Cardiovascular Review

Cardiovascular Review

Approaching a patient with hypertension (HTN)

• Determine if the patient has HTN?

• Contributing factors:

• Non-compliance with daily medication

• Taking drugs that cause HTN (herbal medicine, traditional medicine, licorice)

• High salt intake, stress

• Causes:

• Secondary HTN:

• Common: COPD, sleep apnea syndrome, kidney disease, medication and alcohol

• Less common: Cushing’s syndrome, thyroid disease, primary aldosteronism, adrenal medulla/cortex tumor

• Are there target organ damages?

• Brain: Stroke signs (FAST), findings of neurological localization

• Blood vessels: Aortic dissection (severe chest pain), acute pulmonary edema (severe dyspnea, pink frothy sputum, …)

• Eyes: Blurred vision

• Heart: Triad of dyspnea, left chest pain, findings on examination

• Kidney: Oliguria, foamy urine, hematuria

• Cardiovascular risk factors:

• Non-modifiable: Age, gender, economic level, sleep apnea, pre-existing chronic kidney disease, family history, stress

• Modifiable: Diabetes mellitus, smoking, dyslipidemia, overweight, obesity, unhealthy diet, lack of physical activity

• HTN staging according to AHA 2017:

• Normal: <120 and <80 mmHg

• Elevated: 120 – 129 and < 80 mmHg

• Stage 1: 120 – 139 and/or 80 – 89 mmHg

• Stage 2: > 140 and/or > 90 mmHg

• HTN staging according to ESH 2018:

• Optimal: < 120 and < 80 mmHg

• Normal: 120 – 129 and/or 80 – 84 mmHg

• High-normal: 130 – 139 and/or 85 – 89 mmHg

• Grade I: 140 – 159 and/or 90 – 99 mmHg

• Grade II: 160 – 179 and/or 100 – 109 mmHg

• Grade III: > 180 and/or > 110 mmHg

Approaching a patient with dyspnea

• Is there true dyspnea?

• Dyspnea classification:

• Contributing factors:

• Causes:

• Cardiovascular: Coronary syndrome, heart failure, acute cardiac tamponade

• Respiratory: Upper respiratory syndrome, tracheitis/bronchospasm, pulmonary embolism, asthma, COPD, pneumothorax, pleural effusion, pneumonia

• Neurological – Muscular disease: Phrenic nerve disorders, mitochondrial diseases, polymyositis

• NYHA heart failure staging:

• Class I: Normal physical activity

• Class II: Slight limitation of physical activity (decreased frequency of daily work due to fatigue)

• Class III: Marked limitation (mild exertion causes fatigue)

• Class IV: Fatigue and discomfort even at rest

Approaching a patient with chest pain

• Is there true chest pain?

• Chest pain classification:

• Causes:

• Chest wall: Costochondritis, herpes zoster

• Cardiovascular: Pericarditis, myocarditis, coronary artery disease, aortic dissection, pulmonary embolism, pulmonary hypertension

• Respiratory: Pleuritis, pneumothorax, asthma, COPD, lung cancer

Well’s score

• Signs of deep vein thrombosis in lower extremities:

• Leg swelling, tenderness to palpation (3 points)

• Previous history of DVT, pulmonary embolism (1.5 points)

• Immobilization > 3 days or surgery > 4 days (1.5 points)

• Tachycardia (>100 bpm): (1.5 points)

• Hemoptysis: (1 point)

• Malignancy: (1 point)

• When other diagnoses are less likely than pulmonary embolism: (3 points)

Killip staging in acute myocardial infarction (AMI)

• Class I: No signs of left ventricular failure

• Class II: Rales < 1/2 lung, jugular vein distention, possible gallop T3

• Class III: Acute pulmonary edema

• Class IV: Cardiogenic shock

Murmur characteristics:

• Location:

• Timing:

• Shape:

• Intensity:

• Quality:

• Radiation:

• Carvallo’s maneuver:

Note:

• This article is only an overview and is not exhaustive.

• For more detailed information, please consult professional literature or a specialist physician.