14. Signs And Symtoms Flashcards
What is the key factor in ischaemia that stimulates pain afferents in muscle? How?
pH drop due to lack of O2, then substance P released locally, increases sensitivity of pain afferents in muscle.
Why can young people with thyrotoxicosis develop angina or MI?
Increased metabolic rate, increased O2 demand, requires increased blood supply but cannot be supplied leading to ischaemia.
Why can cardiac pain be brought on by exercise, stress, emotion, cold weather or a meal?
Adrenaline response.
Vasoconstriction due to breathing in cold air.
Blood diverted to gut.
What is the definition of palpitations?
Noticeably rapid, strong, or irregular heartbeat due to agitation, exertion or illness.
Give 3 causes of palpitations
Heightened awareness of normal heart beat.
Sinus tachycardia.
Arterial or ventricular ectopic beats.
Atrial tachycardias (eg supraventricular tachycardia/fibrillation).
Ventricular tachycardia/fibrillation.
What is orthopnea?
Breathing altered with position
What is paroxysmal nocturnal dyspnoea?
Intermittent difficulty breathing lying down
What other disease might dyspnoea be confused with?
Asthma
What is the cause of collapse/loss of consciousness in low/no output cardiac tachy or brady arrhythmias?
Cerebral hypoperfusion
What is required for a patient to be diagnosed with postural hypotension?
Drop in systolic pressure of 20 or more, or diastolic drop of 10 or more from lying to standing.
What leads to a strong bounding pulse?
Lowering of diastolic pressure eg bradycardia caused by heart block, or by lowered peripheral resistance eg exercise or pregnancy
What type of pulse is particularly seen in aortic regurgitation?
Collapsing or water-hammer pulse
What type of pulse is seen in aortic stenosis?
Slow rising pulse
What anatomical pulse best represents the nature/quality of the central aortic pulse?
Carotid
Why does raising the arm exaggerate a bounding pulse?
Pumping against gravity
Why are right-sided murmurs increased during inspiration?
Negative intrathorasic pressure, drawing blood into lungs, higher pressure through vale, louder murmur
Why are left-sided murmurs increased during expiration?
Positive intrathorasic pressure, drawing blood to other parts of the body, higher pressure through valve, louder murmur.
Why might you want to ask a patient to hold their breath when you are listening for heart murmurs?
So you can’t hear their breathing sounds.
Why does the S2 heart sound split on inspiration?
Closure of aortic valve and pulmonary valve not synchronised normally due to changes in pressure on inspiration
Where can you listen to the aortic vale and pulmonary valve anatomically in the chest?
Aortic - 2nd-3rd right intercostal space.
Pulmonary - 2nd-3rd left intercostal space.
Where can you listen to the tricuspid valve and mitral valve anatomically on the chest?
Tricuspid - left sternal border.
Mitral - apex.
In what direction from the source of turbulence are murmurs conducted?
Distally.
What is buerger’s test?
Pale foot on elevation, pink foot on dependency, shows ischaemia
What is sunset foot?
Foot that is nearly ischaemic - not enough O2, substances released locally, vasodilation, collaterals form, area looks red and feels warm, but is actually becoming ischaemic.
