Cardiology

Question 1

Dull, crushing chest pain, >30mins

Answer 1

M.I.

Question 2

Sharp pain on inspiration

Answer 2

Pleuritic chest pain - pneumonia, P.E., pleural effusion, rib fracture
Subdiaphragmatic pathology - gallstones

Question 3

Dull pain on inspiration/expiration

Answer 3

MSK disorders - costochondritis, pulled intercostal muscles

Question 4

Constricting chest pain

Answer 4

Angina, oesophageal spasm, anxiety

Question 5

Chest pain improves on sitting forward

Answer 5

Pericarditis

Question 6

Causes of angina (4) and what can worsen angina?

Answer 6

Coronary artery disease, aortic stenosis, supra ventricular tachycardia, hypertrophic cardiomyopathy

Anaemia can worsen angina

Question 7

What is Tietze’s syndrome?

Answer 7

• Inflammation of costochondral junctions -
• similar to costochondritis but more LOCALISED
• common in people under 40 years, whereas costochondrosis >40 yrs
• Unilateral and one rib affected (costochondritis more than one rib affected)
• acute or gradual onset.
• pain that is often localised to the costal cartilage (ie anteriorly on the chest wall). It may be described as aching, sharp or pressure.
• affects the upper ribs, especially the second or third ribs.
• The pain is aggravated by physical activity, movement, deep inspiration, coughing or sneezing.
• history of recent illness with coughing, or recent strenuous exercise

Question 8

What are your differentials for chest pain & an acutely unwell patient?

Answer 8

M.I.
Aortic dissection
P.E./DVT
Tension pneumothorax
cardiac tamponade
Oesophageal rupture

Question 9

What are the 4 main cardiovascular symptoms to ask about in a CVS history?

Answer 9

Chest pain
Palpitations
Syncope
Shortness of breath

Question 10

What are prodromal symptoms of syncope?

Answer 10

Symptoms occurring before the syncope

Chest pain, palpitations, dyspneoa, OR aura, headache, limb weakness, dysarthria

Question 11

How could you determine if an episode of syncope had a cardiac or CNS cause? (2 Q’s)

Answer 11

Ask about prodromal symptoms

Ask about recovery - prolonged = seizure, rapid = arrhythmia

Question 12

Medication for bradycardia (complete/partial heart block)

Answer 12

Atropine (trip which INCREASES HR) by being a muscarinic antagonists (blocks PANS therefore speeding up the heart)

Ultimately surgical pacing

Question 13

Narrow QRS complex tachycardia treatment (non AF) treatment

Answer 13

SVT (AVRL)

Vagal manaueoves
Adenosine (3 lots) (not in asthma as bronchospasm! verapamil instead)
DC Cardioversion and call for help

Question 14

Acute narrow complex tachycardia (AF) treatment

Answer 14

Vagal manœuvres

Adenosine (not in asthma as bronchospasm - verapamil instead)
Rate control - b blockers, digoxin, Ca2+ blockers
Rhythm control - flecanide, amioderone (if structural heart defect)

DC cardioversion (if less than 48 hours, in more then 3 weeks of LMWH)

Question 15

Paroxysmal AF treatment

Answer 15

Sotalol (B blocker)

Question 16

Torsades de pointes treatment

Answer 16

Magnesium sulphate