. Question : Which of the following is the most important question to ask during
cardiovascular health history?
Student
Answer: Number of offspring
Last physical exam
Sudden death of a family member Use of caffeine
Instructor Explanation:
The sudden death of a family member is an i...
. Question :
Which of the following is the most important question to ask
during
cardiovascular health history?
Student
Answer: Number of offspring
Last physical exam
Sudden death of a family
member Use of caffeine
Instructor The sudden death of a family member is an important question to ask in
Explanatio the health history because it reveals the cardiovascular disease risk of
n: the patient. Sudden death is usually due to an acute cardiovascular
event, such as myocardial infarction, cardiac dysrhythmia, or stroke.
Family history is particularly important for cardiac assessment because
CVD, HTN, hyperlipidemia, and other vascular diseases often have a
familial association that is not easily ameliorated by lifestyle changes. If
there are deaths in the family related to CVD, determine the age and
exact cause of death, because CVD at a young age in the immediate
family carries an increased risk compared with CVD in an elderly family
member. Ask about sudden death, which might indicate a congenital
disease such as Marfan's syndrome. This is especially important to ask
during pre-sports physicals because sudden death in athletes is often
related to congenital or familial heart disease. Familial hyperlipidemia is
autosomal dominant and often leads to CAD and MI at a young age.
Family history of obesity and type 2 diabetes are also secondary risk
factors for heart disease because the familial tendency for these is
strong. Ask about smoking in the house, as secondhand smoke is a risk
factor for respiratory and cardiac disease. (Goolsby 167-168)
Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings
and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company,
11/2014.
VitalBook file.
Points Received: 2 of 2
Comments:
Questio Question :
n 2. A key symptom of ischemic heart disease is chest pain.
However, angina equivalents may include exertional dyspnea.
Angina equivalents are important because:
Student
Answer: Women with ischemic heart disease many times do
not present with chest pain
, Some patients may have no symptoms or atypical
symptoms; diagnosis may only be made at the time of an
actual myocardial infarction
Elderly patients have the most severe
symptoms A & B only
Instructor The key symptom of IHD is chest pain, but other common symptoms
Explanatio include
n: arm pain, lower jaw pain, shortness of breath, and diaphoresis.
These symptoms are referred to as angina equivalents and can also
include fatigue or breathlessness. Some patients may have no
symptoms or atypical ones so that CAD may not be diagnosed until
they experience a myocardial infarction. (Kennedy-Malone 227)
Kennedy-Malone, Laurie, Kathleen Fletcher, Lori Martin-Plank.
Advanced Practice Nursing in the Care of Older Adults. F.A. Davis Company,
2014-01-
14. VitalBook file.
Points Received: 0 of 2
Comments:
Questio Question :
n 3. A 55-year-old post-menopausal woman with a history of
hypertension complains of jaw pain on heavy exertion. There
were no complaints of chest pain. Her ECG indicates normal
sinus rhythm without ST segment abnormalities. Your plan
may include:
Student
Answer: Echocardiogram
Exercise stress test
Cardiac
catheterization
Myocardial perfusion imaging
Instructor Once all the results of the initial laboratory and ECG testing are
Explanatio reviewed, a pretest probability of disease can be generated and
n: additional tests can be ordered.2 The probability of CAD can be
calculated by considering the chosen noninvasive test's sensitivity and
specificity.2 Selection of the proper cardiac test (see Table 115-1) for an
individual depends on the person's risk stratification, age, and tolerable
level of activity. The most common and least invasive test for diagnosis
of CAD is the stress test, also called the exercise tolerance test (ETT) or
treadmill exercise. (Buttaro 488)
, Questio Question :
n 4. Jenny is a 24 year old graduate student that presents to the
clinic today with complaints of fever, midsternal chest pain
and generalized fatigue for the past two days. She denies any
cough or sputum production. She states that when she takes
Ibuprofen and rest that the chest pain does seem to ease off.
Upon examination the patient presents looking very ill. She is
leaning forward and states that this is the most comfortable
position for her. Temp is 102. BP= 100/70. Heart rate is
120/min and regular. Upon auscultation a friction rub is
audible. Her lung sounds are clear. With these presenting
symptoms your initial diagnosis would be:
Student
Answer: Mitral Valve Prolapse
Referred Pain from
Cholecystitis Pericarditis
Pulmonary Embolus
Instructor Pericarditis
Explanatio
n: Pericarditis, inflammation of the pericardium, is usually not a solo
disease process but is seen in conjunction with other diseases or
conditions. Pericarditis may occur as a complication of MI (Dressler's
syndrome) or coronary artery bypass surgery. It is also more commonly
seen in patients with connective tissue disorders such as rheumatoid
arthritis, systemic lupus erythematosus (SLE), scleroderma, and
sarcoidosis. Bacterial, viral, or fungal infections, including HIV, are risk
factors for pericarditis. Pericarditis can occur with kidney failure or
metastatic neoplasias or as a reaction to medication, particularly
phenytoin, hydralazine, and procainamide.
Rarely, it is idiopathic and the cause unknown, although a common viral
infection is suspected. Cardiac tamponade can occur as a serious
complication, and it is an emergency requiring immediate
pericardiocentesis. Constrictive pericarditis can occur over time due to
scarring of the pericardial sac.
Signs and Symptoms
Unlike the symptoms associated with ACS, the pain accompanying
pericarditis is sharp and stabbing; it may worsen with inspiration or
when lying flat or leaning forward. Associated symptoms may include
shortness of breath, fever, chills, and malaise. (Goolsby 179)
Goolsby, Mary J., Laurie Grubbs. Advanced Assessment Interpreting Findings
and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company,
11/2014.
VitalBook file.
Points Received: 2 of 2
Comments:
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