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Differentials > Cardiovascular Symptoms and Signs > Flashcards

Cardiovascular Symptoms and Signs Flashcards

1
Q

Chest pain - alarming and increasing over minutes to hours

A
  • angina (new or unstable) or ACS
  • STEMI
  • NSTEMI
  • Oesophagitis and oesophageal spasm
  • PE/infarction
  • pneumothorax (tension, moderate or mild)
  • dissecting thoracic aortic aneurysm
  • chest wall pain (eg Tietze’s syndrome)
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2
Q

Severe lower chest or upper abdominal pain

A
  • GORD/gastritis
  • biliary colic
  • pancreatitis
  • MI (often inferior)
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3
Q

Sudden breathlessness, onset over seconds

A
  • PE/infarction
  • pneumothorax (tension, moderate or mild)
  • anaphylaxis
  • inhalation of foreign body
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4
Q

Orthopnoea and paroxysmal nocturnal dyspnoea

A
  • pulmonary oedema
  • COPD
  • asthma
  • cardiac arrhythmia
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5
Q

Palpitations

A
  • runs of SVT ?exercise induced due to IHD ?due to electrolyte abnormalities
  • episodic heart block
  • sinus tachycardia
  • AF
  • ventricular ectopics
  • menopause
  • thyrotoxicosis
  • phaeochromacytoma (rare)
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6
Q

Acute breathlessness, wheeze +/- cough

A
  • exacerbation of asthma
  • exacerbation of COPD
  • acute viral or bacterial bronchitis
  • acute left ventricular failure due to ?cardiac event ?valvular disease ?electrolyte imbalance ?arrhythmia
  • anaphylaxis
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7
Q

Cough and pink frothy sputum

A
  • acute pulmonary oedema due to left ventricular failure

- mitral stenosis

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8
Q

Syncope

A
  • vasovagal attack - simple faint
  • postural hypotension
  • Stokes-Adams attack
  • aortic stenosis
  • hypertrophic cardiomyopathy
  • micturition syncope
  • cough syncope
  • carotid sinus syncope
  • hypoglycaemia
  • cerebrovascular accident
  • PE/infarct
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9
Q

Leg pain on walking - intermittent claudication

A
  • arterial disease in legs

- spinal claudication

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10
Q

Leg pain on standing - relieved by lying down

A
  • peripheral venous disease and varicose veins

- disc protrusion

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11
Q

Unilateral calf or leg swelling

A
  • DVT
  • ruptured Baker’s cyst
  • cellulitis
  • abnormal lymphatic drainage
  • congenital oedma (Milroy’s syndrome)
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12
Q

Bilateral ankle swelling

A
  • right ventricular failure
  • poor venous return
  • low albumin states
  • bilateral cellulitis often associated with diabetes mellitus
  • IVC obstruction due to prolonged immobility, carcinoma and oral contraceptive use
  • drugs
  • bilateral thromboses
  • impaired lymphatic drainage
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13
Q

Peripheral cyanosis

A
  • Raynaud’s phenomenon
  • arterial obstruction
  • haemorrhage
  • low cardiac output
  • septicaemia (commonly due to gram -ve organisms)
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14
Q

Central cyanosis

A
  • right to left cardiac shunt
  • right to left pulmonary shunt
  • haemoglobin abnormalities
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15
Q

Pulse rate >120bpm

A
  • fever
  • haemorrhage
  • hypoxia
  • thyrotoxicosis
  • severe anaemia
  • heart failure
  • PE/infarction
  • drugs (eg. amphetamines and beta agonists)
  • severe electrolyte disturbances
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16
Q

Bradycardia

A
  • athletic heart
  • drugs
  • sinoatrial disease
  • ventricular or suraventricular bigemini
  • MI
  • hypothyroid
  • hypothermia
  • severe electrolyte disturbances
17
Q

Pulse irregular

A
  • AF
  • atrial flutter with variable heart block
  • atrial or ventricular ectopics
  • Wenkebach heart block
18
Q

Pulse volume high

A
  • aortic incompetence
  • arteriosclerosis
  • severe anaemia
  • bradycardia of any cause with normal myocardium
  • hyperkinetic circulation
19
Q

Pulse volume low

A
  • poor cardiac contractility
  • hypovolaemia
  • relative hypovolaemia due to poor vascular tone
  • aortic stenosis
20
Q

Hypertension

A
  • temporary hypertension with no risk factors
  • essential hypertension (95% of cases)
  • hypertension of pregnancy
  • obstructive sleep apnoea
  • renal hypertension
  • endocrine hypertension
  • vascular hypertension
  • drug-induced hypertension due to NSAIDs, oestrogen pill, steroids, erythropoeitin
21
Q

Blood pressure very low

A
  • cardiogenic - low output
  • low circulating blood volume
  • loss of vascular tone
  • Addison’s disease
  • spinal cord injuries/disease
22
Q

Postural fall in blood pressure

A
  • drug-induced due to excessive dose of antihypotensive agent
  • autonomic neuropathy
  • idiopathic orthostatic hypotension
  • cardiogenic - low output
  • low circulating blood volume
  • loss of vascular tone
  • CNS diseases eg. MS, Parkinson’s
23
Q

BP/pulse difference between arms

A
  • old or acute thrombosis in atheromatous artery or aneurysm or dissection of ascending aorta
  • supravalvular aortic stenosis (congenital)
  • subcalvian steal syndrome
  • thoracic inlet syndrome
  • aortic arch syndrome, Takayasu’s syndrome
24
Q

BP/pulse difference between arms and legs

A
  • old or acute thrombosis in atheromatous artery
  • aneurysm or dissection of descending thoracic or abdominal aorta or iliac arteries, especially in diabetics
  • coarctation of aorta
25
Q

Prominent leg veins +/- unilateral leg swelling

A
  • varicose veins +/- competent communicatng valves
  • thrombophlebitis
  • DVT
26
Q

Unilateral leg and ankle swelling

A
  • DVT
  • ruptured Baker’s cyst
  • cellulitis
  • unilateral varicose veins
  • chronic venous insufficiency from old DVTs
  • venous insufficiency from obstruction by tumour or lymph node
  • immobility
  • abnormal lymphatic drainage caused by lymphoma or malignant infiltration
  • congenital oedema (Milroy’s syndrome)
  • acute lymphatic obstruction due to streptococcal lymphangitis
27
Q

Bilateral leg and ankle swelling

A
  • bilateral varicose veins or old DVTs
  • low albumin
  • congestive cardiac failure
  • cor pulmonale
  • immobility
  • abnormal lymphatic drainage caused by lymphoma or malignant infiltration
  • congenital oedema (Milroy’s syndrome)
  • acute lymphatic obstruction due to streptococcal lymphangitis
28
Q

Raised JVP

A
  • fluid volume overload
  • congestive cardiac failure
  • cor pulmonale
  • AF
  • complete heart block
  • tricuspid regurgitation
  • pericardial effusion
  • constrictive pericarditis
  • jugular vein obstruction
29
Q

Abnormal apex pulse

A
  • fat, fluid or air between the apex and palpating hand
  • dextrocardia
  • large left ventricle
  • hypertrophied left ventrile
  • hypertrophic cardiomyopathy
  • ventricular aneurysm
  • mitral stenosis
  • right ventricular hypertrophy due to pulmonary hypertension or pulmonary stenosis
30
Q

Extra heart sounds

A
  • normal young heart

- heart failure, cardiomyopathy, constrictive pericarditis

31
Q

Diastolic murmur

A
  • mitral stenosis
  • mitral stenosis with pliable valve
  • aoritc incompetence
32
Q

Mid-systolic murmur

A
  • aortic stenosis
  • hypertrophic cardiomyopthy
  • aortic sclerosis
  • pulmonary high flow
  • ASD causing high pulmonary flow (rare)
  • pulmonary stenosis
33
Q

Pansystolic murmur

A
  • mitral incompetence
  • tricuspid incompetence
  • VSD
34
Q

Murmurs not entirely in systole or diastole

A
  • patent ductus arteriosus

- pericarditis with pericardial friction rub

Differentials (6 decks)

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