ALS Lecture 8 - Cardiac Symptoms and Signs DONE Flashcards
spectrum for acute coronary syndrome (3)
unstable angina, NSTEMI MI, STEMI
unstable angina
angina without exertion
NSTEMI (3)
non-ST elevation MI, partial blockage coronary artery, raised troponin
STEMI (2)
ST elevation MI, completely blocked artery
cardinal symptoms of acute coronary syndrome (8)
chest pain, breathlessness, palpitations, syncope, haemoptysis, oedema, cough, fatigue
acute coronary syndrome chest pain character
crushing ischaemic pain
acute coronary syndrome radiation
left arm, jaw
SOCRATES
site, onset, character, radiation, associated symptoms, time course, exacerbating/alleviating factors, severity
cardiac chest pain
site
character of cardiac chest pain (2)
tight, crushing
time course of MI
always there
time course of angina
comes with stress/exertion
label the diagram of cardiac chest pain (A)
done
chest pain is not likely to be stable angina (4)
prolonged, unrelated to activity, brought on by breathing in, other symptoms
fill in the table of classification of chest pain (B)
done
fill in the table of classification of angina (C)
done
fill in the table of angina vs MI pain (D)
done
pericarditis pain character (2)
sharp, stabbing
pericarditis is worse with (2)
inspiration, lying flat
pericarditis is eased by (2)
sitting up, NSAIDs
pericarditis comes on (2)
hours, days
pericarditis causes (2)
infection, pericardial infusion
pericarditis changes on ECG (2)
concave scooped ST elevation on all leads, PR depression
look at the ECG example of pericarditis (E)
done
aortic dissection pain character (4)
sudden, tearing, knife-like, excruciating
aortic dissection radiates to
back
aortic dissection is often seen in (3)
elderly, hypertension, stressful job
aortic dissection associated symptoms (20-40%)
abdo pain
pulmonary embolus pain character
pleuritic pain
pulmonary embolus associated symptoms (4)
SOB, tachycardia, AF, tachypnoea
look at the diagram of the diagnostic algorithm (F)
done
acute coronary syndrome is an umbrella term that encompasses (3)
unstable angina, NSTEMI, STEMI
bretahlessness can be (2)
dyspnoea, tachypnoea
dyspnoae
uncomfortable awareness of breathing
tachypnoea
faster breathing than normal, >24breaths per minute
pulmonary oedema time course (2)
abrupt, minutes
pulmonary oedema breathlessness associated symptoms (4)
pink frothy sputum, orthopnoea, cold, clammy
pulmonary oedema causes (3)
MI, left ventricular dysfunction, renal artery stenosis
pulmonary embolism chest x-ray (3)
cardiomegaly, bats appearance (fluid/congestion), fluid in interstitial space (kerley B lines)
paroxysmal nocturnal dyspnoea (5)
breathless, wake from sleep, frightening, cough, wheeze
how long does PND last?
15-30mins
PND relevant question
do they have to sit up whilst sleeping?
PND causes (2)
reduced respiratory drive, adrenergic activity of myocardium at night
chronic heart failure symptoms (5)
exertional breathlessness, orthopnoea, nocturnal cough, PND, ankle oedema
classes of chronic heart failure symptoms (1-4)
- none
- severe exertion, more than normal
- modest exertion
- at rest
sensitivity is the probability of a
positive test in patients with disease
specificity is the probability of a
negative test in patients without disease
palpitations
unpleasant awareness of heart beat
syncope (3)
fainting, collapse, due to cerebral hypoperfusion
exertional syncope worrying in young people as it could indicate
underlying heart disease
in syncope it is important to try and get
witness account
defining characteristic symptoms of syncope (5)
transient, self-limited loss of consciousness, falling, rapid onset, prompt spontaneous recovery
questions about circumstances prior to syncope attack (5)
position, activity, situation, predisposing factors, precipitating events
questions about onset of syncope attack (5)
nausea, vomiting, cold feeling, sweating, aura
questions about syncope attack, eye witness (4)
skin colour, duration, movements, tongue biting
questions about end of syncope attack (7)
nausea, vomiting, cold feeling, confusion, skin colour, wounds, aches
questions about background of syncope patient (5)
happened before, fh, cardiac disease, medication, neuro history
pink frothy sputum (1)
pulmonary oedema
clear white mucoid sputum (2)
viral, longstanding bronchial irritation
thick, yellowish sputum (1)
bacterial
rusty sputum (1)
pneumococcal pneumonia
blood streaked sputum (4)
TB, bronchiectasis, lung cancer, pulmonary infarction
haemoptysis causes (4)
pulmonary oedema, mitral stenosis, pulmonary infarction, lung cancer
haemoptysis
expectoration of blood, streaked or lots
peripheral oedema causes (4)
cardiac failure, chronic venous insufficiency, hypoalbuminaemia, drugs
ankle oedema isn’t
specific/sensitive for coronary heart failure
peripheral oedema can also be caused by
low protein states
low protein states that can cause peripheral oedema (5)
nephrotic syndrome, cirrhosis, low albumin, drugs, pregnancy
jugular venous pulse is a measure of
right atrial pressure
JVP normal height
2-3cm, elevated >4cm
label the graph of JVP height with time (G)
done
causes of elevated JVP (5)
heart failure, constrictive pericarditis, cardiac tamponade, renal disease, SVC obstruction
large A waves in JVP causes (3)
pulmonary hypertension, tricuspid stenosis, cannon waves in CHB or VT
JVP no A wave cause (1)
atrial fibrillation
JVP giant V wave causes (3)
complete heart block, VT, tricuspid regurgitation
JVP steep Y descent cause (1)
constrictive pericarditis
schamroth window test (3 steps)
- pt holds nails against each other
- should be diamond space
- if missing = clubbing
clubbing of toes but not fingers indicates (1)
patent ductus arteriosus
clubbing causes (3)
infective endocarditis, congenital cyanotic heart disease, atrial myxoma
splinter haemorrhage causes (5)
gardening, infective endocarditis, vascular disease, rheumatoid arthritis, systemic lupus erythematous
palmar erythema causes (2)
high oestrogen, liver disease
peripheral cyanosis cause (1)
deoxygenated Hb rises
capillary refill should be
<2-3secs
general inspection steps (3)
breathless, hands/nails, face
in the face look for (5)
central cyanosis, anaemia, poor oral hygiene, high arched palate, malar flush
look at the pictures (H)
done
pulse rate
count for 15secs, times 4
tachycardia
> 100bpm
bradycardia
<50bpm
1st heart sound
closure of mitral and tricuspid valves
2nd heart sound
closure of aortic and pulmonary valves
breath sounds (4)
crackle, wheeze, rhonchi, pleural rub
crackles (3)
explosive, sharp, discrete bursts
wheeze (3)
continuous, high-pitched through respiration
rhonchi (3)
low-pitched, disappear after cough, no consequence
pleural rub (3)
sound of inflamed pleurae, vibrations, PE
palpation (3)
apex beat, thrills, heaves
where is the apex beat?
5th intercostal space, mid-clavicular line
osler nodes (2)
painful lesions on fingers, deposition of immune complexes
janeway lesions (2)
black spots on thenar/hypothenar eminence, septic emboli
roth’s spot (2)
retinal haemorrhage, infective endocarditis
when auscultating, listen to (3)
heart sounds, added sounds, murmurs
S3 sounds like
ken-tuc-ky
S4 sounds like
ten-es-see
gallop rhythms
S3, S4
S3 is
start of diastole after S2
S4 is
end of diastole before S1
S3 causes
failing left ventricle (dilated congestive heart failure)
S4 causes (4)
blood into hypertrophic ventricle, aortic stenosis, hypertension, hypertrophic cardiomyopathy
S4 is best heard at
cardiac apex
heart murmur is very common in
prosthetic valves
label the table of aortic stenosis vs. sclerosis (I)
done
