Cardiovascular Symptoms and Conditions Quiz

Islamic Principle

• A quote emphasizing the limited knowledge of humans and the vast knowledge of God.
• The quote states "Say, 'Glory be to You, we have no knowledge except what You have taught us. Indeed, It is You who is the Knowing, the Wise."
• The verse is from Suratul Baqarah (The Cow).
• The verse number is 32.

Medical Screening Information

• Dr. Islam Abuemira has a PhD in Physical Therapy from Cairo University.
• He is certified in Manual Therapy from Winston Salem University (USA), Mulligan (New Zealand), and Capri (India).
• He holds certifications in Schroth (Germany) and SEAS (Italy) for spine deformities.
• He is also certified in Manual therapy and Sport injuries ER (UK).

Cardiovascular Disease Screening

• Information on screening for cardiovascular disease.
• This topic is relevant to the field of medical science.
• The information displayed is related to a presentation.

Heart Structure and Circulation

• Detailed diagram of the heart's structure and blood circulation.
• Sections include right and left ventricles, atria, and major blood vessels.
• The illustration shows the flow of blood through the heart and its connection to the rest of the body.
• A detailed caption explains the functions of the heart valves and the septum to ensure the proper flow of blood.

The Cardiovascular System

• The cardiovascular system consists of the heart, arteries, veins, capillaries, and lymphatics.
• Its function is to coordinate with the pulmonary system to circulate oxygenated blood to all cells and to collect deoxygenated blood to be delivered to the lungs.

Signs and Symptoms of Cardiovascular Disease - Chest Pain

• Common signs and symptoms of cardiovascular disease, specifically related to chest pain.
• Symptoms like chest, neck pain or arm discomfort, palpitations, shortness of breath, fainting (syncope), fatigue, coughing, sweating, discoloration of skin (cyanosis), swelling of legs or edema, and pain in legs (claudication).
• These symptoms are often related to vascular component.
• Information for reviewing table 6-1, for more details..

Cardiovascular Signs and Symptoms by System

• General symptoms of cardiovascular disease.
• Integumentary symptoms (peripheral edema, loss of body hair, pressure ulcers).
• Central nervous system symptoms (headache, impaired vision).
• Cardiovascular system symptoms(impaired vision, dizziness).
• Pulmonary symptoms (dyspnea, cough).
• Genitourinary symptoms (frequency, and reduced urinary output).
• Musculoskeletal symptoms(pain in chest, shoulder, neck, myalgia, and muscular atrophy).
• Gastrointestinal (nausea, vomiting, ascites).
• Information provided by Goodman, CC, and Fuller, K in Pathology.

Informative Websites

• Provides links to websites containing information on heart disease and stroke.
• Resources for patients, healthcare professionals offering risk assessment tools, and clinical guidelines.
• Links to websites for the American Heart Association (AHA), the American College of Cardiology and also other helpful resources.

Case Example of Monitoring Vital Signs

• Clinician case example 6.1 emphasizing the importance of monitoring vital signs during exercise intervention.
• A client with hypertension and various other health issues is evaluated for monitoring during exercise intervention.
• Case study emphasizes the importance of vital sign monitoring and careful consideration of relevant conditions.

Cardiac Related Chest Pain

• Types of cardiac chest pain, secondary to conditions affecting the heart.
• Angina, myocardial infarction, pericarditis, endocarditis, mitral valve prolapse, dissecting aortic aneurysm, and their respective characteristics are mentioned.
• The specifics of symptoms vary.

Palpitation

• Common description is irregular heartbeat.
• Possible causes including benign conditions, severe conditions, and associated symptoms,
• Anxiety, caffeine, and exercise are examples of potentially benign triggers.
• Serious conditions like coronary artery disease and related ones are listed.
• Associated symptoms are lightheadedness and syncope, occasional neck fluttering.

Dyspnea

• Dyspnea as shortness of breath or breathlessness.
• Linked to pulmonary and cardiovascular conditions.
• Dyspnea on Exertion (DOE), is a condition of experiencing difficulty breathing with mild exertion.

Cardiac Syncope

• Description of fainting, relating it to inadequate oxygen supply to the brain.
• Causes of the cardiac condition, including arrhythmias, orthostatic hypotension, poor ventricular function, coronary artery disease, and vertebral artery insufficiency.
• Distinguishing syncope from non-cardiac causes like anxiety and emotional stress is important.

Fatigue

• Often associated with cardiac conditions.
• Symptoms like dyspnea, chest pain, palpitations, and headache are frequently accompanied by fatigue of a cardiac nature.
• The importance of monitoring excessive fatigue in those with cardiac history is highlighted in the given text.

Cough and Cyanosis

• Cough is associated with respiratory problems
• However, it can be a symptom of cardiovascular issues in certain situations, including problems with the left ventricle and pulmonary edema.
• Cyanosis, discoloration of the skin and mucous membranes, can be linked to heart and lung problems, apart other systemic issues.

Edema

• Swelling of ankles, abdomen or hands is an important sign, alongside shortness of breath and fatigue, of potential congestive heart failure.
• Other non-cardiac causes of edema including pulmonary issues, kidney dysfunction, cirrhosis, and other reasons should be considered.

Claudication

• Description of leg pain associated with peripheral vascular disease, often linked to coronary artery disease.
• Presence of pitting edema usually indicates vascular disease or other possible underlying cause of leg pain

Claudication- Vital signs

• During exercise, therapists must pay close attention to heart rate, blood pressure. (systolic and diastolic) and irregular pulse rate.

Cardiac Pathophysiology

• Description of three key aspects of cardiac conditions: heart muscle, heart valves, and the cardiac nervous system.
• Three main processes causing disturbances related to these aspects are listed: Obstruction or restriction, Inflammation, and Dilation or distension.

Cardiovascular Conditions Mimicking Musculoskeletal Problems

• Common cardiovascular conditions that mimic musculoskeletal problems, including angina, myocardial infarction, pericarditis, and dissecting aortic aneurysms
• Also mentioned is degenerative heart disease which is linked to aging and changes related to vessel damage called as Atherosclerotic Cardiovascular Disease (CHD) & Coronary Artery Disease (CAD).

Cardiac Diseases Table

• Summary table categorizing cardiac diseases by the affected component (heart muscle, heart valves, cardiac nervous system).

Hyperlipidemia

• Description of hyperlipidemia as a group of metabolic abnormalities related to elevated serum total cholesterol, LDL, and triglycerides, and reduced HDL.
• Potential risk of muscular breakdown into blood called rhabdomyolysis when taking statin medications to reduce LDL-cholesterol, and must be reported immediately to the physician.

Screening for Side Effects of Statins

• Myalgia, joint pain being the most common adverse effects of statins use.
• Symptoms are more frequent in older individuals.
• List of statins approved in US including Atorvastatin (Lipitor), Fluvastatin (Lescol), Lovastatin (Mevacor, Altocor), Pravastatin (Pravachol), Simvastatin (Zocor), and Rosuvastatin (Crestor).

Myositis

• Muscle aches pain, unexplained fever, nausea, vomiting, and dark urine.
• These signs need immediate referral to a physician for evaluation.
• Risk factors causing myositis including age over 80 (women more than men), small body frame or frail, Kidney or liver disease, Excessive consumption of grapefruit juice, other medications such as cyclosporine, some antibiotics, verapamil, HIV protease inhibitors, and some antidepressants, and alcohol abuse.
• Importance of screening for liver impairment for those taking statins is given in the reference.

Coronary Artery Disease

• Description of coronary artery disease (CAD) which involves the narrowing or blockage of coronary arteries, leading to reduced blood supply to the heart muscle and potentially resulting in tissue damage.
• The major consequence is angina pectoris and myocardial infarction resulting in coronary artery disease (CAD).
• Types of CAD are Atherosclerosis, Thrombus, and Spasms.

Atherosclerosis

• Description of the formation process, progression stages, and potential complications of atherosclerosis, a progressive disease in which plaque builds up in the arteries.
• Also known as arteriosclerosis
• Leads to bleeding, clot formation, and rupture of blood vessels.
• Fatal complications include heart attacks and stroke.

Thrombus and Atherosclerosis

• Information on blood clots (thrombi) formation due to plaque build-up in arteries.
• Blocked vessel (thrombosis) in coronary artery leads to a heart attack and in the brain, it leads to stroke.
• Describing and explaining the formation process of thrombi (blood clots) in arteries when the plaque formation occurs resulting in reduced blood flow.

Atherosclerosis (Spasm)

• Description of a temporary artery constriction (a spasm)
• Describing the possible triggers like nicotine and cocaine, anxiety, and cold air, as potential causes for this condition.

Risk Factors for Coronary Artery Disease(CAD)

• Table of modifiable and non-modifiable risk factors associated with death related to coronary artery disease, including physical inactivity, smoking, elevated serum cholesterol, cholesterol, high blood pressure, diabetes, obesity, stress response, personality, peripheral vascular disease, hormonal status, alcohol consumption, and obesity.

Additional Risk Factors for CAD

• Risk factors for CAD, including exposure to specific bacteria like Chlamydia Pneumoniae , elevated homocysteine levels, high levels of LDL, high levels of fibrinogen and large amounts of C-reactive protein.
• Also, the presence of troponin T and the diagonal earlobe creases ("Frank's sign") are mentioned.

Women and Heart Disease

• Risk factors associated with heart disease in women, including older age, menopause, and race (black women are at greater risk).
• Women with diabetes are at a significantly higher risk of cardiovascular complications and a higher chance of dying from coronary artery disease.
• Symptoms of CAD for women are more subtle and atypical.

Women and Heart Disease (Classic Pain, Symptoms)

• Describes the classic pain associated with coronary artery disease(CAD) in women, characterized by a crushing, squeezing pain occurring during exertion or emotional responses.
• Also describes the symptoms being characterized by unexplained, severe, and episodic fatigue or weakness in daily living activities.

Clinical Signs and Symptoms (Atherosclerosis and CAD)

• Atherosclerosis by itself isn't always visible in symptoms and requires a significant decline in blood supply to the heart.
• Atherosclerosis symptoms usually appear only if the lumen of the coronary artery narrows by as much as 75%.
• A heart attack and sudden death may be the outcome of complete blood blockage.
• Arrhythmias, heart failure, and conduction problems may develop with extensive tissue damage.

Angina

• Chest pain due to an oxygen deficit in myocardial tissue. A symptom of atherosclerosis which obstructs or reduces the supply of blood to the heart muscle.
• This is associated with an imbalance between the heart workload and oxygen supply.

Angina Pain Types

• Describing different types of angina, including chronic stable angina (or walk-through angina), resting angina (or angina decubitus), unstable angina, nocturnal angina, atypical angina, and Prinzmetal's angina or "variant" angina.

Angina Clinical Signs and Symptoms

• A client indicates pain by placing clenched fist against the sternum
• Pain can be transmitted to the left shoulder, arm, and fingers. Can also spread to other parts of the body.

Clinical Signs and Symptoms (Heartburn and Symptoms)

• Describes the sensation of angina which can be confused with heartburn, indigestion, hiatal hernia, or esophageal spasm or gallbladder disease.
• Describing the common signs of heartburn symptoms such as frequent burning sensation in the chest after consuming spicy foods.

Clinical Signs and Symptoms (angina pectoris, MI)

• Symptoms including gripping, viselike feeling of pressure behind the sternum, pain radiating to neck, jaw, back, shoulder, or arms, toothache, dyspnea (shortness of breath), and nausea.
• Myocardial infarction symptoms, including development of ischemia and necrosis of heart tissue.

Clinical Signs and Symptoms: Heart (General)

• A general description about the pain patterns in heart condition.
• Indicates that the onset of an infarct may be characterized by severe fatigue for several days.
• Indicates that a patient may not experience any pain and be unaware of a damaged heart muscle.

Cardiac Arrest

• Describing the signs associated with a sudden cardiac arrest: loss of responsiveness, absence of normal breathing, and absence of signs of circulation.
• Describes the classical warnings signs of myocardial infarction, characterized by unrelenting crushing chest pain lasting 30 minutes, not relieved by rest or nitroglycerin, potential radiation to arms, throat, or back.

Heart Attack: Pain Location

• Describes the varying locations of common symptoms in heart attack, ranging from chest-related pain to those in the upper abdomen radiating from neck, jaw, and shoulder.

Clinical Signs and Symptoms (Myocardial Infarction)

• Symptoms like faintness, numbness, and unexplained skin discoloration during a heart attack.
• Pain, discomfort, pressure, or squeezing sensation in the chest and spreading to the arms, neck, throat, back, jaw, or shoulder.
• Shortness of breath, dizziness, profuse sweating, nausea, and vomiting.

Warning Signs of Myocardial Infraction in Women

• Women might describe the pain as heaviness, squeezing discomfort, pain, in the left-hand side of chest, abdomen, mid back, shoulder or arm.
• Unexplained and severe episodic fatigue and weakness, decreasing their ability to execute daily living functions.
• Additional signs such as mental status changes or confusion, dyspnea when at rest or with exertion.

Warning Signs of Myocardial Infraction in Women ( Additional Signs)

• Symptoms include weakness, lethargy, anxiety or depression, indigestion, or stomach pain, sleep disturbances or difficulty sleeping, sensations similar to inhaling cold air, isolated middle or lower back pain, and right biceps pain that may relieve with antacids use and or other similar symptoms.

Pericarditis

• Definition of inflammation of the pericardial membrane.
• May be caused by primary reasons or be secondary to other health conditions, including tuberculosis, cancer from influenza or HIV.
• Description of pericarditis as an acute or chronic condition, resulting in a rigid, thickened, and scarred pericardium.
• The pain caused by pericarditis might be localized to the sub-sternal region and may be spread to the upper back, or neck, and left upper arm and radiate to other regions such as the left supraclavicular region, and costal margin.

Pericarditis Clinical Signs and Symptoms

• Initial absence of external or visible signs.
• Typical symptoms include chest pain related to breathlessness, raised pulse rate, and fever.
• Muscle aches (myalgia), and general discomfort(malaise).
• The pain is associated with breathing movements, and may be worse in lying down position and gets relieved when sitting up or leaning forward.

Characteristics of Cardiac Chest Pain

• Table presenting a characteristic comparison of chest pain caused by different cardiac conditions, including Angina, Myocardial Infarction, Mitral Valve Prolapse, and Pericarditis.

Congestive Heart Failure (CHF)

• Inability of the heart to adequately pump enough blood to meet the metabolic demand of the body.
• Heart failure results in congestion and pulmonary edema leading to shortness of breath.
• Common symptoms are breathlessness, exhaustion, and lower extremities edema.

Dyspnea (CHF)

• Description of subjective dyspnea, which might not always correlate with the severity of heart failure.
• Describes Paroxysmal nocturnal dyspnea(PND), a type of dyspnea characterized by sudden wakening due to suffocation and the upright position.
• Describes Orthopnea, a condition correlating to three-point position(leaning forward or up with knees).

Dyspnea (CHF) – Additional Signs

• Cough as a common symptom of Left-ventricular failure, possibly due to fluid in the lungs.
• Pulmonary edema from elevated capillary pressure in the lungs causing breathlessness, frothy sputum, nasal flaring, tachypnea, noisy or wet breathing, and diaphoresis.

Cerebral Hypoxia (as a result of CHF)

• Describing the symptoms that might arise from poor blood flow in the brain, including anxiety, irritability, restlessness, confusion, impaired memory, and bad dreams from poor blood circulation.
• Sleep and rest disturbances might aggravate fatigue
• Nocturia could develop due to changes in the kidney functionality during left or right-sided heart failure leading to frequent urination at night.
• This is related with the increase in blood flow and fluid to the kidneys during resting period.

CHF - Muscle Cramp and Headache

• Case example highlighting muscle cramps and headache, accompanying CHF in a client with hip replacement.

Clinical Signs and Symptoms of Lt Side Heart Failure

• Fatigue and shortness of breath that arises after making minimal exertion or during exercise activity.
• Persistent cough, particularly when lying down or while the body is resting.
• Paroxysmal nocturnal dyspnea from blood returning from lower extremities.
• Orthopnea, where shortness of breath improves with an upright position or leaning forward and with knees up.
• Tachycardia (increased heart rate), reduced muscular strength, edema (especially in legs and ankles), weight gain is noticed, and irritability or restlessness may also be observed.
• Reduced kidney functioning causing frequent urination at night.

Right Ventricular Failure

• Caused by left-sided CHF or pulmonary embolism, it results in peripheral edema and venous congestion of organs.
• Dependent edema, typically symmetrical swelling in the feet and ankles, that worsens toward the end of the day and improves with rest is an early sign of right ventricular failure.
• Cyanosis in nail beds is an additional sign due to venous congestion.

Congestive Heart Failure- Bilateral Pitting Edema

• Case example of a patient presenting with bilateral edema following hip replacement, suggestive of heart failure (CHF) and associated difficulties with the hip motion.

Clinical Signs and Symptoms of Right-Sided HF

• Increased fatigue, dependent edema (usually starting at the ankles), pitting edema (after accumulation of 5-10 pounds of fluid), edema in areas like the sacral region or back of thighs, right upper quadrant pain and cyanosis from nail beds.

Aneurysm (Thoracic and Peripheral)

• Describes thoracic aneurysms typically found in hypertensive men between 40 and 70 years of age.
• Also describes the presence of elevated blood pressure playing an important role in these aneurysms.
• Describes peripheral arterial aneurysms most commonly identified in the popliteal area that may lead to lower leg symptoms and a palpable popliteal pulse.

Abdominal Aortic Aneurysms (AAA)

• Description abdominal aortic aneurysms, focusing on the location just below the kidneys, sometimes with referred pain to the thoracolumbar junction, and on the pain patterns with presence of a palpable mass in the affected area.

Aneurysm Causes

• Describing different conditions that can cause aneurysms, including trauma (weight lifting, aging in athletes), congenital issues in vessels, infection, and the impact of atherosclerosis.

AAA Risk Factors

• Describes cardiovascular conditions like heart disease, congenital heart issues, infections, recent coronary artery disease (CAD; atherosclerosis, that are among the risk factors for abdominal aortic aneurysm (AAAs).
• Emphasizes that although an active and healthy lifestyle may cause AAA risk, anti-coagulation therapy can exacerbate AAAs complications.

AAA Clinical Signs and Symptoms

• Description of abdominal aortic aneurysms most commonly noted as an asymptomatic pulsating mass during physical examination.
• Other symptoms mentioned are back pains radiating to the groin and flank, pain characteristics (sharp, intense, and knife-like).
• Pain may also radiate to the chest and posterior thighs
• Symptoms of sudden hypotension, sudden numbness, and nausea may be observed.

Clinical Signs and Symptoms of Aneurysm

• Describes chest pain, palpable pulsating mass (abdomen, popliteal space), dull ache in the mid-abdominal area, groin and/or leg pain, weakness in legs, and a severe tearing sensation associated with these conditions.

Clinical Signs and Symptoms of Aneurysm (additional)

• Characterizations of pain being not relieved by position changes from laying to standing (upright positions), pain is described as tearing or ripping, palpable abdominal mass, elevated heart rate and lower blood pressure in certain cases, and presence of ecchymosis in the flank or in the perianal area, together with lightheadedness and nausea.

Conditions Affecting the Heart Valves

• Description of stenosis and insufficiency (regurgitation) of heart valves, specific to tricuspid, mitral, and pulmonic valves.
• Prolapses, impacting specifically the mitral valve, causes enlargement of leaflets and backward bulging into the atrium.

Clinical Signs and Symptoms of Cardiac Valve Disease

• Symptoms include fatigue, dyspnea, and palpitations. (which may be identified as a throbbing, skipping, or rapid and strong pulsation or forceful contraction of the heart itself.).

Clinical Signs and Symptoms of Cardiac Valvular Disease (continued)

• Symptoms like pitting edema, orthopnea or paroxysmal dyspnea, and dizziness or syncope (fainting).

Rheumatic Fever

• Rheumatic fever is an infection caused by streptococcal bacteria.
• Causes heart valve inflammation, scarring and issues.
• Characterized by fever and joint pain.
• May damage the heart valves and possibly be fatal.
• Usually occurs in children between the ages of 5-15 following an initial strep throat infection.

Clinical Signs and Symptoms (Rheumatic Fever)

• Detailed description of clinical signs and symptoms related to rheumatic fever: Initial cold or sore throat, sudden onset/gradual onset of painful migratory joint pain with or accompanied by fever, palpitation/fatigue, malaise, weakness, weight loss, and anorexia symptoms.
• Acute inflammatory reactions may affect the heart, specifically the heart valves are called rheuatic chore/St. Vitus dance.
• These may last from 1 to 3 months post-strep infection.
• Polyarthritis (a general description of inflamed joints) may also be present which might be accompanied by rapid, purposeless, non-repetitive movements engaging almost all body muscles but excluding the eyes.

Clinical Signs and Symptoms of Rheumatic Fever

• Migratory arthralgias, subcutaneous nodules on extensor surfaces, fever and sore throat, flat painless skin rash, carditis, chorea, weakness, malaise, weight loss, and anorexia, and acquired valvular disease.

Endocarditis

• Description of bacterial endocarditis (an infection of the inner lining of the heart chambers and valves, caused by bacteria entering the bloodstream) and its potential to cause damage to the tricuspid, aortic, and mitral valves.
• Endocarditis is frequently attributed to bacteria from a distant part of the body, such as a skin infection.
• The infection can also be the consequence from damaged valve repair leading to the generation of vegetations (abnormal growths of collagen fibers) that cause damage to the valves and organs like the myocardium, kidney, brain, spleen, abdomen, and extremities.

Endocarditis Risk Factors

• Patients may be at risk of developing bacterial endocarditis due to existing valve damage and/or injection drug use, or having undergone prior cardiac procedures.

Endocarditis: Clinical Signs and Symptoms

• Description of musculoskeletal symptoms relating to endocarditis, including arthralgias, arthritis, low back pain, and arthralgia in the proximal joints which may be present in approximately 45% of patients,
• General description of related symptoms such as joint pain or muscle aches.

Endocarditis: Clinical Signs and Symptoms (additional)

• Common symptoms include infrequent ostearticular infections, located in the sternocostal joints, vertebrae, wrists, and sacroiliac joints.
• These inflammatory issues could be due to septic emboli.
• Low back pain is a symptom that may be caused by endocarditis can be distinguished from herniated disc through neurological assessment.

Conditions Affecting the Cardiac Nervous System

• Describes the failure in the heart's nervous system to transmit normal electrical impulses as a component of cardiac disease.
• Specific types of disorders are arrhythmias, also known as dysrhythmias, including tachycardia (fast heart rate), bradycardia (slow heart rate), extra heartbeats, and fibrillations.
• Further details suggest these conditions lead to hypotension, heart failure, and shock.

Fibrillation

• Description of sinoatrial (SA) node dysfunction.
• The description of damaged heart cells releasing abnormal electrical signals that disrupt the normal conduction pathway causing atria or ventricle fibrillation.
• Immediate life-threatening measures like resuscitation and electrical countershock are required for ventricular fibrillation, however atrial fibrillation is not immediately life-threatening.
• It often results from damaged heart cells that lead to the disruption of the normal conduction pathway resulting in irregular contractions and pooling of blood, with potential for clot formation and travel to the brain leading to a stroke.

Fibrillation Risk Factors

• Individuals with previous heart conditions like heart attacks (MI), high blood pressure (Hypertension), congestive heart failure (CHF), digitalis toxicity, or rheumatic mitral stenosis could be at higher risk of developing fibrillation.

Fibrillation Clinical Signs and Symptoms

• Subjective descriptions of palpitations, fluttering sensations, irregular heartbeats, and shortness of breath (dyspnea).

Clinical Signs and Symptoms of Fibrillation

• Describes the various symptoms associated with fibrillation, including chest pain, anxiety, pallor, nervousness, and cyanosis.

Sinus Tachycardia

• Defined as an abnormally rapid heart rate (usually over 100 beats per minute) that might not always be a cause of concern but can be cause of concern in conditions of myocardial or other organic heart conditions.
• Symptoms may include palpitation and restlessness.

Sinus Bradycardia

• Identified as a heart rate that is below 60 beats per minute, a typical rhythm in some individuals such as athletes but in some cases may be accompanied with symptoms like syncope (fainting or temporary loss of consciousness), profuse sweating, nausea or vomiting with or without impairment from reduced pulse or vision distortions or neurological issues.

Cardiovascular Disorders– Hypertension

• It's a major cardiovascular risk factor.
• May be associated with stroke, peripheral vascular disease (PVD), and cardiovascular death.
• Pulse pressure is the difference between systolic & diastolic blood pressure.
• Widened pressure (high pulse pressure) resulting may be cause by aorta stiffness secondary to atherosclerosis and could cause significant stroke & heart failure risks, especially in patients who are 60+ years of age.

Cardiovascular Disorders- Blood Pressure

• Description of primary/essential/idiopathic hypertension (about 90-95 % of all hypertensive patients) as a risk factor for, stroke, PVD, or cardiovascular death.
• Detailed information on secondary hypertension indicating it is developed due to an identifiable underlying condition such as renal artery stenosis, use of oral contraceptives, hyperthyroidism, adrenal tumors, and medication side effects.

Risk Factors (Hypertension)

• Modifiable factors contributing to hypertension, including smoking, obesity, sedentary lifestyle, stress, cholesterol levels, and alcohol use.

Clinical Signs and Symptoms of Hypertension

• Symptoms include occipital headaches, dizziness, flushed face, spontaneous nosebleeds (epistaxis), changes in vision, and frequent urination during the night

Transien Ischemic Attack (TIA)

• Temporary disruption of blood flow to the brain.
• Warning signs of an obstruction within the arteries that supply blood to the brain; immediate medical evaluation is essential.

TIA Clinical Signs and Symptoms

• Common symptoms during TIA include slurred speech, sudden difficulty understanding others, sudden confusion or memory loss, temporary blindness, dizziness, sudden severe head aches, paralysis or weakness that usually impacts on one side of the body, difficulty in balance and coordination.
• The symptoms usually last a short time (few minutes), but can persist for up to 24 hours.

Orthostatic Hypotension

• An excessive drop in blood pressure when changing from a lying or sitting position to standing.
• Symptoms include a sudden fall or drop more than 20 mm Hg in systolic pressure, or a decrease of 10 mm Hg or more in the diastolic blood pressure value.
• It is also frequently accompanied with increased heart rate (increase of 10% to 20% in pulse rate).
• Should be considered for patient evaluations and treatment.

Peripheral Vascular Disease (PVD)

• Description of impaired blood circulation caused by acute or chronic conditions.
• The condition can involve the arterial or venous systems of the lymphatic system (a part of the vascular system that has a vital role in fluid balance and immune response)
• Acute occlusion involves the 6 Ps: pain, pallor, pulselessness, paresthesia (numbness or tingling), coldness, and paralysis.
• Risk factors for acute or chronic PVD: Diabetes, smoking, hypertension, hyperlipidemia, and increased age.

Comparison of Acute and Chronic Arterial Symptoms

• Comparison table for various acute and chronic arterial symptoms to differentiate the conditions.

Clinical Signs and Symptoms of Arterial Disease

• Specific symptoms of arterial diseases including intermittent claudication (leg pain), ischemic pain (pain related to reduced blood flow), pain worsened by elevated extremities or relieved by hanging the foot, skin changes, possible ulcers or gangrene, vision changes, and fatigue during exertion

Raynaud's Phenomenon and Disease

• Definition of Raynaud's phenomenon including temporary constriction/impairment of small arteries affecting primarily the extremities.
• Caused by temporary constriction of small arteries resulting in skin color changes (pallor or cyanosis) and temperature changes.
• Associated with connective tissue diseases, like scleroderma, lupus, and rheumatoid arthritis

Clinical Signs and Symptoms of Raynaud's Phenomenon and Disease

• Symptoms include pallor (pale digits), cyanosis (blue digits), cold and numb digits, and intense redness in digits (inflammation),.

Venous Disorders

• Introduction of acute and chronic venous conditions (varicose veins, venous insufficiency).

Acute Venous Disorders

• Are related to thrombus (blood clots) that obstruct blood flow through the veins.
• Pulmonary embolism, a life-threatening complication, can result from deep venous thrombosis (DVT) in legs.

Risk Factors for Pulmonary Embolism (PE) and Deep Venous Thrombosis (DVT), and Case Example

• Description of risk factors and clinical symptoms related to pulmonary embolism (PE) and deep venous thrombosis (DVT), along with a case example.
• Pay particular attention to DVT symptoms, noting the potential for immediate medical referral (and referring to Well's Clinical decision rule Table 412)

Clinical Signs and Symptoms (Superficial Venous Thrombosis)

• Visible subcutaneous swelling, palpable cord, warmth and redness, and hardness of affected vein as the key indication of superficial venous thrombosis.

Clinical Signs and Symptoms (Deep Venous Thrombosis)

• Symptoms including unilateral leg pain, swelling, warmth, altered skin coloration, and pain with blood pressure cuff inflation around affected calf area.

Deep Venous Thrombosis (DVT) Case Example

• A case example of DVT in a patient with a spinal cord injury, emphasizing the need to monitor conditions in patients with specific risk factors for DVT. The example highlights vital sign monitoring during exercise, potentially unusual symptoms like muscle cramps and headache that could be symptoms for other factors, and a prompt referral to a medical practitioner.

Lymphedema

• Excessive accumulation of fluid in body tissues.
• Symptoms include edema in the hand or foot dorsum, decreased range of motion, worse with prolonged dependency or inactivity, and can be accompanied or unrelated to a sensation of heaviness and fullness.

Screening for Cardiovascular Medications

• Table summarizing cardiovascular medications and their potential side effects, emphasizing the need for immediate physician notification for specific symptoms.
• Box 6-3 provides a detailed list of conditions, such as abdominal pain, asthmatic attacks, bradycardia, dehydration, etc. that require medical evaluation.

Physician Referral

• It is NOT the therapist's job to diagnose cardiovascular issues. They must identify systemic symptoms like those mimicking musculoskeletal disorders and immediately refer the patient to the physician.

Patient Referral Guidelines

• Describes urgent and recommended referral points to a medical professional for cardiovascular patients including worsening intermittent claudication, unrelieved chest pain (angina) > 20 minutes after nitroglycerin, excessive sweating, pain unrelieved after rest or increase in its intensity or duration, presence of systemic signs and/or other symptoms, recent history of breast cancer or heart disease, lightheadedness or fainting without obvious reason, difficulty climbing up one flight of stairs without feeling winded or shortness of breath that arises during the night, neurological issues, and difference of 40 mm Hg between systolic and diastolic blood pressure (pulse pressure).

Clues for Screening Cardiovascular Symptoms

• Description of three key signs for cardiovascular issues (pleuritic pain related to breathing patterns, pain on palpating the affected area and pain on movement, and chest, neck pain)
• If two of these symptoms are present, the likelihood of myocardial infarction is less probable.

Key Points to Remember

• Fatigue outside of expectations following exercise is a red flag to immediately evaluate for cardiac conditions.
• Focus on identifying/monitoring cardiac risk factors, especially in older adults and women.
• Stable angina clients usually have normal blood pressure; elevated can be associated with anxiety or acute coronary insufficiency. Low blood pressure with angina may be related to heart failure.
• Consider cervical disk problems as potential mimicking symptoms related to chest pain
• Keep nitroglycerin in readily available supplies and check regularly
• Patients on NSAIDs and ACE inhibitors need monitored closely for blood pressure issues during exercise.
• Target heart rate may be impacted by medications (beta-blockers/calcium channel blockers) needed
• Ensure appropriate precautions are taken by asking about a recent cigarette use or after consuming a large meal before exercise.
• Significant and continuous weight gain (3+ pounds) in few days with ankle/abdomen/hand swelling, shortness of breath, fatigue and dizziness are potential CHF symptoms.
• Pain of the pericardium (heart sac), and diaphragm are commonly related to the shoulder's area due to nerve supply.
• Muscle pain/cramps, that cannot be attributed to arthritis, exhaustion or recent falls may need immediate evaluation, if the patient is taking medications to lower cholesterol.

Test your knowledge on various cardiovascular symptoms and their implications. This quiz covers specific indicators of vascular issues, potential causes of palpitations, and red flags for conditions like congestive heart failure. Evaluate your understanding of cardiovascular health with key questions designed for medical students and healthcare professionals.