Cardiovascular Symptoms

Question 1

Pain character - constricting - what conditions may it be? (3)

Answer 1

Angina, oesophageal spasm, anxiety

Question 2

Pain character - sharp - where may the pain originate? (3)

Answer 2

Pleura, pericardium or chest wall

Question 3

Pain radiating to the arms, shoulder or neck/jaw is suggestive of what?

Answer 3

Cardiac ischaemia

Question 4

Pain of aortic dissection is classically …

Answer 4

Instantaneous, tearing and interscapular, but may be retrosternal

Question 5

Epigastric pain may be…

Answer 5

Cardiac

Question 6

Precipitants of pain - suggesting cardiac pain / anxiety?

Answer 6

Cold, exercise, palpitations or emotion

Question 7

Precipitants of pain - suggesting oesophageal spasm/disease?

Answer 7

Pain brought on by food, lying flat, hot drinks, or alcohol

Question 8

Relieving factors - if pain is relieved within minutes by rest or GTM, suspect …

Answer 8

Angina

Question 9

Relieving factors - if pain is relieved by lying forward it is likely to be … pain

Answer 9

Pericarditic

Question 10

Relieving factors - if pain is relieved by antacids it is likely to be a …

Answer 10

GI cause

Question 11

Associated Symptoms - Dyspnoea occurs alongside what? (4)

Answer 11

Pulmonary emboli, pleurisy, cardiac pain and anxiety

Question 12

Associated Symptoms - MI may cause what other symptoms aside from chest pain? (3)

Answer 12

Nausea, vomiting or sweating

Question 13

What causes angina?

Answer 13

Coronary artery disease - and also aortic stenosis, hypertrophic cardiomyopathy and paroxysmal supraventricular tachycardia - and can be exacerbated by anaemia

Question 14

What can exacerbate angina?

Answer 14

Anaemia

Question 15

Chest pain with tenderness suggests what syndrome?

Answer 15

Self-limiting Tietze’s syndrome

Question 16

Odd neurological symptoms and atypical chest pain - think …

Answer 16

Aortic dissection

Question 17

What is pleuritic pain?

Answer 17

Pain exacerbated by inspiration - implying inflammation of the pleura from pulmonary infection, inflammation or infarction.

Question 18

What does pleuritic pain implie?

Answer 18

It implies inflammation of the pleura from pulmonary infection, inflammation or infarction

Question 19

Differentials for pleuritic type pain?

Answer 19

MSK, fractured rib, subdiaphragmatic pathology e.g. gallstones

Question 20

Chest pain and acutely unwell patient - what do you do?

Answer 20

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

Question 21

Dyspnoea may be from …

Answer 21

LVF, PE, any resp cause, anaemia, painm or anxiety

Question 22

To establish severity of dyspnoea, what do we ask?

Answer 22

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

Question 23

PE is associated with …

Answer 23

PE is associated with acute onset of dyspnoea and pleuritic chest pain - ensure to ask about risk factors for DVT

Question 24

Specific symptoms for heart failure are … (3)

Answer 24

Orthopnoea (ask about pillow usage at night) Paroxysmal nocturnal dyspnoea (waking up at night gasping for breath)
Peripheral oedema

Question 25

Palpitations - causes

Answer 25

Ectopics, Sinus tachycardia, AF, SVT, VT, thyrotoxicosis, anxiety and rarely phaeochromocytoma

Question 26

Syncope may reflect …

Answer 26

Cardiac or CNS events

Question 27

Vasovagal ‘faints’ are common, what are the signs? (2)

Answer 27

Decreased pulse and dilated pupils

Question 28

Prodromal symptoms (Cardiac Syncope)

Answer 28

Chest pain, palpitations, dyspnoea = cardiac

Question 29

Prodromal symptoms (CNS Syncope)

Answer 29

Aura, headache, dysarthria and limb weakness = CNS

Question 30

During syncope - things to ask about

Answer 30

Was there a pulse? limb jerking, tongue biting or urinary incontinence>

Question 31

What is Tietze syndrome?

Answer 31

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.

Question 32

Costochondritis vs Tietze’s syndrome.

Answer 32

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.

Question 33

JVP: raised JVP differential - PQRST(EKG waves):

Answer 33

Pericardial effusion
Quantity of fluid raised (fluid over load)
Right heart failure
Superior vena caval obstruction
Tricuspid stenosis/tricuspid regurgitation/tamponade (cardiac)

Question 34

MI: immediate treatment - DOGASH

Answer 34

Diamorphine
Oxygen
GTN spray
Aspirin 300 mg
Streptokinase
Heparin

Question 35

Causes of life-threatening chest pain - PET-MAC

Answer 35

P = Pulmonary embolism
E = Esophageal rupture
T = Tension pneumothorax
M = Myocardial infarction
A = Aortic dissection
C = Cardiac tamponade

Question 36

Atrial fibrillation: causes of new onset: THE ATRIAL FIBS:

Answer 36

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)

Question 37

Acute LVF management - LMNOP

Answer 37

Lasix (furosemide)
Morphine (diamorphine)
Nitrates
Oxygen (sit patient up)
Pulmonary ventilation (if doing badly)

Question 38

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

Answer 38

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.

Question 39

… 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).

Answer 39

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).