cardiac case study Flashcards
SOB common causes
- pulmonary
- cardiac
- hematologic
- endocrine
s3
heart failure
occurs early in diastole. In young people and athletes it is a normal phenomenon. In older individuals it indicates the presence of congestive heart failure. The third heart sound is caused by a sudden deceleration of blood flow into the left ventricle from the left atrium.
s4
usually pathologic finding
low frequency sound, that occurs immediately prior to the first heart sound. It is best heard with the stethoscope’s bell. The S4 heart sound creates a cadence which is like the word ‘Tennessee’, where the syllable ‘Ten’ is S4. It is almost always pathological
PMI displaced and mid axillary
maybe hypertrophy is present
pale conjuctiva
hallmark of anemia
musculoskeletal chest pain
is it reproducible
aortic dissection pain
pain straight through to scapula
PMI displaced beyond 5th ICS LMCL
suggestive of LVH
diastolic murmur is always
pathologic
ie. AR- doe and fatigue most common
aortic stenosis
systolic murmur
most common valvular lesion requiring OHS
risk factors- smoking, HTN, HPL, hypertrophic CM
MVP
may have regurg, can be symptomatic or asymptomatic
think chest pain, dyspnea, fatigue, or palpitaitons
most common in young females
as it worsens with age, it gets louder in systole and is accentuated in standing position of Valsalva maneuver
NT-PRO BNP Gives what
12 HOUR PICTURE OF LEFT VENTRICULAR FILLING IF CONCERNS WITH CHF IN THE ABSENCE OF CKD
labs in setting of arrhythmia
TSH,
BMP - e-lytes, fluid status
anemia is a leading DD to consider in setting of new SOB
ROS questions
Ask about Fatigue
Screen for blood in urine, stool, coughing up blood
Females: menses
Known h/o anemias
May ask about types of food eaten as a vegan is at risk for anemia
What diagnostic testing would you include with high suspicion of anemia as the source of your patients SOB?
CBC
guiaic stools
cscope
What endocrine disorders would you screen for in the ROS questions to rule out endocrine causes of SOB?
hypo- hyper- thyroidism
most common causes of chest pain in ambulatory setting
1) MSK
* non specific chest wall pain, costochondritis
2) GERD
3) Stable angina
4) Unstable angina
5) Psychogenic causes
6) Respiratory conditions: PE/PNA/Exac COPD/asthma/PNTX
7) 1.5 % of visits are due to acute coronary syndrome
Others: pericarditis, aortic dissection, panic disorder etc.
stable angina
Substernal chest discomfort + precipitated by exertion/stress + relief with rest
keys to ROS with CP
must determine if pain is exertion, relieved by rest, how often it occurs and if the quality or frequency has been increasing over time.
gerd pain
burning pain with eating or supine position
pericarditis pain
pleuritic relieved by leaning forward and aggravated laying supine
aortic dissection hallmark
PAIN RADIATING TO THE BACK WITH A 20MHG DIFFERENCE IN SBP LEFT/RIGHT
pna PE
egophony and dullness to percussion
costochondritis PE
palpate chest wall
reproducible MSK
concerns on ECG
ST elevation
New LBBB
ST depression
T wave inversions or new Qwaves
These would result in ASA in office 911 to ER
ST elevation across all leads: pericarditis
Flattening of T wave ischemia
Some literature would support a troponin if moderate risk of CAD and a normal ECG but it is best done and sent to th eER.
