Pathophys
Pulmonary Embolism
A blood clot that usually originates in deep veins of legs or pelvis travels up and causes sudden occlusion of part of pulmonary arterial tree resulting in hypoxia and decreased CO
Deep vein thrombosis, bed rest, hypercoagulable states (SLE, cancer), protein S or C deficiency antithrombin III deficiency; estrogen therapy
Came on suddenly
Severe tearing that radiates to the back
Also experiencing diaphoresis and hoarseness
Hx of hypertension
Aortic Dissection
Positions for listening to heart sounds?
Left lateral decubitus: low-pitched extra sounds such as an S3, opening snap, diastolic rumble of mitral stenosis
Leaning forward after a full exhalation: Soft decrescendo higher-pitched diastolic murmur of aortic regurgitation
Chostocondritis
Local tenderness
Pain can be replicated with palpation
Typical Angina
Temporary myocardial ischemia, usually secondary to coronary atherosclerosis
Dyspnea
Pericarditis
Heart Failure
Valvular disease
Angina
Mitral Stenosis (Features, S/S, complications)
Holosystolic Murmur
Signs of Heart Failure: fatigue, swelling, rapid heartbeat
Could result in pulmonary edema, heart failure, dysphagia, atrial fib, embolism)
Typical Angina
Relieved with rest or nitroglycerin
Brought on by exertion, especially in the cold
Pleuritic Pain
Inflammation of the parietal pleura due to pleuritis, pneumonia, pulmonary infarction, or neoplasm
Pain is described as pressing, squeezing, tight, or heavy
Location: retrosternal or across the chest, radiates to shoulders, arms, neck, lower jaw, or upper abdomen
Angina
Myocardial Infarction
Aortic Stenosis (S/S, Pathophys, Causes)
Heart sounds: Crescendo decrescnedo
Pathophys: thickening/stiffening of the aortic valve -> does not open fully -> pressure gradient increases across the valve -> decreased CO
Causes: damaged endothelial cells fibrose over time; Rheumatic Fever
GERD
Irritation or inflammation of the esophageal mucosa due to reflux of gastric acid from lowered esophageal sphincter tone
Occurs with large meals, bending over, lying down
Burning
Myocardial Infarction
Prolonged myocardial ischemia, resulting in irreversible muscle damage or necrosis
Possible causes of decreased CO: arrhythmias, coronary artery disease, coronary ischemia, or vasospasm
Diffuse retrosternal pressure
Radiates to the left or right arm
Dyspnea
Nausea
Diaphoresis
Typical Angina
Myocardial Infarction
Pulmonary Embolism
Possible chief complaint
Dry cough, especially at night or upon exertion
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Pink frothy sputum or hemoptysis if already with heart failure
Anxiety
Overbreathing, with resultant respiratory alkalosis and fall in arterial partial pressure of carbon dioxide
May present with lightheadedness, numbness or tingling of the hands and feet, palpitations, chest pain
Episodic but can last hours-days
Left- sided Heart Failure
Elevated pressure in pulmonary capillary bed with transudation of fluid into interstitial spaces and alveoli, decreased compliance (increased stiffness) of the lungs, increased work of breathing
Persistant, sharp pain is pleuritic and radiates to the shoulders and back but improves when sitting forward
Also experiencing dyspnea, diaphoresis, hemoptysis
Pericarditis
Pulmonary Embolism
Pneumothorax
Pleuritis
Key features on physical exam
Vital signs: +/- hypotension or decreased pulse pressure
Heart: murmur
Lungs: crackles or wheezes if heart failure
Abdomen: +/- hepatomegaly
Extremities: +/- poor perfusion
Myocardial Infarction
Occurs in any position, is not relieved with rest, and is not triggered by exertion