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Assessment of the Cardiac

SystemPCU-MJCN

Class 2011

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HISTORYPast Medical HistoryPast Surgical History

AllergiesMedications, OTCDietary HabitsSocial HistoryFamily History

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Clinical Manifestations

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CHEST PAINPressureBurning

HeavinessConstriction

Worsened by:Exertion

EatingEmotionsCold

Relieved by:Rest

Nitroglycerin

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CHEST PAINSharp, fleeting, vagueSudden onset

Lasts hours to days

Worsened byDeep breathing

Position changesCoughing

Releived by

Pain pillsSpontaneously

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PALPITATIONSRapid heart beatsthumping

PoundingSimilar to syncopalepisodes -

Vision changes, weakness,dizziness, nausea,doiaphoresis

Ask aboutmedications

Caffaine intakeThyroid diseaseFrequency/pattern

DurationAssociatedmanifestations

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CYANOSIS bluish discoloration due todecreased hemoglobin or decreased tissue perfusionCentral cyanosis

Congenital Heart

DiseasePulmonary DiseaseChemical ExposurePrior MIPrior CHFAnemia

Peripheral CyanosisOccurs with cold

AnemiaAdvanced CHF

New MI

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SYNCOPE- loss of consciousness related todecrease cerebral perfusionSudden onset

Dysrhythmiasseizures

Warning manifestationsProdromal auraPalpitationsVision changes

Dizziness or weaknessOccurs withMicturitionDefections exertionOccurs with fear, smells, sights

Occurs with position changesAlcohol or drug abuseVolume depletionHistory of depressionResidual neuroligic deficit

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DYSPNEASuddenOccurs with:Fever

Exposure to high altitudeAcute pulmonary edemaPnemothoraxPulmonary emboliAirway obstruction

ChronicOccurs with:

Anxiety

DepressionLVHFPulmonary diseasePleural effusionAsthmaObesityPoor physical fitnessPsychosomatic conditions

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DYSPNEAExertional Dyspnea - cardiacOrthopnea - pulmonary

Paroxysmal nocturnal dyspnea - LVHF

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FATIGUEWeariness or exhaustionCan accompany complaints of dyspnea

Other causesAnemiaAnxiety

Chronic diseaseDepressionThyroid dysfunction

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EDEMAUnilateral

Deep vein thrombosisCellulitis

Lymphatic blockageASK

Recent surgery or bed restInjury

Skin color changesFever / rednessHistory of cancer

BilateralInitial site

progression

History of CHF

Nephrotic syndromeShortness of breath

cough

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PHYSICAL EXAMINATIONGeneral Appearance and LOCVITAL SIGNS

Head and Neck Neck Vein Assessment jugular pulsesCarotid Artery Assessment - bruit

Thorax

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PHYSICAL EXAMINATIONAbdomen

ExtremitiesSkin color Skin turgor TemperatureClubbingEdema

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DIAGNOSTIC TESTING Noninvasive Testing

ECG

Exercise TestsUpright Tilt-TableTests

EchocardiogramRadiographic CardiacTests

Chest X-rayCT AngiographyMRI

MRA gadoliniumPET

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DIAGNOSTIC TESTINGInvasive Cardiac Tests

Transesophageal Echocardiography

Cardiac catheterizationLeft/Right heart catheterization

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Laboratory TestsCBCCardiac Enzymes

Myoglobin

Creatinine kinaseCKMM, CKMB, CKBBTroponin

Blood Coagulation TestsPT

PTTSerum Lipids

Serum LipidsC-Reactive ProteinD-Dimer

Serum electrolytesK Ca

NaMaPBUN, Creatinine, GFR Serum Glucose