Cardiovascular Symptoms

Question 1

Chest Pain

Answer 1

Cardiac-sounding chest pain may have no serious cause but always think, could this be an MI, dissecting aortic aneurysm, pericarditis, PE?

Question 2

Chest Pain Character

Answer 2

• Constricting suggests Angina, Oesophageal spasm, or anxiety
• Sharp pain may be from the pleura, pericardium or chest wall
• A dull central crushing pain or pressure suggests MI

Question 3

Radiation

Answer 3

• To shoulder, either or both arms, or neck/jaw suggests cardiac ischaemia
• The pain of aortic dissection is classical instantaneous, tearing and inter scapular but may be retrosternal
• Epigastric pain may be cardiac

Question 4

Precipitants

Answer 4

Pain associated with cold, exercise, palpitations or emotions suggests cardiac pain or anxiety.
If pain brought on by food, lying flat, hot drinks or alcohol consider oesophageal spasm/disease

Question 5

Relieving factors

Answer 5

• If pain is received within minutes by rest or GTN suspect Angina (GTN relieves Oesophageal spasm more slowly)
• Pericarditic pain improves on leaning forward

Question 6

Associations

Answer 6

• Dyspnoea
• MI may cause nausea, sweating, vomiting
• Angina caused by CAD, aortic stenosis, hypertrophic cardiomyopathy, paroxysmal supra ventricular tachycardia and can be exacerbated by anaemia
• Chest pain with tenderness suggests musckoskeletal
• Off neurotransmitters symptoms and atypical chest pain think aortic dissection

Question 7

What is pleuritic chest pain and what does it indicate?

Answer 7

Pain exacerbated on inspiration.
Implies inflammation of the pleura from pulmonary infection, inflammation or infarction.
Can also have a muskoskeletal cause
-usually one sided
-worse on inspiration
-stabbing
-can have sputum cough
-rasied temp

Question 8

Dyspnoea

Answer 8

May be from LVF or PE or any respiratory cause.
Ask about shortness of breath at rest, on exertion and on lying flat. Has their exercise tolerance changed.
Heart failure associated with orthopnoea so ask how many pillows they sleep with or if they have experienced paroxysmal nocturnal dyspnoea also peripheral oedema.
PE associated with acute onset of dyspnoea and pleuritic chest pain - ask about risk factors for DVT

Question 9

Palpitations

Answer 9

Do they mean heart beating fast or irregularly?
Ask about previous episodes and SOCRATES
May be due to ectopics, sinus tachycardia, AF,SVT,VT

Question 10

Syncope

Answer 10

May reflect cardiac or CNS events.
Vasovagal faints are common (pulse down, pupil dilated)
The history from an observer is invaluable (dyspnoea, chest pain, palpitations point to cardiac causes) (Aura,headache, dysarthria, limb weakness indicate CNS causes)
During episode - was there tongue biting, limb jerking, urinary incontinence