Cardiovascular system 5/5 Flashcards
What features of chest pain would suggest cardiac aetiology?
Radiation to left arm Worse on exertion Sweating Radiation to back Relieved by rest Severe pain
What is a cardiac murmur?
An added sound on auscultation caused by abnormal or turbulent blood flow across a valve or septum
What does aortic stenosis result in?
Reduced opening of the valve causing turbulent blood flow and increased pressure
This causes an ejection systolic murmur
How does valve disease manifest clinically?
Ejection systolic murmur with chest pain, shortness of breath, dizziness/syncope
What triad of symptoms points to decompensated heart failure?
Exertional chest pain
Shortness of breath
Pitting oedema
What may be heard on auscultation in decompensating heart failure?
Bi-basal crepitations
What is the main method of imaging for suspected valve disease?
ECG
What symptoms suggest vascular pain?
Oedema Worse on exertion Peripheral pain Numbness (with gradual onset) Claudication Cramping pain
In vascular disease what is loss of hair a sign of?
Pooling of blood
What are differential diagnoses to consider when vascular disease is suspected?
MSK DVT PAD Chronic pain at CABG harvest site Diabetic neuropathy Spinal stenosis
What is ABPI
The ratio of ankle systolic blood pressure to brachial systolic blood pressure
What is ABPI used to detect?
Arterial insufficiency
What is a bad value for ABPI?
The lower it is the more severe the vascular disease, below 0.4 indicates they are at high risk and need to be referred
What are the 6 ps of a critically ischaemic limb?
Pain Pallor (pale) Pulselessness Parasthesia Perishingly cold Paralysis
What are clinical manifestations of PVD?
Chronic exertional pain with intermittent claudication linked to exercise tolerance
Rest pain and acute limb ischaemia
What is claudication?
Pain and/or cramping in the lower leg due to inadequate blood flow to the muscles
What imaging method is used in PVD?
DSA is the gold standard
CT angiography used in secondary care in diagnosis due to ease of access
What are differentials for someone with sudden sharp chest pain radiating to the back who collapsed?
Aortic dissection (this is top) MI Ischaemic stroke Bowel ischaemia Ischaemic limb
What happens in an aortic dissection?
There is a tear in the tunica intima so blood flows into the false lumen, the blood is taken away from the true lumen so downstream organs receive less blood
How many types of aortic dissection and there, how common are they and what is the difference?
Type a (60%) requires surgical repair Type b (40%) starts after the arch of the aorta and only affects the descending so it might be surgically managed
