Cardiovascular

Question 1

FYI: Small number of presenting symptoms
of cardiovascular disease, namely chest discomfort,
breathlessness, palpitation, dizziness and syncope, peripheral edema. However…

Answer 1

A multitude of physical signs, but these are relatively
straightforward to interpret as long as you bear in
mind the underlying cardiovascular physiology and
pathophysiology.

Question 2

How do patient’s usually describe their chest symptoms?

Answer 2

As discomfort, not pain.

Question 3

Pleuritc chest pain of sudden onset

Answer 3

Pulmonary embolism. Described as sharp and stabbing (which can also describe musculoskeletal pain).

Question 4

Chest discomfort between the shoulder blades (interscapular)

Answer 4

Aortic dissection

Question 5

Onset with exertion/emotional stress and usually lasts less than 10 minutes

Answer 5

Angina

Question 6

Chest discomfort at rest, lasting more than 10 minutes.

Answer 6

Myocardial infarction

Question 7

Chest discomfort exacerbated by lying flat and breathing. Relieved by sitting upright and leaning forward

Answer 7

Pericarditis

Question 8

Pleuritc pain

Answer 8

Worse with breathing in and coughing. Differential diagnosis: collapsed lung (CXR), pneumonia, effusion, pulmonary embolism (CT angiogram), emypyema.

Question 9

Worse with movement

Answer 9

Musculoskeletal

Question 10

In pulmonary embolism, a patient will c/o of pleurtic pain and what two other things?

Answer 10

(1) SOB, hemopytosis

Question 11

In pneumonia, a patient c/o pleurtic pain will c/o what two other things?

Answer 11

(1) Productive cough

(2) Fever

Question 12

Common cardiac cause of breathlessness

Answer 12

Left ventricular dysfunction. Pulmonary venous congestion occurs which makes the lungs stiff. Note that SOB is a symptom of MI.

Question 13

Regarding palpitations, ask the patient to tap out the rhythm by clapping with their hands.
(1) An irregularly irregular rhythm can indicate (2) A regularly irregular rhythm can indicate. (3) A definite diagnosis of an irregular rhythm includes (4) Always ask about associated symptoms.

Answer 13

(1) Atrial fibrillation
(2) Bigeminy
(3) ECG

Question 14

Chest discomfort with pericarditis

Answer 14

Exacerbated by lying flat and respiration. Relieved by sitting upright and leaning forward.

Question 15

Drugs that slow the heart rate

Answer 15

Beta blockers, verapamil, diltiazem, digoxin

Question 16

Drugs that increase the heart rate

Answer 16

Atropine, dobutamin, salbutamol.

Question 17

The jugular venous pressure telsl you about the pressure in the

Answer 17

right atrium

Question 18

Causes of elevated JVP

Answer 18

Heart failure 
Fluid overload
Superior vena cava obstruction 
Pulmonary embolism 
Constrive pericarditis 
Cardiac tamponade

Question 19

Kussmaul’s sign

Answer 19

Normally, JVP falls on inspiration, if there is R ventricular impairment, opposite happens.