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					Cardiovascular

--> General notes / thoughts on review
   Huge chapter
   Too huge really -
   Plan is to walk away with a big picture perspective of the major diseases, their manifesta-
   tions and a bit about medical management-
   PT management will be covered in Cardiopulmonary PT

   For symptoms - good to know what they might indicate in order of concern - and what
        s
   sign’ would be associated with particular “causes”of the symptom (i.e. chest pain with
   ST segment depression is likely angina (chest pain due to ischemia)


I. Signs & Symptoms of Cardiovascular Disease
   Chest pain or discomfort (symptom)
   Local vs. systemic origin
   If local - provoked by local palpation (and usually a history of local trauma)
   Systemic - can also radiate to neck, jaw, upper trapezius, upper back, shoulder or arms
   If cardiac and due to ischemia == angina
   If cardiac - radiation is most common to left arm (certainly NOT exclusively to left arm)

   Signs: ECG - if really severe can show up with cardiac enzymes
   Angina (symptom)
   Chest pain due to ischemia
   Most clear when “  exertional” and when exertional considered stable; but can also be
    non
   “ exertional”and when non exertional considered “    unstable”
   Associated with ST segment changes on the ECG, and/or ventricular ectopic beats
   (VPBs more commonly called PVCs)
   Palpitations (symptom)
   feeling irregular heart beats / rhythm; extra or skipped - can feel like a fluttering in the
   chest, a bump, pounding, jump, flop, butterfly, racing sensation

   Signs include: electrocardiograph assessed arrythmias
   Dyspnea (SOB) (symptom)
   breathlessness - uncomfortable feeling with breathing
   Dyspnea that occurs in recumbant position (including supine) -> orthopnea

   Signs of dyspnea can include tachypnea, nasal flaring, accessory muscle use

   Signs that dyspnea is due to a medical emergency include: wheezing, cyanosis, drops in
   BP, irregular cardiac rhythm
2    Cardiovascular.nb
          breathlessness - uncomfortable feeling with breathing
          Dyspnea that occurs in recumbant position (including supine) -> orthopnea

          Signs of dyspnea can include tachypnea, nasal flaring, accessory muscle use

          Signs that dyspnea is due to a medical emergency include: wheezing, cyanosis, drops in
          BP, irregular cardiac rhythm
          Cardiac Syncope (sign)
          Fainting (passing out) due to cardiac issue (BP drops due to cardiac pathology)
          Vasovagal Syncope (sign)
          Fainting (passing out) due to non cardiac issue (BP does not drop due to cardiac
          pathology)
          Fatigue (symptom)
          At a minimum exertion - can be due to cardiac pathology (if so usually includes other
          symptoms such as dyspnea, chest pain, palpitations) or signs (drop in BP, ECG abnormali-
          ties, abnormal heart or lung sounds)
          Cough (sign)
          dry vs wet
          productive vs non productive (does something come up (or get swallowed)
          dry can be a sign of early onset of CHF (low specificity) - specificity increases if highly
          repeatable with physical exertion / fatigue (i.e. if every time the patient exerts to fatigue
          they get a dry cough)
          Cyanosis (sign)
          bluish discoloration due to a lack of oxygen
          Can be due to low oxygen in the blood (Hct and/or SpO2); or due to oxygen delivery
          (blood flow)
          Blood flow problems can be local (vascular issues) or systemic (low cardiac output)
          Peripheral edema (sign)
          Hallmark sign of right ventricular failure
          Most common cause of right ventricular failure is left ventricular failure; the book gets a
                                                             non
          bit confused and calls pulmonary hypertension a “ cardiac”cause of right ventricular
          failure; however idiopathic pulmonary hypertension is rare; common causes of pul-
          monary hypertension includes: left heart failure (most common) and pulmonary disease

          Claudication (sign) (stable angina in the legs)
          Pain in the legs brought on by activity due to peripheral vascular disease; if pain in legs
          is not brought on by PVD then it is not claudication
          Claudication is to leg cramping/pain as angina is to chest pain


    II. Aging and the Cardiovascular System
          A. Specific effects of aging
          Aging vs disease is difficult to separate in the CV system due to the high prevalence of
          high blood pressure and ischemic cardiac diseases
          Disease independent changes include:
          1. reduction in myocytes and conduction system cells
          2. cardiac fibrosis
          3. decreased calcium transport across membranes
                                                                            Cardiovascular.nb   3




   Aging vs disease is difficult to separate in the CV system due to the high prevalence of
   high blood pressure and ischemic cardiac diseases
   Disease independent changes include:
   1. reduction in myocytes and conduction system cells
   2. cardiac fibrosis
   3. decreased calcium transport across membranes
   4. lower capillary density
   5. decreased response to Β adrenergic stimulation (possibly due to increased adenosine
   antagonism)
   6. impaired autonomic reflex control (partly related to #5)
   B. Effects of aging on function
           1
   Aging Α function during load (demand) - such as orthostatic changes, increased
   metabolic demand (from exercise, activity, disease)
   Relatively unaffected at rest (if affected at rest --> bigger problems during load)
   “Allostatic”load vs homeostatic imbalances
   C. Effects of exercise on aging
   Blunts (but does not stop) the changes mentioned in A and their functional consequences
   as mentioned in B


III. Gender Differences and the Cardiovascular System
   Women vs men
   Higher prevalence of mitral valve prolapse
   Greater risk if have long QT syndrome
   Increased LVH with aging (left ventricular hypertrophy)
   Higher incidence of bleeding episodes if treated with thrombolytics
   Differential outcomes with surgery and angioplasty (increased number of repeat proce-
   dures)

   Same CAD mortality (after 60s)
   Under diagnosis is a problem due to previous assumptions; and slightly different presenta-
   tions (i.e. women are more likley to have CAD without chest pain) and microvascular
   problems that do not show up as easily with stress testing

   Difficult to discern how many of the differences in outcomes are due to biological vs
   social factors - i.e. studies show that women are treated less aggressively following
   initial signs of cardiac disease as compared to men

   There is an increased risk of heart disease after menopause, but HRT does not seem to
   change the risk

   More women than men develop hypertension (related to longevity most likely)
4    Cardiovascular.nb




    IV. Diseases Affecting the Heart Muscle (myocardium)
          A. Ischemic Heart Disease
          B. Angina Pectoris
          C. Hypertensive Cardvascular Disease
          D. Myocardial Infarction
          E. Congestive Heart Failure
          F. Orthostatic (postural) hypotension
          G. Myocardial Disease
          H. Trauma
          I. Myocardial Neoplasm
          J. Congenital Heart Disease


    V. Diseases Affecting the Cardiac Nervous System
    (conduction)
          A. Arrhythmias


    VI. Diseases Affecting the Heart Valves
          A. Mitral stenosis
          B. Mitral regurgitation
          C. Mitral valve prolapse
          D. Aortic stenosis
          E. Aortic regurgitation
          F. Tricuspid regurgitation and stenosis
          G. Infective endocarditis
          H. Rheumatic Fever and Heart Disease


    VII. Diseases Affecting the Pericardium
          A. Pericarditis
                                                  Cardiovascular.nb   5




IIX. Diseases Affecting the Blood Vessels (peripheral)
   A. Aneurysm
   B. Peripheral vascular disease
   C. Vascular neoplasms


IX. Other Cardiac Conditions
   A. Surgery
   B. Cardiogenic Shock
   C. Collagen & Vascular diseases
   D. Cancer treatment

				
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posted:12/7/2011
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