Cardiac assessment and differentials

Question 1

What are some cardiovascular causes for chest discomfort?

Answer 1

Angina, MI, Pericarditus and Aortic distension.

Question 2

What are some other causes for chest discomfort?

Answer 2

MSK pain, Pnemotherax and Oseopharyngeal spasm

Question 3

What are some cardiovascular causes for breathlessness?

Answer 3

Heart Failure, Valvular disease, PE, Angina and pulmonary hypertension.

Question 4

What are some other causes for breathlessness?

Answer 4

Anxiety, COPD, Respiratory disease and obesity.

Question 5

What are some cardiovascular causes for Syncope/ presyncope?

Answer 5

Posteral hypotension, Arrhythmias, aortic stenosis, hypertronic cardiomyopathy (heart muscle becomes thickened).

Question 6

What are some other causes for Syncope/ presyncope?

Answer 6

Simple faints, epilepsy, anxiety

Question 8

What does ischemia cause on an ECG?

Answer 8

ST segment depression depression and t wave inversion. Causes repolarisation to occur along an abnormal pathway

Question 9

What is an infarction?

Answer 9

Where tissue has died

Question 10

Define a STEMI

Answer 10

Portion of the cardiac muscle that is deprived of coronary artery blood flow long enough that sections of the muscle die.

Question 11

What are the clinical features of a STEMI

Answer 11

• Central Chest pain described as heavy, squeezing, crushing or tight
• levines sign (unconsciously clenches a fist when describing pain)
• pain radiating to arm, neck or jaw
• palpitations
• feeling of impending doom
• hypotension
• confusion.
• pale, cold or clammy
• ST elevation

Question 12

What is the management of a STEMI

Answer 12

Aspirin 300mg
GTN 400mcg - check bp before giving
Two pain scores recorded before and after treatment
Analgesia (entonox, paracetamol and morphine)
SATS recorded

Question 13

What is angina pectoris?

Answer 13

Supply of oxygen to the myocardium is insufflent to meet the demands.

Question 14

What is the presentation of unstable angina?

Answer 14

Chest pain while at rest
SOB, sweating, nausea, vomiting and palpitations
ECG showing st depression, and or t wave inversions or normal ecg

Question 15

What are the signs and symptoms of acute dissecting aneurysm of the aorta?

Answer 15

Chest pain
Pain comes on suddenly - ripping, tearing or sharp
ECG changes can mimic an MI

Question 16

What are the signs and symptoms of expanding and ruptured AAA?

Answer 16

Sudden onset of abdominal or back pain.
Pain is constant and cannot be relieved by changing position.
Keep as flat as possible

Question 17

What are the signs and symptoms of cocaine toxicity?

Answer 17

Hypertension
Irregular heart beat
Nausea
Agitation
Tremors
Anxiety
Confusion

Question 18

What is the management for cocaine toxicity?

Answer 18

Diazepam

Question 19

What does diazepam do in cocaine toxicity?

Answer 19

CNS depressant, sedative, anticonvulsant

Question 20

What ECG changes could suggest pericarditus?

Answer 20

Global saddle shape ST elevation

Question 21

What ECG changes indicate a bifasicucular block?

Answer 21

Right bundle branch block with Left axis deviation (left anterior fasicular block)
OR
RBBB with Right axis deviation (Left posterior fasicular block)

Question 22

Why is it important to take notice of the patients medication history?

Answer 22

Can provide insight into their medical history.

Question 23

What locations allow me to listen for heart murmours?

Answer 23

Aortic - 2nd intercostal space, right side sternal boarder
Pulmonary - 2nd intercostal space, left side sternal boarder
Tricuspid - 4th intercostal space, left lower boarder
Mitral - 5th intercostal space mid clavicular

Question 24

What can Mallor flush indicate?

Answer 24

Mitral stenosis or CO2 retention

Question 25

What is mitral stenosis?

Answer 25

Condition where the mitral valve, which separates the left atrium and left ventricle of the heart, narrows, making it difficult for blood to flow from the left atrium into the left ventricle.