1. As the treating therapist, what signs and symptoms would clue you to a possible mitral valve dysfunction, should it occur with this patient while she was exercising?
2. During an initial interview with the patient, she describes that she thinks she is having heart palpations. You ask her to describe what she feels. What would be some of the ways that she might describe what she is feeling? Define heart palpitations.
3. What are some associated symptoms that can occur with palpitations?
4. A patient describes palpitation as part of his or her symptoms but may not be experiencing heart disease. What could be other causes of heart palpitations?
5. Syncope that occurs without any warning period of lightness, dizziness or nausea may be a sign of _____________?
6. What is the difference between cardiac syncope and non-cardiac syncope?
7. How would you know the difference between a patient complaining of heartburn or anginal pain?
8. You are examining a 52 year old patient who complains of substernal pain radiating into the neck and down the left arm. Based on your readings, how would you be able to differentiate between a patient having a myocardial infarction or a patient with acute onset of pericarditis?
9. Why is it important that patients with a comprised cardiac condition not smoke or eat a large meal before performing his or her exercise program?
10. What are the 3 Ps? What is the significance of each one?
11. When are palpitations clinically significant?
1: The signs and symptoms of mitral valve dysfunction are not prominent for many patients. However, early diagnosis and treatment may repair any damage. The signs and symptoms of mitral valve dysfunction have been summarized below.
Since the patient had a history of mitral valve dysfunction, so the patient might be having a relapse (Cheung et al., 2013). Although the initial symptoms are not that relevant but this can occur with the patient while she was exercising.
2: Heart palpitations are the defined as the conditions of fluttering, pounding or rapid heart. This can get initiated by exercise, stress, medical condition or medication. Usually, the heart palpitations are harmless but the more severe condition of cardiac arrhythmia may require an intervention (Tayal & Dancy, 2013).
Her descriptions might include the condition of the heart beating too rapidly, it may beating harder than normal, the heart may be fluttering and skipping beats. She might be feeling the symptoms of heart palpitations in her neck, chest or throat. She might be experiencing these conditions when she is lying down, seated or even while standing (Jastrezebski, Hart & Czernecka, 2015).
3: There are a few associated symptoms of palpitations that require immediate medical intervention. These have been listed below.
The palpitation that lasts for a few seconds or is infrequent does not require any medical intervention or evaluation. But in case the patient has a medical history of heart disease and suffer from frequent palpitations or if it worsens, medical intervention is required. Heart monitoring examinations may be carried out to detect the cause of the palpitations and diagnosis of any underlying heart disease.
4: The causes of palpitations, which are non-heart related, have been listed below.
5: Syncope that occurs without any warning symptom of dizziness or nausea may be a sign of cardiac arrhythmia. Cardiac arrhythmia may be defined as the condition in which the heart beats are either too slow or too fast. In case the heartbeats are too slow, the condition is bradycardia and in case the heartbeats are too fast, the condition is known as tachycardia. The cardiac arrhythmias usually do not have any symptom. However, in case the symptoms are present, these may include palpitations, shortness of breath, lightheadedness and chest pain. Cardiac arrest or heart failure may result out of cardiac arrhythmias (Nguyen et al., 2015).
6: Syncope can be defined as the temporary and sudden loss of consciousness, which is not due to seizures or trauma. Usually, aged patients are at a higher risk of cardiac death and falls due to syncope. The cardiac syncope is the one that occurs due to the cardiovascular causes. These causes include the mechanical causes like obstruction of cardiac valves and electrical causes like arrhythmias. Obstruction of a major vascular structure and central circulation can also cause syncope. On the contrary, the causes of non-cardiac syncope include vasovagal reaction, orthostatic hypotension, hypersensitivity of the carotid sinus, neurologic and micturition (Bhat et al., 2014).
7: The differences between angina pain have been listed below.
The pain due to angina radiates to the neck, arms and shoulders while the heartburn pain does not radiate.
The angina pain is not associated with meals while the pain due to heartburn may occur usually after meals.
Angina pain does not respond to antacids whereas heartburn pain responds quickly.
Angina pain is accompanied with lightheadedness, dizziness or cold sweat while the pain due to heartburn rarely accompanies them.
Nausea and vomiting are accompanied with angina pain whereas these are absent in the case of heartburn pain (Chawla et al., 2015).8: It is quite difficult to distinguish between the presence of myocardial infarction and onset of pericarditis. The misdiagnosis of myocardial infarction (MI) and pericarditis may lead to complications (Fisher et al., 2015). However, few differences can be stated between these two diagnoses based on the ECG findings, which have been mentioned below.
Serial monitoring of the graphs of ECG may help in differentiating between MI and acute onset of pericarditis as MI is not associated with the depression of the PR segment.
The ratio of T-wave to ST-segment of 0.25 or more helps in differentiating.
In case of MI the ST segment is convex and in case of pericarditis it is concave.
Patients with MI show QRS complex prolongation whereas it is absent in pericarditis.
9: A patient with a comprised cardiac condition has a weak state of heart. Under this condition, smoking or eating a large meal will increase the blood pressure. After that, if the patient goes for his exercise program, it may result in cardiac arrest. The weak heart may not be able to handle the increased heart rate and thus, result in the cardiac failure of the patient. Also, regular smokers and consumers of fatty diets develop atherosclerosis. This will reduce the blood and oxygen supply to the heart, especially in case of exercise. The heart will not be able to withstand the pressure, eventually collapse, and result in a heart attack or arrhythmia.
10: The 3Ps are Pulse, Periphery and Blood Pressure. A cardiac condition may require immediate intervention if the 3Ps are found to be in the following order.
Pulse: <60/min or >110/min.
Periphery is clammy and cool.
Blood pressure (Systolic) < 100mm of Hg.
11: Palpitations are clinically significant as markers for the identification of the conditions of cardiac arrhythmia, which are underlying. The type of disturbance in the rhythm and the clinical reference of their occurrence make palpitations clinically significant. However, the symptoms alone do not signify the occurrence of cardiac conditions (Jonsbu et al., 2013).
References
Bhat, P. K., Pantham, G., Laskey, S., Como, J. J., & Rosenbaum, D. S. (2014). Recognizing cardiac syncope in patients presenting to the emergency department with trauma. The Journal of emergency medicine, 46(1), 1-8.
Chawla, L. S., Goldstein, S. L., Kellum, J. A., & Ronco, C. (2015). Renal angina: concept and development of pretest probability assessment in acute kidney injury. Crit Care, 19, 93.
Cheung, A., Webb, J. G., Barbanti, M., Freeman, M., Binder, R. K., Thompson, C., … & Ye, J. (2013). 5-year experience with transcatheter transapical mitral valve-in-valve implantation for bioprosthetic valve dysfunction. Journal of the American College of Cardiology, 61(17), 1759-1766.
Fisher, P., Sidhu, R., Behuria, S., & Rachko, M. (2015). Pericardial effusion in the setting of Takosubo Cardiomyopathy.
Jastrzebski, M., Hart, R., & Czarnecka, D. (2015). Wide QRS complex tachycardia in a patient with complete heart block: What is the mechanism?.Journal of cardiovascular electrophysiology.
Jonsbu, E., Martinsen, E. W., Morken, G., Moum, T., & Dammen, T. (2013). Change and impact of illness perceptions among patients with non-cardiac chest pain or benign palpitations following three sessions of CBT.Behavioural and cognitive psychotherapy, 41(04), 398-407.
Nguyen, T., Van Tran, H., Minh, H. P. N., Rigatelli, G., & Dagubati, R. (2015). GW26-e5423 Strategies for Investigations of Patients Presenting with Syncope. Journal of the American College of Cardiology, 66(16_S).
Tayal, U., & Dancy, M. (2013). Palpitations. Medicine, 41(2), 118-124.
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