Cardiology Presentations Flashcards
Asymptomatic presentations cardiology
- As part of routine health checks
- As part of family screenin gprocess
- Incidental finding in non-cardiac presentations
- As part of a pre-op screening for non-cardiac procedures
Symptomatic presentations of cardiology
- Sudden cardiac death
- Chest pain - stable/unstabel
- Breathlessness
- Palpitations
- Syncope
- Secodnayr to Non-cardiac diagnosis (Type 2 MI (type 2 is deth of myocardium etc but mechanim might not be primary occlusion of artyer, more increased stress)/ACS, Cor pulmonale, arrhythmias, LVF etc)
**Syncope: (Most isnt cardiac cause)
- Neurally medoated syncope - MC cause of syncope. Slightly more in female and in young subjects with FH and 1st degree relatives
- CV - in emergency room settings and older patients
- Orthostatic hypertenion - increases in prevalence with age as reduced baroreflex responsiveness, decreased cardiac compliance, attenuation of vestibulosympathetic reflex
- Explained by greater prevaence of: **
- Syncope due to basillar migraine
** Pathophysiological mecahnisms in vasovagal syncope
** PIC
ATherosclerosis
Normal artery -> fatty streak -> fibrous plaque -> atheroslerotic plaque -> plaque disruption and thrombosis -> Atherotrhombosis -> MI, Stroke, CV death, Limb ischaemia
Atherosclerotic plaque causes flow limiting stenosis where you get symptosm with exercise eg, stable angina, TIA or intermittent caludication
RFs for CHD
- Non modifiable - age, gender, faimly history, previous CHD event
- Modifiable - lifestyle, BMI, Smoking, DM. BP, Lipids, stress
- Often inter-related and additive
- Underlying atherosclerosis
CHD stats in uk
- CHD is UKs largest cause of mortality
- 1/7 men and 1in11 women die from CHD
- mOST DETAHS FROM mi
Presentations CHD
- nEW aNGINA - op SETTING
- ua/acs (nsTEMI) OR SEMI - de novo Type 1
- UA/ACS (NStemi) or STEMI - secondary Type 2
- CHD in contxt of other cardia cpresentation - valve disease, CCF, Arrhythmias
- Othe rvascular or metaboic presentations- PVD,Stroke, AAA, DIabetes, CKD
Causes Chest Pain
- Non cardiac causes - pulmonary, pleuritic, PE, traumatic, MSK, arthritis, Upper GI
- Aortic - aneurysm/dissection
- Pericardial/ Valvular
- Cardiac - stable vs unstable
- Acute cornary syndromes 9STEMInn STEMI, ACS with negative enzymes)
Aortic aeurysm
- Abnorma dilation of aorta
- Location: thoracic/abdominal (6cm abdo threshold)
- Causes: degenerative, BP, arthritis, connective tissue disease, biuspid AV, FH
- Uusally assymptomatic incidental finding on CXR/CT
- Severe sharp back -/ interscapular pain
- Complications - dissection, rupture, AV regurgitation
- Surveillance, repair, replacement
** Classification of Aortic Dissection (DeBakey and Sanford)
**IMAGE
Chets pain presentatio plan
- Intiial assessment + firts measures
- Working thorugh differentials
- Identify predisposing facto
- Impact of multiple RFs
- Adressing immediate and longer term risks
- Rehabilitation
1st steps with chest pain
- Asses spatient
- Stabilise
- Oxygen
- IV cannula
- Anagesia
- Reassure
(MONA - intiial management of MI - orphine, 02, nitrates, apsirin)
History takign for chets pain
- Site
- Duration
- Severity
- Radiation
- Relation to activit
- Associate dautonomic factors
- Aggravating/relieving factors
- Pattern - if any (Nocturnal/decubitis angina)
- Previous history of similar problems/ RF assessment
Invetsiagtions chets pain
- ECG
- CXR
- ABG
- Blood - FBC, renal, cardiac ezymes, lipids tft
- Repeat ECG/enzymes]ECHO/ett/mps/ctca/aNGIOGRAPHY/mri
