Week 12 Cardiovascular (Moodle Version)_3.pdf

CARDIOLOGY & CARDIOVASCULAR DISEASE (CVD) ASSESSMENT & DIAGNOSIS CMS150  LEARNING OUTCOMES Identify conditions classified as cardiovascular disease, including must not miss conditions Apply diagnostic evidence to clinical reasoning in the assessment of cardiovascular diseases Identify m...

CARDIOLOGY & CARDIOVASCULAR DISEASE (CVD) ASSESSMENT & DIAGNOSIS CMS150  LEARNING OUTCOMES Identify conditions classified as cardiovascular disease, including must not miss conditions Apply diagnostic evidence to clinical reasoning in the assessment of cardiovascular diseases Identify medical tests used in the evaluation of a patient with suspected cardiovascular disease, based on evidence of accuracy Apply cardiovascular risk assessment tools to estimate individual patient risk Demonstrate an understanding of patient-centred care in the context of medical screening for cardiovascular risk Apply appropriate strategic patient-centred interviewing skills to establish and sustain patient rapport in the context of cardiovascular disease CARDIOVASCULAR DISEASE: OVERVIEW Vascular Cardiac Disease Carditis Heart Failure Arrythmias Ischemic Heart Atrial Myocarditis Disease Fibrillation Multiple etiologies Cerebrovascular Supraventricular Disease Endocarditis Tachycardia Peripheral Vascular Bundle Branch Pericarditis Disease Blocks MORE ON VASCULAR CONDITIONS Ischemic Heart Cerebrovascular Peripheral Vascular Disease Disease Disease Transient Peripheral Angina Ischemic Attack Artery (TIA) Disease Myocardial Deep Vein Infarction (MI) Stroke Thrombosis Aortic Pulmonary Dissection Embolism MUST NOT MISS CONDITIONS Must not miss cardiovascular conditions to rule out with a history of chest pain and/or shortness of breath on exertion: Acute coronary syndrome/ Myocardial infarction Myocarditis, Endocarditis, Pericarditis Pulmonary embolism Aortic dissection “This review summarises the evidence for the clinical value of physical examination of the cardiovascular system[…] The best was judged to relate to the detection and evaluation of valvular heart disease, the diagnosis and treatment of heart failure, the jugular venous pulse in the assessment of central venous pressure, and the detection of atrial fibrillation, peripheral arterial disease, impaired perfusion, and aortic and carotid disease.” Elder A, Japp A, Verghese A. How valuable is physical examination of the cardiovascular system? BMJ. 2016 Jul 27;354:i3309. doi: 10.1136/bmj.i3309. PMID: 27598000. https://www-bmjcom.ccnm.idm.oclc.org/content/354/bmj.i3309  MYOCARDIAL INFARCTION Acute Coronary Syndrome; Myocardial Infarction (myocardial cell death due to prolonged ischemia) Table: MI in patients presenting with chest pain to ER Table: Ruling out Acute Coronary Syndrome Sign/Symptom LR + Symptom LR - Radiation to both arms 9.7 Pain that is stabbing, pleuritic, 0.2-0.3 Radiation to right arm 7.3 positional, or reproducible by palpation Third heart sound 3.2 Swap CJ, Nagurney JT. Value and Limitations of Chest Pain History in the Evaluation of Patients With Suspected Acute Coronary Syndromes. JAMA. 2005;294(20):2623–2629. doi:10.1001/jama.294.20.2623 Hypotension 3.1 Radiation to left arm 2.2 Radiation to right shoulder 2.2 Crackles (auscultation) 2.1 Diaphoresis 2.0 Nausea and vomiting 1.9 Beiser D. Acute Myocardial Infarction (MI). In: Stern SC, Cifu AS, Altkorn D. eds.Symptom to Diagnosis: An Evidence-Based Guide, 4e. McGraw Hill; 2020. MYOCARDIAL INFARCTION Presentation Variations MI is more often missed in women, non-white patients, and younger patients According to one study: women (OR 1.3 95%CI 1.2-1.5, p