Cardiac Symptoms and Signs

Question 1

State four cardinal symptoms of cardiovascular disease

Answer 1

• Chest Pain
• Breathlessness
• Palpitations
• Syncope

Question 2

What are the three characteristics of typical / definite angina?

Answer 2

• Substernal chest discomfort
• Provoked by exertion
• Relieved by rest or GTN

Question 3

What does SOCRATES stand for?

Answer 3

Site
Onset
Character
Radiation
Alleviating factors
Time
Exacerbating factors
Severity

Question 4

Where might angina radiate to?

Answer 4

Left / right arm, jaw

Question 5

What is Pericarditis?

Answer 5

Inflammation of pericardium

Question 6

What does GTN stand for? What is its mechanism of action

Answer 6

Glyceryl tri-nitrate.

A prodrug, which is reduced to NO, and promotes vasodilation. Used to treat angina

Question 7

What is an adverse effect of vasodilation caused by GTN?

Answer 7

Patient becomes hypotensive

Question 8

What is the most common cause of Pericarditis?

Answer 8

Viral infection

Question 9

On an ECG, what would you expect to see which may suggest Pericarditis?

Answer 9

Concave ST elevation and PR depression

Question 10

Outline the characteristics of pain in an Aortic dissection

Answer 10

Sudden, tearing pain which radiates to the back. Abdominal pain as well.

Question 11

Outline the characteristics of pain in a Pulmonary Embolus

Answer 11

Plueretic pain (worse on inspiration), associated with Shortness of Breath

Question 12

What test can be performed to confirm a diagnosis of a Pulmonary Embolism or Aortic Dissection?

Answer 12

D-Dimer test

Question 13

What is the normal respiratory rate per minute?

Answer 13

16 - 20 breaths per minute

Question 14

What is the term for faster breathing than normal?

Answer 14

Tachypnoea

Question 15

What is Orthopnoea?

Answer 15

Shortness of breath when lying flat

Question 16

What is Paroxysmal Noctural Dyspnoea?

Answer 16

Waking up from sleep at night

Question 17

What does pink frothy sputum suggest?

Answer 17

Pulmonary Oedema

Question 18

What is the underlying mechanism of Syncope?

Answer 18

Transient global cerebral hypoperfusion

Question 19

What is Syncope defined as?

Answer 19

Transient loss of consciousness and postural tone with rapid recovery

Question 20

Central cyanosis is defined as having Oxygen saturation less than 80%, or how many g of deoxyhaemoglobin per decilitre?

Answer 20

5g or more

Question 21

In clubbing, what angle is the fingernail bed at?

Answer 21

Greater than 180 degrees

Question 22

What is the significance of the first heart sound?

Answer 22

Closure of the AV valves: Mitral and Tricuspid

Question 23

What is the significance of the second heart sound?

Answer 23

Closure of the Aortic and Pulmonary valves

Question 24

A normal JVP is less than what height?

Answer 24

Less than 3cm

Question 25

What is a “Thrill”?

Answer 25

A palpable murmur

Question 26

When does the 3rd heart sound occur?

Answer 26

Beginning of diastole, after S2

Question 27

When does the 4th heart sound occur?

Answer 27

End of diastole, before S1

Question 28

In an Aortic valve prosthesis - what kind of murmur can you hear?

Answer 28

Systolic ejection murmur

Question 29

In a Mitral valve prosthesis - what kind of murmur can you hear?

Answer 29

Diastolic flow murmur

Question 30

Where are Osler’s nodes found?

Answer 30

Usually fingertips, toe-tips, thenar and hypothenar eminences

Question 31

Where are Janeway lesions found?

Answer 31

Soles, palms, thenar and hypothenar eminences, plantar aspect of foot

Question 32

Which are painful: Osler’s nodes or Janeway lesions?

Answer 32

Osler’s nodes are painful

Janeway lesions are not