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Questions and Answers
Which symptom is NOT associated with cardiovascular disease?
Which symptom is NOT associated with cardiovascular disease?
What typically triggers chronic stable angina?
What typically triggers chronic stable angina?
Which of the following best describes unstable angina?
Which of the following best describes unstable angina?
Which of the following processes is NOT a typical cause of cardiopulmonary pathology?
Which of the following processes is NOT a typical cause of cardiopulmonary pathology?
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In which scenario would resting angina most likely occur?
In which scenario would resting angina most likely occur?
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Which of the following symptoms is commonly categorized under the musculoskeletal system related to cardiovascular disease?
Which of the following symptoms is commonly categorized under the musculoskeletal system related to cardiovascular disease?
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What is the primary cause of angina pectoris?
What is the primary cause of angina pectoris?
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Which symptom is specifically observed in patients with cardiovascular issues in the urinary system?
Which symptom is specifically observed in patients with cardiovascular issues in the urinary system?
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What symptom, if present, may indicate a cardiac origin for upper quadrant pain?
What symptom, if present, may indicate a cardiac origin for upper quadrant pain?
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Which sign might suggest a pulmonary or cardiac source of symptoms when the client holds their breath?
Which sign might suggest a pulmonary or cardiac source of symptoms when the client holds their breath?
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What finding would make myocardial infarction (MI) very unlikely?
What finding would make myocardial infarction (MI) very unlikely?
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What is indicated by chest pain that reproduces with palpation?
What is indicated by chest pain that reproduces with palpation?
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In older clients, what condition may joint or muscle pain indicate if there is a history of heart murmur?
In older clients, what condition may joint or muscle pain indicate if there is a history of heart murmur?
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What percentage does the likelihood of a coronary event drop to if symptoms of bacterial endocarditis are altered by a change in position?
What percentage does the likelihood of a coronary event drop to if symptoms of bacterial endocarditis are altered by a change in position?
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What symptom is typically NOT associated with a musculoskeletal origin of pain?
What symptom is typically NOT associated with a musculoskeletal origin of pain?
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Angina is typically triggered by which of the following?
Angina is typically triggered by which of the following?
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Which of the following activities would most likely reproduce upper quadrant pain in a person with risk factors for congestive heart disease?
Which of the following activities would most likely reproduce upper quadrant pain in a person with risk factors for congestive heart disease?
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What symptom is NOT associated with vascular occlusive disease?
What symptom is NOT associated with vascular occlusive disease?
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What symptom might accompany thoracic pain indicating a possible cardiac event?
What symptom might accompany thoracic pain indicating a possible cardiac event?
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Which of the following symptoms suggests that pain may have a cardiac origin rather than a musculoskeletal origin?
Which of the following symptoms suggests that pain may have a cardiac origin rather than a musculoskeletal origin?
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When evaluating for a coronary event, which observation is crucial for neurologically unstable clients?
When evaluating for a coronary event, which observation is crucial for neurologically unstable clients?
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What characteristic differentiates ischemic rest pain from other types of pain?
What characteristic differentiates ischemic rest pain from other types of pain?
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What is a common sign of angina not occurring immediately after physical activity?
What is a common sign of angina not occurring immediately after physical activity?
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What condition is indicated by calf pain that is relieved by rest?
What condition is indicated by calf pain that is relieved by rest?
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What is the most common trigger of unstable angina?
What is the most common trigger of unstable angina?
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Which symptom is not typically associated with angina pectoris?
Which symptom is not typically associated with angina pectoris?
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What condition may nocturnal angina be associated with?
What condition may nocturnal angina be associated with?
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Which of the following is a potential sign of myocardial infarction (MI)?
Which of the following is a potential sign of myocardial infarction (MI)?
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Which of the following best describes pericarditis?
Which of the following best describes pericarditis?
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What is NOT a characteristic symptom of myocardial infarction?
What is NOT a characteristic symptom of myocardial infarction?
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Which symptom is particularly noted in angina pectoris but not typically in myocardial infarction?
Which symptom is particularly noted in angina pectoris but not typically in myocardial infarction?
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What does a person experiencing unstable angina typically feel?
What does a person experiencing unstable angina typically feel?
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What could persistent shortness of breath, fatigue, and dizziness indicate in conjunction with weight gain and swelling?
What could persistent shortness of breath, fatigue, and dizziness indicate in conjunction with weight gain and swelling?
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What is a common early warning sign of an impending rupture in the abdominal area?
What is a common early warning sign of an impending rupture in the abdominal area?
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Why should clients using nitroglycerin be monitored for their supply?
Why should clients using nitroglycerin be monitored for their supply?
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Which symptom is typically associated with thoracic aneurysm pain?
Which symptom is typically associated with thoracic aneurysm pain?
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What is a key consideration for someone taking both NSAIDs and ACE inhibitors during exercise?
What is a key consideration for someone taking both NSAIDs and ACE inhibitors during exercise?
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What relieves the symptoms associated with an abdominal aneurysm?
What relieves the symptoms associated with an abdominal aneurysm?
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Which symptom could mimic atypical chest pain of angina pectoris due to cervical disk disease?
Which symptom could mimic atypical chest pain of angina pectoris due to cervical disk disease?
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Which of the following is a sign of a potential cardiac issue during exercise?
Which of the following is a sign of a potential cardiac issue during exercise?
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What could be a consequence of muscle pain for clients taking statins?
What could be a consequence of muscle pain for clients taking statins?
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What might a palpable, pulsating abdominal mass indicate?
What might a palpable, pulsating abdominal mass indicate?
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What is a common feature of stable angina regarding blood pressure?
What is a common feature of stable angina regarding blood pressure?
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What aggravates symptoms in a patient with an abdominal aneurysm?
What aggravates symptoms in a patient with an abdominal aneurysm?
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Which symptom is NOT typically associated with the pain of a thoracic aneurysm?
Which symptom is NOT typically associated with the pain of a thoracic aneurysm?
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Study Notes
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.
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Description
Explore the key signs and symptoms associated with cardiovascular diseases as outlined in Chapter 7 of Goodman and Snyder's 'Differential Diagnosis for Physical Therapists'. This quiz covers various systems affected by cardiovascular conditions, including general, integumentary, central nervous, pulmonary, gastrointestinal, musculoskeletal, and genitourinary systems.
