Approach To The Pt With Cardiovascular Dz

Front 1

Cardinal sx of CV disease

Back 1

1. CP
2. dypnes, oropthopnea, paraoxysmal nocturnal dyspnea
3. palpitations , dizziness, syncope
4. cough
5. fatigue, weakness
6. claudication
7. peripheral edema

Front 2

causes of CP

Back 2

1. Cardiac --> AS, AVP, Aortic dissection
2. Non-cardiac --> GI, psychiatric, pulmonary, dermatological, musculoskeletal
3. Ischemic --> ACS

Front 3

Ischemic CP

Back 3

ISCHEMIA IS THE MOST COMMON CAUSE OF CARDIAC CP!
-describe character, duration, intensity, location, radiation, precipitation factors, assoc sx, change in pattern (unstable)!
-think of the 4 E's: Exertion, Emotion, Exposure to cold, overEating

Front 4

Description of typical ischemic CP

Back 4

1. tightness
2. pressure
3. dull ache
4. with or without radiation to the neck, jaw, shoulders or arms
-Levine's sign (clutching of chest)
-woman more atypical- jaw, ear, back pain

Front 5

Dyspnea

Back 5

-an uncomfortable awareness of breathing (acute vs. chronic)
-orthopnea: exacerbation of dyspnea when the pt is recumbent due to an increased work of breathing
-paroxysmal nocturnal dyspnea: severe dyspnea that awakens a pt from sleep and requires a sitting or standing position to achieve gravitational redistribution of fluid

Front 6

Palpitations

Back 6

-a subjective sensation of an irregular or abnml heart beat
-defined in terms of duration, frequency, preciptating factors and associated sx

Front 7

dizziness vs. syncope

Back 7

-usually caused by decreased cardiac output
-the cause of decreased output must be determined

Front 8

Other symptoms

Back 8

1. nonproductive cough: may be early manifestation of early pul veous P and unsuspected HF
2/ fatigue and Weakness
3. Hemoptysis: may be seen with mitral stenosis or pul edema
4. Peripheral edema: secondary to CHF, fluid overload
5. claudication: vascular dz

Front 9

Vital signs

Back 9

-HR rate and rhythm
-BP document for discrepancies
-Carotid pulses: contour and listen for bruits

Front 10

ophthalmologic exam

Back 10

-external eye findings associ with systemic diseases
-xanthoses: cholesterol around eyes
-fundi may show: diabetic or hypertensive retinopathy, beading of the retinal arteries, roth spots

Front 11

Inspection and palpation

Back 11

-apical impulse
-pulsations
-heaves and lifts
-thrills

Front 12

Murmurs

Back 12

assess for the following characteristics:
1. timing and duration- systolic or diastolic, early, mid, late or continuous
2. pitch- high, med, low
3. intensity- grade 1-V1
4. pattern or shape- crescendo, decrescendo, plateau
5. quality- harsh, raspy, musical, blowing
6. location and radiation- anatomical landmarks
-slide 26

Front 13

Abdomen

Back 13

1. hepatojugular reflux
2. ascites
3. aorta
4. hepatosplenomegaly
5. bruits

Front 14

Edema

Back 14

-usually cardiac edema is symmetrical and progresses upward
-document location, pitting, and utilize a universal scale
1: slight
2: moderate
3: marked
4: pitting

Front 15

peripheral pulses

Back 15

-bilateral and utilize a universal scale
3+ bounding
2+ avg
1+ diminished
0 absent

Front 16

Cyanosis

Back 16

-bluish discoloration caused by reduced hemoglobin in the cap bed

Front 17

clubbing

Back 17

-loss of nml concave configuration it then nail as it emerges from the distal phalynx

Front 18

Lab studied

Back 18

1. blood testing: CBC, thyroid profile, lipids
2. EKG: rate, rhythm, conduction abnormalities, ischemia
3. CXR: yields info about chamber enlargement, pulmonary vasculature and great vessels
4. specific cardiac testing: echo, stress test, holter monitor, cardiac catheterization, electrophysiologic testing