Cardiovascular Signs and Symptoms Flashcards
What would your differential be for chest pain which is increasing in severity over minutes or hours?
- Angina or ACS
- Oesophagitis/Oesophageal spasm
- PE
- Pneumothorax
- Aortic dissection
- Chest wall pain
What would your differential diagnosis for acute chest pain be (think of everything you would want to consider)?
- ACS
- Aortic Dissection
- Pericarditis/Tamponade
- Myocarditis
- Arrhythmias
- PE
- Pneumonia
- Pneumothorax
- Pleurisy
- Musculoskeletal
- Chostochondritis
- GORD
- Anxiety
- Oesophageal spasm
What are more chronic causes of chest pain?
- Stable angina
- PHT
- Aortic Stenosis
- Lung Cancer
- Peptic Ulceration
- Fibromyalgia
What would your differential diagnosis for lower chest or upper abdominal pain be?
- GORD
- Biliary colic
- Pancreatitis
- Peptic ulceration
- Acute cholecystitis
- MI
What would be the cause of sudden breathlessness with an onset over seconds?
- PE
- Pneumothorax
- Anaphylaxis
- Foreign body inhalation
- Cardiac arrhythmia
What would your differential diagnosis be for acute breathlessness onset over minutes to hours?
- Asthma exacerbation
- COPD exacerbation
- Acute LVF
- ACS
- PE
- Acute bacterial/viral infection
- All causes of sudden acute breathlessness - Pneumothorax, Anaphylaxis, Arrhythmia, foreign body, PE
What are causes of orthopnoea or PND?
- Pulmonary oedema
- COPD
- Asthma
- Cardiac arrhythmia
- GORD - airway irritation on lying down
- Respiratory muscle weakness
What are causes of palpitations?
- SVT
- Episodic heart block
- Sinus Tachycardia
- AF
- Ventricular ectopics
- Menopause
- Thyrotoxicosis
- Phaeochromocytoma
What would your differential for cough with pink frothy sputum be?
- Acute pulmonary oedema due to LVF
- Mitral stenosis
What would your differential for syncope be?
- Vasovagal attack
- Postural hypotension
- Cardiac Arrhythmias
- Aortic Stenosis
- Hypertrophic cardiomyopathy
- Micturition syncope
- Cough syncope
- CArotid sinus syncope
- Hypoglycaemia
- Epilepsy
- TIA/Stroke
- Massive PE
What would your differential for leg pain on walking be?
- Arterial disease of the legs
- Spinal claudication
What would your differential for leg pain on standing which is relieved by lying down?
- Peripheral venous disease
- Varicose veins
- Disc protrusion
What would your differential diagnosis for unilateral leg swelling be?
- DVT
- Ruptured baker’s cyst
- Cellulitis
- Abnormal lymphatic drainage
What can cause bilateral ankle swelling?
- RHF - due to PHT, CCF, Cor pulmonale
- Abdominal mass - preventing venous return
- Hypoalbuminaemia
- Bilateral cellulitis - in those with DM
- Drugs - CCBs or alpha blockers
- Bilateral thrombosis
- Impaired lymphatic drainage - lymphangitis, abnormal drainage
- Immobility
- Congenital oedema
What are causes of peripheral cyanosis?
- Raynaud’s
- Arterial obstruction - atheroma or small vessel disease
- Haemorrhage
- Low cardiac output - HF
- Septicaemia - gram -ve organisms commonly
What are causes of central cyanosis?
- R->L cardiac shunt - cyanotic heart disease
- R->L pulmonary shunt due to atelactesis or consolidation
- Haemoglobin abnormalities
- Asthma exacerbation
- Severe pulmonary fibrosis
- Neuromuscular disease
- PHT
- PE
What are pathological causes of tachycardia?
- Fever
- Haemorrhage
- Hypoxia
- Thyrotoxicosis
- Severe anaemia
- HF
- PE
- Drugs
- Cardiac tachyarrhythmias, SVT, AF, VT
What are pathological causes of bradycardia?
- Drugs
- Sinoatrial disease
- MI
- Hypothyroid
- Hypothermia
- Severe electrolyte disturbance
What are causes of an irrgeular pulse?
- AF
- Atrial flutter
- Atrial/ventricular ectopics
- Wenkebach
- VF
What are causes of a high pulse volume?
Aortic incompetence
What are causes of a low volume pulse?
- IHD
- Cardiomyopathy
- Cardiac Tamponade
- Constrictive pericarditis
- Hypovolaemia
- Vasodilation - typically septic
- Aortic Stenosis
What are causes of hypertension?
- Temporary
- Essential - 95% cases
- Pre-eclampsia/eclampsia
- Obstructive sleep apnoea
- Renovascular disease
- Primary renal disease
- Co-arctation
- Conn’s syndrome/primary hyperaldosteronism
- Cushing’s
- Acromegaly
- Phaeochromocytoma
- Drug-induced - NSAIDs, Oestrogen, Steroids
What are causes of a postural fall in BP?
- Drug induced
- Autonomic neuropathy
- Idiopathic
- Low ouput heart conditions
- Low BV - haemorrhage, dehydration
- Septicaemia
- Adrenal failure
- MS
- Parkinson’s disease
What can cause a different BP/pulse between arms?
- Thrombosis/Dissection
- Supravalvular aortic stenosis
- Subclavian steal syndrome
- Thoracic inlet syndrome
What can cause prominent leg veins?
- Varicose veins
- Thrombophlebitis
- DVT
What are causes of a raised JVP?
PQRST plus arrythmias
- Pericardial effusion/contrictive Pericarditis
- Quantity - volume overload
- Right heart failure - CCF, cor pulmonale
- Superior vena cava obstruction (SVC syndrome)
- Tricuspid regurgitation (V waves)/Tricuspid stenosis
- Complete heart block
- AF
What are causes of extra heart sounds?
- Normal young heart
- Heart failure
- Cardiomyopathy
- Constrictive pericarditis
- Severe HF
What are the causes of a mid systolic/ejection systolic murmur (anywhere on the chest)?
- Aortic stenosis
- Hypertrophic cardiomyopathy
- Aortic Sclerosis
- ASD
- Pulmonary stenosis
What are causes of a pansystolic murmur?
- Mitral incompetence
- Tricuspid incompetence
- VSD
Where would you hear the murmur of mitral stenosis?
