Cardiovascular Symptoms Flashcards
Pain character - constricting - what conditions may it be? (3)
Angina, oesophageal spasm, anxiety
Pain character - sharp - where may the pain originate? (3)
Pleura, pericardium or chest wall
Pain radiating to the arms, shoulder or neck/jaw is suggestive of what?
Cardiac ischaemia
Pain of aortic dissection is classically …
Instantaneous, tearing and interscapular, but may be retrosternal
Epigastric pain may be…
Cardiac
Precipitants of pain - suggesting cardiac pain / anxiety?
Cold, exercise, palpitations or emotion
Precipitants of pain - suggesting oesophageal spasm/disease?
Pain brought on by food, lying flat, hot drinks, or alcohol
Relieving factors - if pain is relieved within minutes by rest or GTM, suspect …
Angina
Relieving factors - if pain is relieved by lying forward it is likely to be … pain
Pericarditic
Relieving factors - if pain is relieved by antacids it is likely to be a …
GI cause
Associated Symptoms - Dyspnoea occurs alongside what? (4)
Pulmonary emboli, pleurisy, cardiac pain and anxiety
Associated Symptoms - MI may cause what other symptoms aside from chest pain? (3)
Nausea, vomiting or sweating
What causes angina?
Coronary artery disease - and also aortic stenosis, hypertrophic cardiomyopathy and paroxysmal supraventricular tachycardia - and can be exacerbated by anaemia
What can exacerbate angina?
Anaemia
Chest pain with tenderness suggests what syndrome?
Self-limiting Tietze’s syndrome
Odd neurological symptoms and atypical chest pain - think …
Aortic dissection
What is pleuritic pain?
Pain exacerbated by inspiration - implying inflammation of the pleura from pulmonary infection, inflammation or infarction.
What does pleuritic pain implie?
It implies inflammation of the pleura from pulmonary infection, inflammation or infarction
Differentials for pleuritic type pain?
MSK, fractured rib, subdiaphragmatic pathology e.g. gallstones
Chest pain and acutely unwell patient - what do you do?
Admit Check pulse BP in both arms (unequal in aortic dissection) JVP HS Examine legs for DVT Give O2 IV line Relieve pain (E.g. 5mg IV morphine) Cardiac monitor 12-lead ECG ABG
Dyspnoea may be from …
LVF, PE, any resp cause, anaemia, painm or anxiety
To establish severity of dyspnoea, what do we ask?
About SOB at rest, on exertion and on lying flat
Has their exercise tolerance changed?
Associations - e.g. specific symptoms for heart failure are orthopnoea (ask about pillow usage at night) paroxysmal nocturnal dyspnoa (waking up at night gasping for breath), and peripheral oedema
PE is associated with acute onset of dyspnoea and pleuritic chest pain - ensure to ask about risk factors for DVT
PE is associated with …
PE is associated with acute onset of dyspnoea and pleuritic chest pain - ensure to ask about risk factors for DVT
Specific symptoms for heart failure are … (3)
Orthopnoea (ask about pillow usage at night) Paroxysmal nocturnal dyspnoea (waking up at night gasping for breath)
Peripheral oedema
Palpitations - causes
Ectopics, Sinus tachycardia, AF, SVT, VT, thyrotoxicosis, anxiety and rarely phaeochromocytoma
Syncope may reflect …
Cardiac or CNS events
Vasovagal ‘faints’ are common, what are the signs? (2)
Decreased pulse and dilated pupils
Prodromal symptoms (Cardiac Syncope)
Chest pain, palpitations, dyspnoea = cardiac
Prodromal symptoms (CNS Syncope)
Aura, headache, dysarthria and limb weakness = CNS
During syncope - things to ask about
Was there a pulse? limb jerking, tongue biting or urinary incontinence>
What is Tietze syndrome?
Tietze syndrome is a rare, inflammatory disorder characterized by chest pain and swelling of the cartilage of one or more of the upper ribs (costochondral junction), specifically where the ribs attach to the breastbone (sternum). Onset of pain may be gradual or sudden and may spread to affect the arms and/or shoulders.
Costochondritis vs Tietze’s syndrome.
Costochondritis may be confused with a separate condition called Tietze’s syndrome.
Both conditions involve inflammation of the costochondral joint and can cause very similar symptoms.
But Tietze’s syndrome is much less common and often causes chest swelling, which may last after any pain and tenderness has gone.
Costochondritis also tends to affect adults aged 40 or over, whereas Tietze’s syndrome usually affects young adults under 40.
JVP: raised JVP differential - PQRST(EKG waves):
Pericardial effusion
Quantity of fluid raised (fluid over load)
Right heart failure
Superior vena caval obstruction
Tricuspid stenosis/tricuspid regurgitation/tamponade (cardiac)
MI: immediate treatment - DOGASH
Diamorphine Oxygen GTN spray Aspirin 300 mg Streptokinase Heparin
Causes of life-threatening chest pain - PET-MAC
P = Pulmonary embolism E = Esophageal rupture T = Tension pneumothorax M = Myocardial infarction A = Aortic dissection C = Cardiac tamponade
Atrial fibrillation: causes of new onset: THE ATRIAL FIBS:
Thyroid Hypothermia Embolism (P.E.) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis) Stimulants (cocaine, theo, amphet, caffeine)
Acute LVF management - LMNOP
Lasix (furosemide) Morphine (diamorphine) Nitrates Oxygen (sit patient up) Pulmonary ventilation (if doing badly)
Which of the following conditions does not classically cause cor pulmonale?
A Chronic obstructive pulmonary disease B Idiopathic pulmonary fibrosis C Mitral regurgitation D Pulmonary embolism E Idiopathic pulmonary arterial hypertension
Cor pulmonale refers to alteration of the right ventricular structure and/or dysfunction as a result of pulmonary hypertension.
The causes of cor pulmonale are quite extensive and may be associated with lung pathology (e.g. COPD or interstitial lung disease), vasculature problems (e.g. pulmonary embolism), idiopathic pulmonary hypertension, upper airway problems (e.g. obstructive sleep apnoea) or other rarer causes.
Right-sided heart dysfunction secondary to congenital heart defects, valvular disease or left-sided heart problems (e.g. systolic or diastolic left ventricular dysfunction) is not considered cor pulmonale.
… is one of major different causes of muscloskelatal chest pain, some of which are very rare. It causes pain at the costochondral or costosternal junctions with tenderness to palpation but no evidence of acute inflammation (e.g. heat, erythema, swelling).
Costochondritis is one of major different causes of muscloskelatal chest pain, some of which are very rare. It causes pain at the costochondral or costosternal junctions with tenderness to palpation but no evidence of acute inflammation (e.g. heat, erythema, swelling).
