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One high-risk population group is patients with cardiac disease. The many implications of this are reviewed.


This is for general health education purposes only.


Patients with cardiac disease must be treated differently on a day-to-day basis. Maintenance for them is entirely different from maintenance for the average healthy person. Screening is different. And all of this is because they respond to different diseases differently. And they are at higher risk for different diseases themselves.

So physicians need to be constantly aware of patients that are presenting to them that have cardiac disease. This is because the patients may not know it themselves, and if the physician is not in tune with this, he will slight their healthcare.

So, your doctor needs to be constantly aware of things that will make him think, ahh, this person is a cardiac patient.

I promise you that your doctor, if she or he is a good one, has these memorized like the back of their hand.


Signs and Symptoms of Heart Disease


These are the clues to underlying cardiac disease. They are easiest remembered in the pneumonic “PALS”

  1. Peripheral infarct HX
  2. Afib
  3. Left ventricular stasis <- left ventricular aneurysm, valve disorders, end stage cardiomyopathy, low EF (any cardiac dz)
  4. Smoking


What is Cardiac Infarction?


If there has been an infarction of any of their tissues in their past medical history, the physician knows that cardiac risk is high. Infarction means the end organ has a piece of it that has died. Like a slice of pie. Perhaps they had a kidney infarction. If something like that is in their past medical history, whether the patient is aware of it, whether or not their regular doctors that surround or used to surround them are aware of it, it doesn’t matter. If you are a physician that has to work with them today, it is in your mind as a possibility the moment you hear there has been an infarction of any tissue.

Atrial fibrillation. This is always a huge clue that the patient has some sort of underlying cardiac problem. Atrial fibrillation is extremely common. There are many causes. If the patient presents to with a history of atrial fib, whether persistent or intermittent, you are certain that they are at an increased risk for cardiac disease, presently, or in future. And you had better treat them like a cardiac patient.

Left ventricular stasis. This means that you have a clue that there something bothering their left ventricle. If you have this clue, you can be certain they have increased cardiac risk. Perhaps they have a left ventricular aneurysm. Perhaps they have a valve disorder, almost always only affected are the valves on the left side. Perhaps they have cardiomyopathy, usually end stage is required for stasis. Or, lastly, perhaps they have reduced ejection fraction. The ejection fraction of the left ventricle is the percentage of a evacuation of that chamber for cardiac cycle. It’s best determined by an echocardiogram. If a patient has a reduced ejection fraction, you can be fairly certain they are at increased risk for cardiac disease.


Smoking and Heart Disease


And smoking. If the patient is a smoker, you can be immediately clued into the high likelihood that they have cardiac disease.

So once you have identified a cardiac patient, they immediately become one of your PALS! That is, you know they are at increased risk for infarction of any tissue. They may be at increased risk for a kidney infarction. They may be at increased risk for a bowel infarction. So, for example, theypresent with a domino pain, and you have clues that they are cardiac patient, Then you immediately need to be thinking that they perhaps have embolized their superior mesenteric artery. You will have a differential diagnoses filled with possibilities as you are working this patient up. But if they have one of the PALS clues, gut embolism is on your list.


Once you suspect cardiac disease, you immediately start treating a patient differently. They are at risk for different things. They will handle different things differently. Not maintaining an awareness of their cardiac risk will definitely put the patient at risk. If his or her doctor does not bear in mind cardiac arrest and every step of such a patient’s care, things will go poorly.

The pneumonic is “PALS”


  • Peripheral infarction history
  • Atrial fibrillation
  • Left ventricular stasis
  • Smoker

These things imply cardiac patient. This patient immediately gets treated differently from all the rest of us. I guarantee you your doctor knows this. Now you do as well!

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