1. Continuing Medical Education Programs
Dr. Anika Niambi Al-Shura, Lecturer
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Level 1 Course Titles
Health Communications in TCM Cardiology
Integrative Anatomy and Patho-physiology in TCM Cardiology
Integrative Examination in Cardiovascular Disease
Integrative Diagnosing of Cardiovascular Diseases
Integrative Study of Hematology in Cardiology
Integrative Hyperlipidemia Treatments in Cardiovascular Disease
Integrative Cardiovascular Clinical Therapies
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3. Niambi Wellness continuing medical education programs presents
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4. Integrative Diagnosing of Cardiovascular Disease
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5. Diagnosing in Cardiovascular
This course is approved by the
following agencies:
National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for 8 PDA points and Florida State Board of Acupuncture for 10 CEUs.
The companion textbook:
Diagnosing in Cardiovascular
Chinese Medicine
must be ordered at
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Course Description
This course covers the finer details of cardiovascular patient examination techniques and clinical pearls used in western medicine, together with TCM examination techniques.
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Course Objectives
Understand the 6 basic signs and symptoms connected to cardiac diseases and their clinical significance.
Learn the methods and techniques used in physical examination to detect the signs.
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Course Modules
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Module 1:
Chest pain
Module 2:
Breathing Difficulties
Module 3:
Heart Rhythm
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Module 4:
Fainting Spells
Module 5:
Swellings
Module 6:
Gait
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Module 1
Chest Pain
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Contents
Chapter 1:
Clinical Significance
Chapter 2:
Inquiry and Examination
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16. Chapter 1: Clinical Significance
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Contents
Part 1:
Etiology
Part 2:
Answers to Textbook Questions
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Part 1: Etiology
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The pain may be transmitted by the sympathetic, vagus, and phrenic nerves, and well as nerves along the intercostal areas.
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The sensation may be felt upon the skin, between the rib bones within the intercostal muscles, under the diaphragm, around pleural tissue, inside of the esophagus, or through the sections of the heart including the aorta.
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Sometimes the breathing may become laboured. Weak or impaired gastrointestinal functioning may mimic or complicate symptoms.
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Part 1: Textbook Answer
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Answer #1
Xiong bi
In Chinese medicine, when chest pain is a positive sign of an adverse health condition it may be called xiong bi or chest obstruction.
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Answer #2:
Pulmonary and other (esophageal disorders)
Esophageal disorders are in the “other” category of differential diagnosis and includes contraction, acid reflux or esophagitis.
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Sources of pain are differentiated in Western medicine as:
Cardiovascular
Pulmonary
Other causes
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Answer #3:
Stagnation
Patients will complain about symptoms which are most bothersome and considered common to heart problems.
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30. Chapter 2:Inquiry and Examination
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Contents
Part 1:
Examination
Part 2:
Acute Chest Pain
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Contents
Part 3:
Chronic Chest Pain
Part 4:
Answers to Textbook Questions
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34. Part 1:Inquiry and Examination
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Chest pain is an unpleasant and possibly severe sensation, which originates or radiates around the chest. It is characterized by a feeling of pressure, tightness, or discomfort.
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37. Cardiovascular Causes
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Obstruction:
aorta disorders
Ischemia:
myocardial infarction
Non-ischemic:
aneurysm and pericarditis
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Pulmonary Causes
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Chest wall:
pneumothorax and pleuritis
Functional:
pneumonia, sarcoidosis,
cancer and tuberculosis
Vascular:
hypertension and embolus
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Cough or dyspnea often accompany chest pain, which may also give any clues about respiratory complications.
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Cough=
sharp sound expelled from the lungs and throat and out of the mouth
Dyspnea=
difficult or laboured breathing
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Other Causes
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Gastrointestinal
Esophageal problems
Peptic ulcers
GERD
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Psychological:
Neurosis
Depression
Anxiety
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Part 2: Acute Chest Pain
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Hyperventilation
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The pain occurs with rapid breathing and during heightened anxiety or emotional upset.
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50. Pneumonia and Pneumothorax
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Pain due to puncture, microbial infection, or obstruction which can be identified on x-ray.
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Pericarditis
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The pain is due to ischemic pain behind the sternum radiating to the left arm. The pain occurs and is worse while lying down and relieved by sitting up.
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A pericardial friction rub may or may not be heard in auscultation.
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The EKG may show ST segment elevations in multiple leads.
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This may confuse a diagnosis towards acute myocardial infarction.
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However this is not true in all cases.
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Also a chest x-ray may often be considered normal.
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62. Myocardial Infarction
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The pain is similar in quality and location to angina pectoris, but lasts longer, and is more intense.
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The pain often occurs at rest and is not relieved by nitroglycerin. It may be accompanied by:
Diaphoresis
Dyspnea
Nausea
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The patient usually needs to be hospitalized for treatments.
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An electrocardiogram will show Q waves and ST segment depressions.
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Blood work should include cardiac enzyme test.
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Unstable Angina
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These patients have coronary artery disease. The pain is relieved by rest or nitroglycerin.
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These patients have coronary artery disease. The pain is relieved by rest or nitroglycerin.
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The patient usually needs to be hospitalized for treatments.
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An electrocardiogram will show Q waves and ST segment depressions.
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Blood work should include cardiac enzyme test.
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Aortic Dissection
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The pain is located in the anterior and posterior areas within the chest. It is described as a feeling of something being ripped, and is not relieved with nitroglycerin.
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The pulse may be absent.
There may be regurgitation heard at the aortic position in auscultation.
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82. Part 3: Chronic Chest Pain
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Esophageal Disorders
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Esophagitis is due to acid reflux and causes burning sensation.
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Symptoms can occur with flow of stomach acid such as:
After meals
Bending at the waist
Lying down
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Esophageal spasms are contractions of the wall of the esophagus.
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Motor disorder is pain due to the contraction and spasm of the muscular wall of the esophagus.
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Dysphagia is a common symptom in these patients.
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Chest Wall Pain
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92. This pain is aggravated by Movement Palpation
Chest tissue manipulation
Bending or rotating the arms
Twisting at the waist
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94. Coronary Artery Disease
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95. Coronary artery disease presents in the clinic as recurrent angina pectoris.
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96. Evidence of pain due to coronary artery disease, is getting relief within 3 minutes of taking nitroglycerin.
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Myocardial Ischemia
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The pain usually awakens a sleeping patient.
An emotional episode also triggers an attack.
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Some patients get relief from taking nitroglycerin, and calcium channel blockers.
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Q waves and ST segment depressions and elevations occur during pain episodes.
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Mitral Valve Prolapse
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These patients should be monitored for endocarditis and arrhythmias.
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Check in auscultation for a late systolic murmur or mid-systolic click.
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107. Part 4: Answers to Textbook Questions
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Answer block #4
qi deficiency
blood stasis
blood stagnation
phlegm stasis #5
Separation of yin and yang
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Answer block #6
valvular or aortic disease #7
infections such as bronchitis, pneumonia or rheumatic fever #8
hypertension #9
a high homocysteine level is a risk factor for atherosclerosis in coronary artery disease.
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Answer block
#10
Usually an EKG will show Q waves and ST segment elevations.
#11
Blood work including cardiac enzymes
#12
EKG
#13
Chest X-ray
#14
EKG
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Answer block
#15
pain is relieved after taking nitroglycerine
#16
pain is not relieved by rest or nitroglycerine
#17
pain is worse while lying down and relieved by sitting up
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113. Module 1 Review Questions
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114. review interactive practice quiz.
Complete the Module 1
review interactive practice quiz.
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115. Please continue on to Module 2
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