Untitled Quiz

Screening for Cardiovascular Diseases

• This is chapter 7 of Goodman and Snyder's 2022 7th edition of Differential Diagnosis for Physical Therapists.

Signs and Symptoms of Cardiovascular Disease

• General System:

  • Weakness
  • Fatigue
  • Weight change
  • Poor exercise tolerance
  • Peripheral edema
  • Pressure ulcers
  • Loss of body hair

• Integumentary System:

  • Pressure ulcers
  • Loss of body hair
  • Pallor
  • Skin changes

• Central Nervous System:

  • Headache
  • Impaired vision
  • Dizziness or syncope

• Pulmonary System:

  • Labored breathing, dyspnea
  • Productive cough
  • Cough

• Gastrointestinal System:

  • Nausea and vomiting
  • Ascites (abdominal distention)

• Musculoskeletal System:

  • Chest, shoulder, back, neck, jaw, or arm pain
  • Myalgia
  • Muscular fatigue
  • Muscle atrophy
  • Edema
  • Claudication

• Genitourinary System:

  • Urinary frequency
  • Nocturia
  • Concentrated urine
  • Decreased urinary output

Cardiac Pathophysiology

• In most cardiopulmonary conditions, there's usually one of these factors

  • Obstruction or restriction
  • Inflammation
  • Dilation or distention

• Heart Muscle:

  • Coronary artery disease
  • Myocardial infarct
  • Pericarditis
  • Congestive heart failure
  • Aneurysms

• Heart Valves:

  • Rheumatic fever
  • Endocarditis
  • Mitral valve prolapse
  • Congenital deformities

• Cardiac Nervous System:

  • Arrhythmias
  • Tachycardia
  • Bradycardia

Angina Pectoris

• Definition: Acute chest pain.

• Cause: Imbalance between cardiac workload and oxygen supply to myocardial tissue, often due to obstructed or decreased blood supply from atherosclerosis.

• Types of Anginal Pain:

  • Chronic Stable: Predictable pain triggered by physical or emotional stress, relieved by rest or nitroglycerin.
  • Resting/Decubitus: Pain occurring at rest, especially in supine position, with no relief from rest.
  • Unstable: Abrupt changes in pain intensity, frequency, or threshold of stimulus, not relieved by rest or nitroglycerin. Often triggered by plaque rupture.
  • Nocturnal: Awakens patients from sleep with a similar pain pattern experienced during exertion. Often associated with congestive heart failure.

• Clinical Signs and Symptoms:

  • Gripping, vise-like chest pain
  • Radiating pain (neck, jaw, back, shoulder, arms, often left arm)
  • Toothache
  • Burning indigestion
  • Shortness of breath (dyspnea)
  • Exercise intolerance
  • Nausea
  • Belching

Myocardial Infarction (MI)

• Definition: Heart attack; coronary occlusion leading to myocardial tissue death and ischemia.
• Cause: Sudden decrease in coronary perfusion or increase in myocardial oxygen demand without enough blood supply.
• Clinical Signs and Symptoms:
  • Silent: May be absent - common in smokers or diabetics
  • Sudden cardiac death
  • Prolonged/severe substernal chest pain (squeezing) radiating to arms, jaw, shoulder,
  • Feeling of nausea or indigestion
  • Angina lasting 30+ mins
  • Unrelieved angina
  • Nausea
  • Loss of vision or speech
  • Pallor
  • Diaphoresis (heavy perspiration)

Pericarditis

• Definition: Inflammation of the pericardium, the sac surrounding the heart.

• Cause: Primary or secondary to other diseases/conditions.

• Clinical Signs and Symptoms:

  • Substernal chest pain radiating to neck, upper back, arms.
  • Pain aggravated by trunk movements (side-bending, rotation, lying down).
  • Difficulty swallowing
  • Pain relieved by leaning forward/ sitting up; holding breath.
  • Pain aggravated by movement associated with deep breathing (laughing, coughing).
  • Lower extremity edema.

Guidelines for Immediate Medical Attention

• Sudden worsening of intermittent claudication (a sign of blocked blood flow in the leg) could mean blood clot.
• Unrelieved anginal pain despite rest or medication, nausea/vomiting, or profuse sweating need immediate doctor attention
• Changes in the pattern of angina (increased intensity, reduced or lowered stimulus, longer duration).

Guidelines for Physician Referral

• Any combination of systemic signs or symptoms is concerning and require immediate doctor visit.
• Woman with chest/breast pain, positive family history of breast cancer or heart disease should be evaluated.
• History of unexplained sudden death in family members should trigger immediate referral.
• Inability to climb one flight of stairs without feeling significantly winded.
• Anyone waking up at night or experiences shortness of breath when lying down warrants physician evaluation.
• Fainting without prior warning requiring immediate referral.

Clues to Screening for Cardiovascular Signs and Symptoms

• Pay attention to these details when assessing chest, breast, neck, jaw, back, or shoulder pain:
  • Personal or family history: Heart disease, hypertension (high blood pressure)
  • Age and Ethnicity: (postmenopausal women, African-American women) ( over 65 typically).
  • Additional symptoms: Pallor, excessive sweating, inability to speak, nausea, vomiting, a sense of impending doom, or extreme anxiety.
  • Nature of pain: Angina is triggered by exertion, stress, large meals, or cold exposure, with a 5-10 minute lag time before the pain occurs. Pain occurring immediately after activity needs different analysis.