue and soreness should be limited to the muscles exercised and resolve within 24-48 hours · Statin-related fatigue --> involve muscles not recently exercised and may progress or fail to show signs of improvement even after several days of rest

how to differentiate between exercise-related muscle fatigue & Statin-related fatigue

cardiac pain will be described as sharp, knifelike p!, this description is not used for the other causes

how to differentiate true cardiac angina from referred pain from heartburn or indigestion, hiatal hernia, esophageal spasm, or gallbladder disease

Dyspnea relieved by specific breathing patterns or by a specific body position à more likely to be pulmonary

how to distinguish between dyspnea of cardiac origin vs pulmonary origin?

Cough is often hacking and may produce frothy, blood-tinged sputum

how to know if a cough is cardiac in nature?

vascular: usually accompanied by pitting edema, see skin dislocation & tropic changes. cold skin. if have normal skin at rest, with claudication may see paleness psuedo: bilaterally & improves with rest or flexion of lumbar spine infection/ inflammation: warm skin

how to know if claudication is form spinal stenosis or vascular reasons ? infection/ inflammation?

- dark urine - asterisks (liver flap) - bilateral CTS - palmar erythema (liver palms) - spinder angioma - changes in nail beds, skin color - ascites

- S/S of liver impairment

-CAD -Hyperlipidemia (statin med complications) -MI -Pericarditis -CHF -Aneurysms

Cardiac conditions/diseases that can affect heart muscle

- angina, - MI, - pericarditis, - endocarditis, - mitral valve prolapse, - dissecting aortic aneurysm

Cardiac related p! can be secondary to:

o Sudden worsening of intermittent claudication can be from thromboembolism so report to physician immediately. o Angina attacks requires immediate cessation of exercise. - Symptoms should reduce immediately or within 3-5 of stopping exercise - Relief should be within 1-2 minutes of taking nitro à women can get same relief from antacids - If not relieved in 20 minutes of if they have nausea, vomiting, or profuse sweating à immediate medical intervention. Changed in angina pattern: intense intensity, decreased threshold of stimulus, or longer duration of pain -->immediate physician intervention.

- Guidelines for immediate medical attention

- weakness - fatigue - weight change - poor exercise tolerance - peripheral edema

Clinical signs /symptoms of CVD on the general system

Isolated systolic hypertension (ISH)

-an average SBP of 140 mm Hg or more, coupled with an average DBP of less than 90 mm Hg

-Pressure ulcers -loss of body hair -Cyanosis of lips and nails

Clinical signs /symptoms of CVD on the integumentary system

Variant angina

-symptoms similar to typical angina, but caused by arterial spasm rather than plaque buildup - typically occurs at rest and at the same time each day - in postmenopausal woman the reduction of estrogen can cause coronary arteries to spasm

-Labored breathing, dyspnea -productive cough

Clinical signs /symptoms of CVD on the pulmonary system

-Palpitations -Irreg Heartbeat -Dyspnea- Chest pain -Anxiety -dizzy, - nervousness -Cyanosis - pale - fatigue

Clinical signs and symptoms of fibrillation

1. Cardiac Function: performance & contractility 2. Cardiac Output: supply & demand, distribition 3. Vascular function: BP, vascular health, peripheral resitance 4. Vascular Parameters; blood viscosity, arterial & venous integrity

4 factors where cardiac issues go awry

pain, pallor, pulselessness, paresthesia, paralysis, poikilothermic (cold)

6ps of acute arterial symptoms

Past medical history/risk factors:Personal or family history of coronary artery disease, heart disease, angina, myocardial infarction, or risk factors associated with these Assess menstrual history: A menopausal or postmenopausal woman with a high risk for heart disease may develop symptomatic coronary artery disease. Clinical presentation—Objective findings from the clinical evaluation do not seem consistent with temporomandibular dysfunction; assess the effect of using a stationary bicycle or treadmill (stairs or walking will also work) without upper extremity exertion on jaw pain. Increased pain or symptoms with increased lower body exertion may be a sign of cardiac involvement and should be reported to the referring dentist. Associated signs and symptoms—Assess for coincident nausea, diaphoresis, pallor, or dyspnea during painful or symptomatic periods. Look for recent history (last 6 weeks to 6 months in onset) of shortness of breath at night, extreme fatigue, lethargy, and weakness. Ask about the presence of other body aches and pains (be alert for "heartburn" unrelieved by antacids, isolated right biceps muscle aching, and breast or chest pain). Measure vital signs for any unusual findings, and assess changes in vital signs with changes in workload during exercise.

A 48-year-old woman with temporomandibular joint syndrome has been referred to you by her dentist. How do you screen for the possibility of medical (specifically cardiac) disease?

The onset of myocardial infarction can be precipitated by working with the arms extended over the head. Ischemia or infarction may be the cause of this client's symptoms. Assess for history of heart disease and the presence of known hypertension, angina, past episodes of heart attack, or congestive heart failure. Assess vital signs and changes in vital signs with increased workload and assess the effect of increasing the workload of the lower extremities only. Evaluate for thoracic outlet syndrome (TOS), especially with a cardiovascular component (see Table 17-5). Evaluate for and treat trigger points of the chest, upper abdomen, and upper extremity. This client should be evaluated by his physician; the therapist's information gathered from the assessment will be helpful in the medical differential diagnosis.

A 55-year-old male grocery store manager reports that he becomes extremely weak and breathless when he is stocking groceries on overhead shelves. What is the possible significance of this complaint?

systemic lupus erythematosus (SLE)

A multisystem illness associated with the release of a broad spectrum of autoantibodies into circulation

mitral valve

A valve in the heart that guards the opening between the left atrium and the left ventricle; prevents the blood in the ventricle from returning to the atrium. Alternative name is bicuspid valve.

tricuspid valve

A valve that is situated at the opening of the right atrium of the heart into the right ventricle and that resembles the mitral valve in structure but consists of three triangular membranous flaps.

trauma, congenital vascular disease, infection, atherosclerosis, weight lifting in aging athletes

AAA's can be caused by:

Grade 0: no agina Grade 1: Lightly,barely noticable Grade 2: Moderately bothersome Grade 3: Severe Grade 4: most pain ever experienced

Angina grading scale

chronic, swollen limbs; Hemosiderin venous stasis ulceration (lateral ankle)

Chronic venous disorder: S/S

Myocardial ischemia is a deficiency of blood supply to the heart muscle that is usually caused by narrowing of the coronary arteries. Angina pectoris is the chest pain that occurs when the heart is not receiving an adequate supply of blood, and therefore, has insufficient quantities of oxygen for the workload. Myocardial infarction is death of the heart tissue when blood supply to that area is interrupted.

Briefly describe the difference between myocardial ischemia, angina pectoris, and myocardial infarction.

- first sign- loss of hair on toes - most important : intermittent claudication & ischemic rest pain - rest pain aggravate by elevating the extremity; relieved by hanging foot over side of bed - change in color, temp, skin, nail beds - dec skin temp - dry, scaly, shiny skin - possible ulceration & gangrene on WB surfaces - change in vision (diabetic atherosclerosis) - fatigue on exertion (diabetic atherosclerosis)

Clinical S/S of arterial (occlusive) disease

-HA -impaired vision -dizzy/syncope

Clinical signs /symptoms of CVD on the CNS

-N/V -Abdominal distention

Clinical signs /symptoms of CVD on the GI system

occipital headache (in early morning) vertigo, flushed face, spontaneous epistaxis (nose bleeds) , vision changes, nocturnal urinary frequency

Clinical S&S of HTN

· Common symptoms = joint pain and fever o Migratory arthralgia (knees, shoulder, feet, ankles, elbows, finger, or neck) o Subcutaneous nodules on extensor surfaces o Fever and sore throat (initially) o Flat, p!less skin rash (short duration) o Carditis - palpitations o Chorea may occur 1-3 months after strep infection: rapid, purposeless, non repetitive movements that involve all muscles except eyes o Weakness, malaise, wt loss, anorexia o Acquired valvular disease**** (by the inflammatory response) - SOB & increasing nocturnal cough

Clinical S&S of Rheumatic Fever (all layers of the heart may be involved)

- most common= radiates to the left shoulder following an ulnar nerve distribution to the fingers - also can refer pain to neck, jaw, teeth, upper back, possibly down right arm, occasional abdomen women- experience a sensation similar to inhaling cold air, others complain only of weakness and lethargy , some have noted pain at TMJ, mid thoracic spine, R biceps muscle

Clinical S&S of angina (from text)

- usually asymptomatic & found during physical or radiographic examine of abdomen or spine for some other reason - pulsating mass in abdomen w/ or w/o pain * most common symptom - abdominal pain - back pain - feel a heart beat in abdomen or stomach when laying down - groin (scrotal), butt, or flank pain from increased pressure on other structures - severe, intense, knife like pain from text^^ - chest pain with any of the following: - palpable, pulsating mass (abdomen, popliteal space) - abdominal heartbeat when laying down - dull ache in mid abdominal left flank or low back - Pain in hip, groin, scrotal, butt, leg (posterior thigh) -Weakness/transient paralysis of legs

Clinical S/S of AAA

-increased urinary freq -nocturia -concentrated urine -decreased urine output

Clinical signs /symptoms of CVD on the GU system

-chest, shld, back, neck, arm, jaw pain -myalgias -muscle fatigue - muscle atrophy -edema -claudication

Clinical signs /symptoms of CVD on the MSK system

almost all symptom from dysautonomia- imbalance in ANS -Profound fatigue not corrupted to exercise or stress -Chest, arm, back, shld pain -Palpitations/irreg heartbeat -Tachycardia -Migraine -Anxiety, depression, panic -Dyspnea - MSK: joint hypermobility, TMj syndrome, myalgias most common triad of symptoms= fatigue, palpitations, and dyspnea 2/3 of those with MVP have no symptoms 1/3 experience occasional symptoms that are mild-mod only 1% experience severe symptoms

Clinical signs and symptoms of mitral valve prolapse

-Substernal pain (can radiate to neck, upper back, upper trap, left supraclavicular area, down left arm) -Difficulty swallowing -Pain relieved by leaning forward or sitting upright or kneeling on all 4s -Pain reduced by holding breath -Pain aggravated by deep breaths (laugh, laugh, deep inspiration), trunk movements (side bending or rotation) & by lying down -Cough -LE edema

Clinical signs and symptoms of pericarditis

-Increased fatigue -Edema in LE (especially ankles) -Pitting edema - edema in sacral area or back of thighs -RUQ pain -Cyanosis of nail beds: from venous congestion reducing peripheral blood flow

Clinical signs and symptoms of right sided heart failure

-Palpitation (most common) -Restlessness -Chest pain -Agitation -Anxiety

Clinical signs and symptoms of sinus tachycardia

-Sudden severe chest pain with tearing sensation -Pain in neck, shoulders, scaps, LB, abdomen; pain radiating to the posterior thighs from an MI -Pain not relieved by change of position - pain feels like tearing or ripping -Pulsating mass -Cold, pulseless LE -BP changes (systolic less than 100, more than 10 mmHG difference in DBP in both arms) -HR more than 100 -Ecchymoses in flank & perianal area -Lightheaded/nausea

Clinical signs/symptoms of a ruptured aneurysm

-Gripping feeling of pain or pressure behind breast bone -Pain radiates to neck, jaw, back, shld, arm (left arm in men) -Toothache -Dyspnea -Nausea -Belching

Clinical signs/symptoms of angina pectoris (from chart)

-Fatigue -Dyspnea -Palpitations (throbbing, skipping rapid, or forcible pulsation of the heart) -Chest pain -Pitting edema -Orthopnea or PND -Dizzy/syncope

Clinical signs/symptoms of cardiac valvular disease (stenosis, insufficiency, prolapse?)

-Fatigue -dyspnea -Orthopnea -Edema (LE) - weight gain -Jugular vein distention - normal ejection fraction

Clinical signs/symptoms of diastolic heart failure

-Frequent heartburn attacks -Antacids relieve -Wakes patient at night -Acid/bitter taste -Burning sensation in chest -Discomfort from spicy foods -Abdominal bloating/gas

Clinical signs/symptoms of heartburn

-Reduced pulse rate -Syncope - Sudden onset of weakness, sweating, nausea, pallor, vomiting, & distortion/dimming of vision

Clinical signs/symptoms of sinus bradycardia

-Fatigue/dyspnea w mild exertion -Spasmodic cough especially when lying down -Nocturnal dyspnea -Orthopnea -Tachycardia -Muscle weakness -LE edema -Increased urination at night ^^ chart S/S Text info (also): - Paroxysmal nocturnal dyspnea (PND): client awakens bc feels like suffocating - Orthopnea: often sleeping with pillows and assumes the "three point position" - Cough: hacking up a lot of "frothy" sputum - Pulmonary edema: when there is an overload of fluid in the lungs - breathlessness, anxiety, tachypnea - Cerebral hypoxia: inadequate brain profusion = depressed cerebral function - Fatigue and muscular cramping/weakness: tissues are becoming hypoxic

Common clinical signs/symptoms of left ventricular failure

-Atherosclerosis (fatty buildup on arterial walls) -Thrombus (blood clots narrowing artery) -spasms (intermittent constriction)

Conditions that cause CAD

damaged heart muscle cells, deprived of O2 can release small electrical impulses that may disrupt normal conduction pathway

How can a MI cause fibrillation?

A- Parietal pericardium B- pericardial space/ pericardial fluid C- visceral pericardium/ epidcardium D- endocardium E-Myocardium F- epicardium/ visceral pericardium

Label all the layers of the heart

-advanced age, - hypertension, - obesity, - sedentary lifestyle, - excessive alcohol consumption, - oral contraceptive use (over age 35 & smoking) - first generation family hx, - tobacco use, (including 2ndhand) - abnormal cholesterol, - race (African Americans. Mexican Americans, Native Americans, Pacific Islanders

Known risk factors for CVD

-a quick change in a prolonged position - physical exertion involving increased ab pressure (like straining to poor or lifting

Lightheadedness resulting from orthostatic hypotension may occur with

-chest, neck, arm pain or discomfort -palpitations -dyspnea -syncope -fatigue -cough -excessive sweating -Cyanosis

Most common cardinal signs of CVD

-Angina pectoris -MI

Most common disorders resulting from CAD ( insufficient blood supply to myocardium)

unexplained, severe episodic fatigue and weakness associated with a decreased ability to carry out normal ADLs --- Weakness, fatigue, sleeping difficulty and nausea have been reported as a common occurrence as much as a month before the development of acute MI in women

One of the most important primary signs of CAD in women

Sharp-Purser Test

Patient sitting, the palm of one hand is on the patient's forehead, and the index finger or thumb of the other hand is on the SP of C2, the patient slowly flexes the head while the examiner presses posteriorly on the forehead, a positive result is a reduction in symptoms, a "clunk" sensation, or pt reports a "click" or "clunk" in the roof of the mouth

Arterial and occlusive diseases are synonymous for the same thing: Occlusion of the arteries produces arterial disease; occlusion of the veins produces venous disorders. Arteries and veins constitute the major peripheral blood vessels; therefore, any diseases or disorders of the arteries and/or veins are included in peripheral vascular disorders. so d all of the above

Peripheral vascular diseases include a. Arterial and occlusive diseases b. Arterial and venous disorders c. Acute and chronic arterial diseases d. All of the above e. None of the above

-Disease (rheumatic fever, coronary thrombosis) -congenital deformity -Infection (endocarditis) -Valve deformities

Possible conditions affecting the heart valves

-Disease (rheumatic fever, coronary thrombosis) -congenital deformity -Infection (endocarditis) -Valve deformities (mitral valve prolapse)

Possible conditions affecting the heart valves

b. Emphysema

Pursed-lip breathing in the sitting position while leaning forward on the arms relieves symptoms of dyspnea for the client with a. Orthopnea b. Emphysema c. Congestive heart failure d. (a) and (c) B

secondary to cardiac surgery, venous valve incompetence/obstruction, cardiac valve stenosis, CAD, mitral valve dysfunction

R HF & subsequent edema can occur with

Paroxysmal nocturnal dyspnea (PND)

Refers to attacks of severe shortness of breath and coughing that generally occur at night. It usually awakens the person from sleep, and may be quite frightening.

infection causes by streptococcal bacteria that can lead to rheumatic heart disease -a condition caused by scarring and deformity of heart valves

Rheumatic fever:?

benign condition in isolation - is associated with a number of conditions (Ehler's-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta) also: - endocarditis - myocarditis - atherosclerosis - SLE - muscular dystrophy - acromegaly - cardiac sarcoidosis

Risk factors for mitral valve prolapse

liver disease, acute infection, and hypothyroidism

Risk for statin induced myositis is highest in people with

-HTN -CAD -Cardiomyopathy -Heart valve abnormalities -Arrythmia -Fever - infection -Anemia - thyroid disorder, - pregnancy, - Paget's disease, - nutritional deficiency (thiamine deficiency 2ndary to alcoholism) - pulm disease, - SCI, - hypervolemia from poor renal function - Medications: CV drugs, antibiotics, CNS drugs (sedatives,hypotics, antidepressants, narcotic analgesics), and anti-inflammatory drugs - Chemotherapy is linked to increased risk of CVD! - consider cancer tx in children who were treated successfully for cancer years ago a warning sign!!

Risk fx for CHF

-Age -High BP -CAD -Cardiac muscle damage -Valve dysfunction also: diabetes, anemia, & thyroid disease inc the risk

Risk fx for diastolic heart failure

-Previous MI -High BP -CHF -Digitalis toxicity -Pericarditis -Rheumatic mitral stenosis other factors that can overstimulate the sinus node: - emotional stress - hyperthyrodism - alcohol & caffine - high fevers - chronic gastritis - H pylori - C reactive protein

Risk fx for fibrillation

Peripheral vascular disease

Rubor (dusky redness) is a common change in skin color that is associated with what disease process?

Episodes occur in response to cold temps or strong emotion 1-pallor in the digits- from vasconstriction of arterioles 2-followed by cyanosis w/ feelings of cold/numbness/and occasionally p!, 3- and finally, intense redness w/ tingling or throbbing- from vasospasm & period of hyperemia

S&S of Raynaud's phenomenon (RP) and disease

- superficial thrombophlebitis appears as local, raised, red, slightly hard, warm and tender; DVTs are usually asymptomatic - may have unilateral tenderness or leg p! and swelling, warmth, and discoloration - may or may not have a fever maybe chills and malaise, maybe first symptom is a pulmonary embolism

S&S of an acute venous disorder

- edema of dorsum foot/hand, - decreased ROM, flexibility, and function, - usually unilateral, - worse after prolonged dependency, - no discomfort or a dull, heavy sensation

S/S of lymphedema

nope we are saying an overactive

T or F an under-reactive thyroid can cause heart palpitations

Ejection Fraction (EF)

The fraction of blood pumped out of the left ventricle with each contraction, determined by dividing stroke volume by end-diastolic volume and expressed as a percentage.

angina, MI, pericarditis, and dissecting aortic aneurysm

The most common CV conditions to mimic MSK dysfunction

referred to a physician immediately

a pt has these S/S: Muscle aches and p!'s, fever, nausea, vomiting, and dark urine what we doing?

- Pleuritic pain: worsened by respiratory movement like deep breathing, coughing, sneezing, laughing or hiccups --> reduction or elimination of symptoms with Valsalva indicates pulmonary or cardiac origin - Pain on palpation: MSK origin - Pain w/ changes in position: pain worse with lying down and improves with sitting up or leaning forward is often pleuritic. - If 2 of 3 P's are present then MI is unlikely.

Three P's in CV screening?

- often have prodromal symptoms (occurring 1 month before), - classic chest discomfort (less common though) - mental status change or confusion (older), - dyspnea, (at rest or with exertion) - weakness/lethargy, (unable to do ADLs) - indigestion/heart burn/stomach p!, - anxiety/depression, - sleep disturbance, - sensation like inhaling cold air, - aching/heaviness/weakness of both arms, - symptoms may be relieved by antacids (sometimes better than Nitro) - heaviness, squeezing, or pain in left side of chest, abdomen, mid back (thoracic), shoulder, or arm with no midchest symptoms - fatigue, nausea, and lower abdominal pain - isolated right biceps pain - inability to talk , move, or breathe - ankle swelling or rapid weight gain

Warning signs of MI in women

- previous valvular damage, - injection drug users - postcardiac surgical clients - congenital Heart diease - degenerative heart disease ex. calcific aortic stenosis The prosthetic cardiac valve surgery and any invasive diagnostic procedure (renal shunts, catheters, dental) can result in this bacteria!!

What are risk fx for endocarditis?

1 pt: active cancer or within 6mon 1 pt: paralysis, paresis, immobilziaiton 1pt: bedridden more than 3 days or major sx past 12 weeks 1 pt local tenderness in calf, pop space, femoral vein 1 pt LE swelling 1 pt: unilateral calf swelling (more than3 cm larger than uninvolved side) measured 10cm below tibial tube 1 pt: pitting edema on symptomatic LE 1 pt: collare superifical vein 1pt: previous DVT -2 pt: alt diagnosis as likely as a DVT 2 or + = DVT likley less than 2= DVT unlikely

Wells Criteria & Points

- response to stress - peronsality - PVD - hormonal status - alcohol consumption - obesity

What are contributing factors for CAD

-Physical inactivity -Smoking -Elevated cholesterol levels -High BP -Diabetes -Obesity

What are modifiable risk fx for CAD

-Age (65 or older) -Male -Family hx -Race -Postmenopausal

What are nonmodifiable risk fx for CAD

-Left ventricular failure -Right ventricular failure -Diastolic heart failure

What are the 3 types of CHF

a. Fatigue, dyspnea, edema, nocturia

What are the primary signs and symptoms of congestive heart failure? a. Fatigue, dyspnea, edema, nocturia b. Fatigue, dyspnea, varicose veins c. Fatigue, dyspnea, tinnitus, nocturia d. Fatigue, dyspnea, headache, night sweats

-Chronic stable angina -Resting angina -Unstable angina -Nocturnal angina -atypical angina -Prinzmetal's (variant) angina

What are the six types of anginal pain

-Diseases affecting the heart muscle -the heart valves -the cardiac nervous system

What are the three components of cardiac diseases

-obstruction/restriction -inflammation/congestion -dilation/ distention *these may occur sequentially

What are the three processes that affect heart muscle

-Respiratory distress from: -Pulmonary congestion - disturbances of respiratory control mechanisms you have blood backing up into the lungs

What does left ventricular failure typically manifest as?

when coronary artery becomes narrowed or blocked, and area of heart supplied by that artery becomes ischemia and injured

What is CAD?

When the heart is no longer able to pump enough blood to meet the metabolic needs of the body (O2 consumption) at rest or during exercise. is NOT a disease itself but a group of manifestations the heart fails because due to intrinsic disease or structural defects, the heart cannot handle a normal blood volume, or in total absence of disease, cannot tolerate a sudden expansion in blood volume. when it cannot pump blood out, congestion occurs in pulmonary circulation as blood accumulates in the lungs-- get SOB, and if it continues, actual flooding of air spaces of the lungs with fluid seeping from distended blood vessels--> called pulmonary congestion or pulmonary edema

What is CHF?

-Mitral leaflet thickness with increased extensibility, decreased stiffness, and decreased strength -Floppy valve syndrome - causes leaking of blood from L ventricle to L atrium - an be heard as a click with a stethoscope or as a murmur

What is a mitral valve prolapse

An abnormal dilation of the wall of an artery, vein, or the heart that occurs when vessel or heart wall becomes weakened from trauma, congenital vascular disease, infection, or atherosclerosi s

What is an anuerysm?

-When the left ventricle stiffens and hypertrophies -This makes is difficult for the cardiac muscle to relax between beats and thus unable to fill completely during diastole this Results in not enough blood supply to the organs and tissues

What is diastolic heart failure caused by

-A common heart infection causing inflammation of cardiac endothelium (layer lining the cavities of heart) -Can damage tricuspid, mitral, and aortic valve

What is endocarditis?

-AKA regurgitation -Valve does not close properly, and causes blood to flow back into the heart chamber

What is insufficiency of a valve

Inflammation of parietal and visceral pericardium (the sac like covering of the heart)

What is pericarditis?

- Affects only mitral valve -Occurs when enlarged valve leaflets bulge backwards into left atrium

What is prolapse of a valve

May occur in response to left sided CHF or as a result of a pulmonary embolism results in peripheral edema and venous congestion of the organs (I.e. the liver becomes enlarged and painful with the buildup of venous fluid inside- causes p! in the upper right quadrant)

What is right ventricular failure typically caused by? what can it cause?

-A narrowing that prevents the valve from opening fully -Can be caused by growths, scars, abnormal deposits

What is stenosis of a valve

1) Age > 60 = 1 Point 2)Blood Pressure >140/>90 = 1 Point 3) Clinical Features - Unilateral Weakness = 2 Points, Speech Disturbances w/o weakness = 1 Point 4) Duration: Sx > 60 Mins = 2 Points, 10 Mins to 60 Mins = 1 Point 5) DM = 1 Point Score 0 to 3: Low Stroke Risk Score 4 to 5: Moderate Stroke Risk Score 6 to 7: High Risk

What is the ABCD score?

Monitor vital signs, and palpate pulses. Evaluate past and current medical history for the presence of coronary artery disease. Any suspicion of thoracic aneurysm must be reported to the physician immediately. It is beyond the scope of a physical therapist's practice to suggest the possibility of an aneurysm. Rather, clinical observations should be documented and submitted to the physician. A summary comment can be made such as, "This clinical presentation is not consistent with a musculoskeletal problem. Please evaluate."

What should you do if a client complains of throbbing pain at the base of the neck that radiates into the interscapular areas and increases with exertion?

morning because: - body's clotting system is more active - BP is surging - HR increases - stressed getting ready for the day - level & activity of stress hormones

When time of day do many MI's occur?

· Palpitations may be considered physiologic (i.e., "within normal limits") when they occur at a rate of less than six per minute. Malo: · Palpitations lasting for hours or occurring in association with pain, shortness of breath, fainting, or severe lightheadedness require medical evaluation. · Palpitations in any person with a history of unexplained sudden death in the family require medical referral. · Palpitations can also occur as an adverse effect of some medications, through the use of drugs such as cocaine, as the result of an overactive thyroid, or because of caffeine sensitivity. · Palpitations as a recurring symptom (even if less than six/minute) should always be reported to the physician.

When are palpitations clinically significant?

c. Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed.

Which statement is the most accurate? a. Arterial disease is characterized by intermittent claudication, pain relieved by elevating the extremity, and history of smoking. b. Arterial disease is characterized by loss of hair on the lower extremities and throbbing pain in the calf muscles that goes away by using heat and elevation. c. Arterial disease is characterized by painful throbbing of the feet at night that goes away by dangling the feet over the bed. d. Arterial disease is characterized by loss of hair on the toes, intermittent claudication, and redness or warmth of the legs that is accompanied by a burning sensation.

Examine this client for the presence of cyanosis, orthopnea, and tachycardia; for changes in renal function (decreased urination during the day but frequent urination at night); and for a spasmodic cough triggered by lying down or at night. These may be indicators of congestive heart failure and must be reported to the physician. Take note of whether this client is taking NSAIDs and digitalis together; this combination of medications can cause ankle swelling—a symptom that must also be reported to the physician

You are seeing an 83-year-old woman for a home health evaluation after a motor vehicle accident (MVA) that required a long hospitalization followed by transition care in an intermediate care nursing facility and now home health care. She is ambulating short distances with a wheeled walker, but she becomes short of breath quickly and requires lengthy rest periods. At each visit the client is wearing her slippers and housecoat, so you suggest that she start dressing each day as if she intended to go out. She replies that she can no longer fit into her loosest slacks and she cannot tie her shoes. Is there any significance to this client's comments, or is this consistent with her age and obvious deconditioning? Briefly explain your answer

athletes heart

a nonpathological enlarged heart, often found in endurance athletes, that results primarily from left ventricular hypertrophy in response to training

hypertension

a pattern of consistently elevated diastolic pressure, systolic pressure, or both measured over a period of time, usually several months

generally involve the aorta below the diaphragm , between the renal & iliac branches

abdominal aneurysm?

orthopnea

ability to breathe easily only in an upright position; its severity is judged by how many pillows needed to breath comfortably.

- thrombus, embolism or trauma to an artery - arteriosclerosis obliterans - thromboangitis obliterans or Buerger's disease - Raynaud's diease

acute arterial occlusion may be caused by:

Labile Hypertension

also known as borderline hypertension, is a variation of hypertension where blood pressure continuously fluctuates between low and high levels. This fluctuation may cause ringing in the ears or headaches, and could stem from emotional stress throughout the day.

unstable angina

angina that: -AKA preinfarction angina -abrupt changes in intensity and frequency of symptoms -most commonly caused by a bursting of a cholesterol filled plaque - these can last up to 20-30 minutes and can process into full blown heart attack - pain unrelieved by nitro or rest need immediate doctor attention

Resting angina

angina that: -Chest pain in supine position -Frequently at same time every day -Not brought on by exertion or relieved by rest

Nocturnal agina

angina that: -Person awakes with the same sensation experienced during exertion -Exertion caused by dreams -may be related to underlying CHF

Atypical angina

angina that: -Unusual symptoms (tooth or ear ache) -Subside with rest and nitroglycerin

Chronic stable angina

angina that: -occurs at predictable level of physical or emotional stress -responds well to rest and nitroglycerin - no pain at rest

breathlessness or dyspnea

as stenosis or insufficiency progresses, the main symptom of heart failure ______ appears

mitral valve prolapse, "athletes heart", caffeine, anxiety, exercises

benign causes of palpitations

- arrhythmias - tachycardia - bradycardia

cardiac disease of the CNS?

fainting caused by reduced oxygen delivery to the brain

cardiac syncope?

1. hypersensitivity of digital arteries to cold 2. release of serotonin 3. congenital predisposition to vasospasm

cause of Raynaud's disease

- coronary thrombosis (most common) - coronary artery spasm - platelet aggregation & embolism - thrombus 2ndary to rheumatic heart diease - endocarditis - aortic stenosis - thrombus on a prosthetic mitral or aortic valve - dislodge Ca plaque from a calcified aortic or mitral valve can be provoked by cold & by exercise

causes of MI/heart attack

· Can occur by itself or by myocardial trauma (HA, chest injury, cardiac surgery) - Secondary- influenza, HIV, TB, cancer, kidney failure, hypothyroidism Previous infection may be mild or asymptomatic with post infectious onset of p! occurring 1 -3 weeks later (i.e. had flu and then a week later getting chest p!, difficulty breathing - ask if they have been to a doctor)

causes of pericarditis

identifiable cause such as renal artery stenosis, oral contraceptive use, hyperthyroidism, adrenal tumors, and med use

causes of secondary HTN

- slurred speech, sudden difficulty with speech or difficulty understanding others - sudden confusion, memory loss, loss of consiousness - temporary blindness or dramatic visual changes - dizziness - sudden, severe HA - paralysis or extreme weakness, usually on 1 side of the body - difficulty walking, loss of balance/ coordination - brief symptoms: minutes to 24 hours

clinical S/S of a TIA

- older men & women - menopausal women - African- American women

demographics most at risk for CAD

Myocardial infarction duration: atleast 30 min S/S: none with silent MI, dizziness, N/V, pallor, diaphoreses, anxiety, fatigue, sudden weakness, dyspnea reliving factors: NONE

describe this pain pattern & the S/S you would see with it

is a dissenting aortic aneurysm location: anterior chest= thoracic; abdomen = AAA description: knife-like, tearing. dull ache in lower back intensity: SEVERE, excruciating S/S: pusles absent, feel heartbeat in belly, palpable pulsating abdominal mass, lower BP in one arm no relieving factors aggravating: supien position

describe this pain pattern & the S/S you would see with it

pain patterns associated with angina. substernal discomfort in left shoulder & over distribution of ulnar nerve. occasionally, anginal pain may be referred to area of the of the left scapula or inter scapular region. duration: ave 3-5 min Associated S/S: extreme fatigue, lethargy, weakness (women), dyspnea, diaphoresis, anxiety, heartburn, belching, sensation of inhaling cold air (women), prolonged & repeated papliations relieving factors: rest, nitro, antacids(women) aggravating: cold weather, exercise, heavy metals, stress

describe this pain pattern & the S/S you would see with it

this is pericarditis. is substernal is more localized that pain of MI & is sharp, stabbing, knife-like of mod- severe intensity duration: last hours to days relief by sitting up right or leaning forward aggravating factors: deep breathing, left lateral side bending, trunk rotation, supine

describe this pain pattern & the S/S you would see with it

may be cardiac or noncardiac and may radiate to the neck, jaw, upper back, upper trap muscle, shoulder, or arms (commonly left) C3-T4

does chest pain automatically mean cardiac? where else can it radiate to?

- OTC drugs: - appetite suppressants, - pseudoephedrine in cold and allergy remedies, prescription: MAO inhibitors, and corticosteroids for a long period of time

drugs that can cause HTN

o Nitro doesn't relieve anginal pain o Angina pattern changes. o Abnormally severe chest pain with nausea and vomiting o Angina pain that radiates to the jaw or left arm o Angina not relieved by rest o Upper back feels abnormally cool, sweaty, or moist o Develops worsening of dyspnea o Pt with coronary artery stent gets chest pain o Pt has a difference of more than 40mmHg in pulse pressure - women with chest/ breast pain with a + family hx - palpitations: anyone with a hx of sudden death in family -or- more than 6+ in 1 minute -or- lasting for hours -or- occurring with pain, SOB, fainting, severe light-headedness, fainting - anyone who cannot climb a single flight of stairs w/o feeling mod-severe winded - awakens at nigh or OB when laying down - fainting without any warning sings - neurologically unstable pts displaying new arrhythmias

guidelines for Dr. Referral

take their BP may have a failure of BP rise --> may indicate cardiac output that is inadequate in meeting the demands of exercise

if pt is having fatigue that is due to cardiac issues but that cardiac issue is not diagnosed yet, what can we look for?

Raynaud's phenomenon (RP) and disease

intermittent episodes when small arteries in extremities constrict, causing pallor and cyanosis of digits, & changes in skin temp

yes- may be a sign of hidden neoplasm

is unilateral Raynaud's phenomenon (RP) and disease concerning?

A. Abdominal aneurysm

it may be necessary to assess for __ in an older patient presenting with lower back pain, particularly if this pain is worse in the supine position A. Abdominal aneurysm B. Gall bladder rupture C. Pancreatic Cancer D. Kidney infection

Heart disease

leading causes of death in the united states & other industrialized nations

o PT must keep in mind that NSAIDs have the ability to negate the anti-hypertensive effects of ACE inhibitors. o Anyone being treated w/ both of these should be monitored closely for elevation in BP.

link between NSAIDS & ACE inhibitors

o NSAIDs have the ability to decrease the excretion of digitalis glycosides, therefore, levels of glycosides increase producing digitalis toxicity. - glycosides can increase the side effects of NSAIDS- especially LE & abdominal swelling

link between NSAIDS & digitalis glycosides

masked hypertension

low clinic blood pressure, but elevated ambulatory/home blood pressure

- smoking/ tobacco - T2 DM - high cholesterol - chronic alcohol use/abuse - obesity - sedentary lifestyle - stress - diet, nutrition, K deficiency

modifiable risk factors for HTN

site is the popliteal space in the LE - causing ischemic p! in the LE and easily palpable pulse of large amplitude - an enlarged area may present behind the knee

most common site for peripheral arterial aneurysm:

edema & leg pain (claudication)

most common symptoms of the vascular component of a CV pathologic condition?

a collagen vascular disease: scleroderma, polymyositis, SLE, or rheumatoid arthritis also as a long term complication of cancer tx may occur after trauma or use of vibrating equipment

may see secondary Raynaud's phenomenon (RP) and disease with

mild myalgia: muscle ache/weakness w/o nc CK levels myositis: muscle symptoms & inc CK levels frank rhabo: muscle symptoms with marked CK elevation

mild myalgia vs myositis vs frank rnhabdomylosis

(1) age over 80 y/o, (2) small body frame/frail, (3) kidney or liver disease, (4) drinks excessive grapefruit juice daily, (5) use of other medications- cyclosporine, some antibiotics, HIV protease inhibitors, some antidepressants (6) alcohol abuse

muscle symptoms in response to statins seen in these populations:

pulmonary hypertension, kidney dysfunction, cirrhosis, burns, infection, lymphatic obstruction, use of NSAIDs, allergic reaction

non cardiac causes of edema

- African American - Age (60+) - post menopausal - family hx of CVD also sex: men experience HTN at higher rates & an earlier age than women do until after menopause

nonmodifiable risk factors for HTN

normal- 1.8-3 mg/DL or 1.5-2.5 mEq/L Deficits are often seen in alcoholics. Deficits often accompany potassium and calcium deficits. Low levels: results in myocardium irritability and cardiac arrhythmias.

normal Mg levels? Potential cause? can result in ?

between 2.5- 4.0 cm it increases with age mens larger than women's

normal aortic pulse width?

decrease of 15mmHG

normal nocturnal drop in BP?

fall in systolic BP of 20 mmHg or more - or a drop of 10 mmHg or more of both systolic and diastolic arterial BP with a 10-20% increase in pulse rate - light-headed, dizzy - pale - sweaty - syncope - mental/ visual blurring - sense of weakness or rubbery legs

objective measures to diagnose orthostatic hypotension? other S/S

known to release prostaglandins capable of causing muscle spasms - in turn promoting platelet aggregation = vicious spasm/pain cycle begins

platelet aggregations can release what?

- cardiac - neurologic, - muscular, - metabolic, - pulmonary pathologic condition - Beta blockers if cardiac usually see these S/S with it: dyspnea, chest pain, palpitations, or headache

possible causes of fatigue that is provoked by minimal exertion indicates lack of energy. what S/S are seen if the fatigue is cardiac in origin?

ulnar nerve distribution

radiating chest chest pain down the arms follows a _____ distribution

(1) exposures to bacteria such as Chlamydia pneumoniae, (2) excess levels of homocysteine 3) high levels of alpha- lipoprotein (cousin of LDL) (4) high levels of fibrinogen, (5) large amounts of C- reactive protein, (6) the presence of troponin T, (7) the presence of diagonal earlobe creases, (8) past hx of cancer treatment

recently found causes of CAD

in the form of a 3 lbs or greater weight gain or a gradual, continuous gain over several days that results in swelling of the ankles, abdomen, and hands combined with SOB, fatigue, and dizziness

red flag symptoms of CHF in regards to edema

external abdominal muscle

referred pain from a trigger point on this muscle can cause a sensation of heartburn in the chest wall

- hx of smoking - known congenital heart diseease - sx to replace/repair an aortic valve before 70 years - recent infection - diagnosis of CAD - genetic conditions: Marfan, Loeys-Dietz, Turner, Ehlers- Danlos

risk factors for a AAA

- heart disease - HTN - smoking/tobacco - age over 65 - diabetes - overweight immediate medical referral is advised with anyone with S/S of TIAs

risk factors for a TIA

- personal or family hx of thromboembolism - CHF - over 50 - immobilization or inactivity - obstertic/ gynecologic conditions - obesity - neoplasm - pacemaker - trauma: sx, indwelling central venous catheter, fx, burns, SCI, endothelial injury, CVA) - blood disorders: hyper coagulable, clotting - hx of infetion - DM

risk factors for a pulmonary embolism or a deep vein thrombosis

- diabetes increases susceptibility to CHD; others: - smoking, - hypertension, - hyperlipidemia, - older age - abnormal platelet activation - metabolic disturbance

risk factors for arterial (occlusive) disease:

high total serum cholesterol, high LDL, high triglycerides, and low HDLs primary risk factors for atherosclerosis & CAD

serum levels that factor into hyperlipidemia diagnosis this is a primary risk factor for what?

CAD, cardiomyopathy, complete heart block, ventricular aneurysm, AV valve disease, mitral or aortic stenosis

severe causes of palpitations

- anxiety - irritability - restlessness - confusion - impaired memory - bad dreams - insomnia

signs of depressed cerebral function due to cerebral hypoxia

are at risk for trauma to the aorta -->internal bleeding can result in: distended ab, changes in BP changes in stool, possible back and/or shoulder p!

signs of internal bleeding from complications of anterior spinal sx

is when rapidly rising pulmonary capillary pressure causes fluid to move into the alveoli, resulting in: - extreme breathlessnes - anxiety - frothy sputum - nasal flaring - use of accessory breathing muscles - tachypnea - noisy & wet breathing - diaphoreses

signs of pulmonary edema

- SBP below 100 & a pulse rate of 100 - ecchymoses in flank & perianal area - severe & sudden pain in abdomen, paravertebral area, or flank - lightheaded & nausea with sudden hypotension

signs of shock related to an AAA

- symptomatic: myopathy: muscle soreness, pain, weakness, dyspnea; myositis: elevated CK level--> looked for weakness in large muscle groups bilaterally, such as thigh, back, butt, shoulders - unexplained fever - N/V - S/S of liver impairment

statin-induced side effects

75% angina

symptoms of CAD do not appear until the lumen of the coronary artery narrows by ____% - the heart when deprived of oxygen, may ache, causing chest pain or discomfort referred to as ____

systolic -- less than 35%

systolic or diastolic HF is there a decrease in ejection fraction?

cogenital CV abrnomalitie that are asympomatic & undiagnosed - marfan syndrome - congenital artery anomalies - rupture aorta

the main cause of sudden death in athletes? the most common reports of sudden death in athletes?

orthostatic intolerance

the most common cause of light-headedness in clients

just below the kidney (95%) look for referred pain to the thoracolumbar junction

the most common site for an AAA?

occlusion of the superficial femoral artery between groin and knee, producing pain in the calf that sometime radiates upward toward the popliteal region & lower thigh will see: 2+ or normal femoral pulse but arterial pulses are absent at the knee/foot

the most frequent arterial lesion

MVP

these triad are associated with what disease?

involve the ascending, transverse, or descending portion of the aorta from the heart to the top of the diaphragm

thoracic aneurysm?

1- venous stasis (prolonged immobilization), 2- hypercoagulability, 3-injury to the venous wall: IV injections, Buerger's disease, fx, dislocations, sclerosing agents, opaque mediatior radiography other risk factors: - SCI - multiple trauma - CHF - obesity - pregnancy - major sx

thrombus formation is usually attributed to these 3 things:

less than 6 in one minute

what are "normal" palpitations?

interrupts the chain that constricts blood vessels. · SE: dry cough and rash · Generic names end in -pril

what do ACE inhibitors do? concerns/ AEs?

- a HR that is either too high or too low during exercise, - an irregular pulse rate - a systolic BP that falls during exercise - a change in diastolic pressure greater than 15 to 20 mmHg

what are some vital signs we need to watch out for in our patients with cardiac conditions ?

- normal part of aging - Secondary to the effects of drugs (hypertensives, diuretics, antidepressants) --> a result of venous pooling, in association w/ neurogenic origins, and diseases affecting the ANS, such as GB syndrome, diabetes, or MS

what can cause orthostatic hypotension?

angina pain pattern for women other subjective presenting symptoms= extreme fatigue, lethargy, dyspnea, weakness

what condition is this pain pattern

block beta receptors on SA node decreasing force of contraction and reducing HR. · PT monitors perceived exertion and watches for bradycardia contractibility. · SE: depression, worsening of asthma symptoms, sexual dysfunction and fatigue. · Generic names end in -olol

what do B-blockers do? concerns/ AEs?

inhibit calcium from entering blood vessel walls. · SE: swelling in feet and ankles, orthostatic hypotension, headache, and nausea. · Generic names end in -pine

what do Ca channel blockers do? concerns/ AEs?

lower BP by dilating blood vessels. · PT must observe signs of hypotension, and reflex tachycardia. · Generic names end in -zosin

what do alpha1-blockers do? concerns/ AEs?

: lower BP by eliminating sodium and water. · Some remove potassium from the body causing life-threatening arrhythmias. Adverse effects: fluid/electrolyte imbalance; muscle weakness/spasm, dizziness, headache, and nausea.

what do diuretiecs do? concerns/ AEs?

dilate the coronary arteries · SE: headache, dizziness, tachycardia, orthostatic hypotension

what do nitrates do? concerns/ AEs?

- heart - capillaries - veins - lymphatics

what does the CV system consist of?

Ventricular Septal Defect

what heart defect?

atrial septal defect

what heart defect?

patent ductus arteriosus (PDA)

what heart defect?

tetralogy of fallot

what heart defect?

transposition of great vessels

what heart defect?

may be a sign of heart valve or arrhythmia problems a medical referral is recommended especially in the presence of heart or circulatory problems or if the client has risk factors for heart attack or stroke

what if a pt reports: Syncope without any warning period of lightheadedness/dizziness/nausea

Development of ischemia and necrosis due to decreased blood flow. it results from a sudden decrease in coronary perfusion or an increase in myocardial O2 demand w/o adequate blood supply

what is a MI/heart attack

irregular heartbeat Described as a bump, bound, jump, flop, flutter, or racing sensation in the heart

what is a palpitation? how may a pt describe it?

imbalance b/w cardiac workload and oxygen supply to myocardial tissue - primarily form atherosclerosis (CAD) Accompanied by hypertension and signs of PVD

what is angina? what is primarily from?

- sudden loss of responsiveness, - no normal breathing, - no signs of circulation, - no movement or coughing - no response to gentle shaking CALL FOR 911 and begin CPR unless has a DNR. use an AED if available

what is cardiac arrest? how do you know it is happening? what do you do?

early on: - during day not as much blood going to kidneys so not much urine - night, more blood to kidneys get nocturia later - oliguria (dec urine output) due to less blood flow to kidneys

what is going on with HF & the kidneys?

level: 10.2 mg/Dl or 5.5 mEq/L cause: thiazide diuretic use (diurnal (chlorothiazide), acidosis, adrenal insufficiency, immobility, and vitamin D excess, problem: AV conduction blocks or tachycardia and ultimately can cause cardiac arrest

what is high Ca level? cause of this? problems of this?

level- 5.3 mEq/L cause: Increased levels occur due to renal or endocrine problems or potassium replacement overdoes - Cause: ventricular arrhythmias and asystole (flatline):

what is high K level? cause of this? problems of this?

level- 145 mEq/L indicates-indicates water loss or dehydration

what is high Na level? what does it indicate?

is differentiated bc there is 2 years of no press ion of symptoms & no underlying cause:

what is idiopathic Raynaud's disease?

level: 8.2 mg/dL or 4.5 mEq/L cause: can be decreased as a result of multiple transfusions of citrated blood, renal failure, alkalosis, laxative or antacid abuse, and parathyroid damage or removal problem: cause serious and life-threatening ventricular arrhythmias and cardiac arrest.

what is low Ca level? cause of this? problems of this?

level- 3.5 mEq/L cause- can be lowered as a result of diuretics (especially Lasix (furosemide), vomiting, diarrhea, sweating, and alkalosis problems: low levels cause increased electrical instability of the myocardium, life threatening ventricular arrhythmias, and increased risk or digitalis toxicity

what is low K level? cause of this? problems of this?

level- 136 mEq/L indicates water overload or extensive loss of sodium through diuretics, vomiting, diarrhea, or diaphoresis.

what is low Na level? what does it indicate?

· The inflammatory process mediated by the immune response can target the heart and vasculature of the client with SLE (systemic lupus erythematosus) · Pericarditis is the most common cardiac lesion associated with SLE · Myocarditis is strongly associated with skeletal myositis in SLE - may also have endocarditis or a combo of the 3

what is lupus carditis?

during the day, effects of gravity in an upright position & shunting of extra fluids to LR allows effective ventilation & perfusion of the lungs, keeping them relatively fluid free, depending on degree of CHF in the recombant positon, the amount of blood returning to the heart & lungs from the LE increases

what is the cause of PND?

hardening of the arteries- it starts with an injury to the endothelial lining of the artery (intimal layer) that makes the vesicle permeable to circulating lipoproteins. when lipoproteins get into smooth muscle cells of the intima this causes fatty streaks.

what is this image trying to show

- nausea, - vomiting, - diaphoresis, - dyspnea, - fatigue, - pallor, - syncope

what symptoms are often accompanied with cardiac chest pain ?

referral to Dr. immediately

what to do if a pt with a stent has chest pain?

they may be having a thromboembolism & this must be reported to physician immediately

what to do if pt with known claudication has Abrupt onset of ischemic p! or sudden worsening of intermittent claudication?

A= normal B= formation of fatty streaks after injury to endothelial lining causes lipoproteins to collect in smooth muscle cells of the intima C- positive remodeling- the coronary lesion grows outward first to try to maintain an open lumen D- the plaque (atheroma) is building E- the atheroma continues to build, and starts pushing inward into the lumen with obstruction of blood flow F- large obstruct possible of rupture and thrombosis, possible leading to an MI or stroke

whats going on here?

- If lasting for hours or occurring in association with pain, SOB, fainting, or severe light headedness - any person who a family hx of unexplained sudden death

when do palpitations need a medical eval?

- Anyone who cannot climb a single flight of stairs without feeling moderately/severely winded or who awakens at night with SOB - those with a known cardiac/pulmonary problem have increased dyspnea

when does dyspnea need a physician eval?

If AROM for trunk and shoulder motions, or resisted motions does NOT reproduce symptoms or if heat & stretching do not reduce/ eliminate symptoms this is indicating that pt complaints are not coming from a MSK issue

when screening for chest pain, what objective MSK findings are red flags?

an enlarged liver

when we see edema, with RUQ pain that is described as a constant aching or sharp what organ may be involved?

medium sized arteries- the heart, brain, kidneys, and legs

where is atherosclerosis common to happen?

- men between the ages of 40-50 with HTN risk: divert blood from organs & tissues & can result in heart attack, stroke, or kidney damage rupture risk: marked elevation of BP may facilitate rapid disruption & final rupture--> can lead to massive internal hemorrhage

who most at risk for thoracic aneurysms? risk?

because the anemia causes lack of oxygenation of the myocardial (heart muscle) during physical exertion

why is there chest pain with anemia?

- often accopmanies malignant neoplasms, especially visceral and ovarian tumors - oral contraceptives; 3rd gen - selective estrogen receptor modulators (SERMS) - clotting disorders

why meds can cause hyper coagulability of the blood? what else?

Left ventricular dysfunction resulting from pulmonary edema, mitral valve dysfunction, or left ventricular CHF, may result in a cough when aggravated by exercise, metabolic stress, supine position, or PND

why might a cardiac pt have a cough?

A fluttering sensation can be caused my anxiety, random muscle fasciculation, or minor muscle strains

why might a pt with palpitations say they feel a flutter in their neck?

80% are women of 20-49 y.o

women or men more likely to get Raynaud's?

o Sudden death is the first symptom for over half of men and woman who have a HA o May be silent--> increases with advanced aging, esp with hx of CAD. also smokers, diabetes have a dec sensitivity to pain o Prolonged chest (spubseternal) p! or squeezing pressure o Pain radiating down 1 or both arms, throat, neck, back, jaw, shoulder (abdomen) o Increases in HR, BP surges, AM clotting is more active o Feeling of nausea or indigestion o Angina > 30 minutes and unrelieved by rest, NO tablets, or antacids o Pain of infarct unrelieved by rest or a change in position o Sudden loss of vision, pallor, diaphoresis, SOB, weakness, numbness, faintness may experience symptoms prior to MI such as severe fatigue

· Clinical S&S of MI

o Arthralgia (symmetrical): mostly in the proximal joints (shoulder), arthritis - HELPFUL clue to determine b/w rheumatoid arthritis = morning stiffness is usually NOT present with endocarditis clients o MSK symptoms o Low back/ SI pain: similar pattern to a herniated disc HOWEVER, neurologic deficits are usually absent in bacteria endocarditis o Myalgia: especially in the legs o Petechiae - splinter hemorrhage o Constitutional symptoms, - dyspnea - chest p!, - cold and p! in the extremities - may also see arthralgia in knee, hip, wrist, ankle, MTP, MCP, AC joints - arthralgia usually only 1 or 2 joints

· Clinical S&S of endocarditis