Cardiac symptoms and signs Flashcards
20% of all CHD deaths are attributable to =
Smoking
Leading cause of death =
Acute coronary syndrome
CVD symptoms
Chest pain Breathlessness Palpitation Syncope Oedema Cough Fatigue
Cardiac pain tends to feel
Tight
3 characteristics of ‘typical angina’
- Substernal chest discomfort
- Provoked by exertion or emotional stress
- Relieved by rest/GTN
What would make a diagnosis of stable angina unlikely?
- Continuous, very prolonged
- Unrelated to activity
- Worse on inspiration
- Associated symptoms
Stable angina vs unstable angina
Stable = on exertion Unstable = on rest
How many ‘classes’ are there for angina
I-IV
Class IV angina =
Pain comes on at rest
Angina vs MI
Angina: exertional, emotional stress, cold, relieved by rest or GTN, 2-10 mins
MI: rest, gradually builds up and lasts for 30+ minutes, no releif with rest or GTN, associated symptoms (fear, breathless, nausea, sweating)
What is pericarditis?
Inflammation of the pericardium
Pericarditis is most commonly caused by
Viral infection
Character of pericarditis pain
Sharp, stabbing
Worse on inspiration
Worse lying flat, eased by sitting
Hrs-days
Character of aortic dissection pain
Sudden, tearing, knife-like
Excruciating
Radiates to back
In 50% of cases, aortic dissection presents as
Abdominal pain
Character of pain in PE:
Pleuritic (sharp, stabbing, burning)
Worse in expiration/inspiration
Alongside pain, what usually occurs in a PE?
Shortness of breath
Abnormal uncomfortable awareness of breathing
Dyspnoea
faster breathing than normal
Tachypnoea
Tachypnoea =
> 20 bpm
Breathlessness in pulmonary oedema =
Abrupt
Orthopnoea
Cold, clammy
Pink frothy sputum
Orthopnoea
Breathlessness when lying flat
PND =
Paroxysmal nocturnal dyspnoea
Features of PND =
Wake from sleep, have to sit up
Frightening
What conditions are associated with orthopnoea?
Left ventricular heart failure
Pulmonary oedema
Classification of heart failure
NYHA classification (I-IV)
Symptoms of chronic heart failure:
Exertional breathlessness Orthopnoea Nocturnal cough PND Oedema Lack of energy
Syncope =
Brief transient loss of consciousness and postural tone with spontaneous recovery
Letters associated with JVP waveform =
A X C V Y
A wave on JVP =
Atrial systole
X wave on JVP =
Atrial distole
C wave of JVP =
Rapid filling of RV before closure of tricuspid valve
V wave of JVP =
RA filling during ventricular systole
Y depression of JVP =
Closure of tricuspid valve
Elevated JVP wave associated with
Heart failure
Pericarditis
Renal disease
Large A wave
Pulmonary hypertension
Tricuspid stenosis
Giant V waves
Tricuspid reguritation
Tricuspid regurgitation is associated with what on JVP
Giant V wave
Steep Y descent on JVP =
Pericarditis
S1 =
Closure of mitral and tricuspid valve
S2 =
Closure of atrial and pulmonary valves
S1 - S2
Systole
S2 - S1
Diastole
S3 occurs at:
Start of systole/after S2
S3 sounds like:
Ken-tuc-ky
Cause of S3:
Oscillation of blood back and forth between ventricular walls (volume overload)
S3 can be benign in:
Atheletes
Youth
Pregnancy
S3 pathological in
Heart failure
S4 occurs at:
Before S1/end of diastole/just after atrial kick
S4 sounds like:
Tenn-es-see
Cause of S4:
Blood forced into stiff ventricles
Conditions that cause S4:
Heart failure
Hypertension
Murmers are graded from stages:
1-6
What kind of heart murmers aren’t pathological?
Innocent
Most common place for an innocent heart murmer in children:
Lower left sternal border
What stage in cardiac cycle are murmers almost always pathological?
Diastolic
Murmers can be due to:
Stenosis
Regurgitation
Normal flow murmers are produced with
Prosthetic valves
