Cardiac History and Physical Exam

Question 1

What are the 5 categories of cardiac disease?

Answer 1

1. CAD (Coronary Artery Disease)
2. HTN (Hypertension)
3. Rheumatic Heart Disease
4. Bacterial Endocarditis
5. Congenital Heart Disease

*having this card memorized is likely low yield, just for greater perspective*

Question 2

Name at least 5 symptoms that could indicate an underlying cardiac etiology.

Answer 2

1. SOB (w/ or w/out exertion)
2. Arrythmia
3. Faintness/Dizzyness
4. Edema in extremities
5. Leg pain with activity
6. Chest pain/pressure
7. Syncope
8. Cyanosis

Question 3

Name at least 3 different causes of angina (chest pain) with a cardiac etiology.

Answer 3

Cardiac Etiology

1. Coronary artery disease
2. Aortic valvular disease
3. Pulmonary hypertension
4. Mitral valve prolapse
5. Pericarditis
6. Idiopathic hypertrophic subaortic stenosis

Question 4

Name a vascular etiology of angina

Answer 4

1. Dissection of the aorta

Question 5

Name at least 2 Pulmonary etiologies for angina

Answer 5

1. PE (pulm embolism)
2. PNA (Pneumonia)
3. Pneumo (Pneumothorax)
4. Pleuritis

Question 6

Name at least one cause of angina with a muskuloskeletal etiology

Answer 6

1. Costochodritis
2. Arthritis
3. Muscular spasm
4. Bone tumor

Question 7

Name a cause of angina neural in etiology

Answer 7

1. Herpes zoster

Question 8

Name at least 1 cause of angina G.I. in etiology

Answer 8

1. Ulcer or bowel disease
2. Hiatal hernia
3. Pancreatitis
4. Cholecystitis

Question 9

Name a cause of angina emotional or psychological in etiology

Answer 9

1. Anxiety/Depression

Question 10

What causes Angina Pecotoris (myocardial ischemia)?

Answer 10

Angina Pectoris

• Supply-demand mismatch in the coronary arteries leads to hypoxia in the myocardium that results in pain

Question 11

What is a positive Levine’s sign indicative of?

Answer 11

Angina Pectoris (myocardial ischemia)

Question 12

Describe the following as it relates to myocardial ischemia (Angina Pectoris)

1. Location
2. Radiation
3. Type of Pain
4. Intensity
5. Duration
6. Precipitated by
7. Relieved by

Answer 12

1. Retrosternal, diffuse
2. Left arm, jaw, back
3. “Achy”, “Dull”, “ Squeezing”
4. Mild to severe
5. Minutes
6. Effort, emotion, eating, cold
7. Rest, nitroglycerin

Question 13

What is Dyspnea?

Answer 13

Fancy name for Shortness of Breath

Question 14

Name one cause of dyspnea with a cardiac etiology

Answer 14

1. Left ventricular failure
2. Mitral stenosis

Question 15

Name three causes of Dyspnea with a pulmonary etiology

Answer 15

1. Obstructive lung disease
2. Asthma
3. Restrictive lung disease
4. Pulmonary embolism (PE)
5. Pulmonary HTN

Question 16

Name a cause of dyspnea with an psychological etiology

Answer 16

Anxiety

Question 17

Name an environmental cause of dyspnea

Answer 17

High altitutde exposure

Question 18

Name a hematologic cause of dyspnea

Answer 18

Anemia

Question 19

Cardiac Dyspnea

1. Define Orthopnea
2. Define Paroxysmal nocturnal dyspnea (PND)
3. Define Dyspnea on exertion (DOE)

Answer 19

1. Orthopnea – shortness of breath when lying flat, relieved by sleeping on multiple pillows
2. Paroxysmal nocturnal dyspnea (PND) – shortness of breath that wakes one out of sleep
3. Dyspnea on exertion (DOE) – shortness of breath with walking

Question 20

SYNCOPE

1. Define
2. What is the key to diagnosing the type of syncope?

Answer 20

1. Transient loss in conciousness due to cerebral hypoperfusion
2. The pt’s history

Question 21

What is the clinical definition of Orthostatic hypotension?

Answer 21

After patient has been lying for 5 minutes, check blood pressure and pulse. Then have the patient stand and repeat measurements.

Orthostatic hypotension = 20 mm Hg drop in BP upon standing.

Question 22

What are the 5 pulses a physician should palpate when doing a c_omprehensive cardiac physical exam_

Answer 22

1. Radial
2. Brachial
3. Carotid
4. Dorsalis Pedis
5. Posterior Tibial