Cardiovascular system 5/5

Question 1

What features of chest pain would suggest cardiac aetiology?

Answer 1

Radiation to left arm
Worse on exertion
Sweating
Radiation to back
Relieved by rest 
Severe pain

Question 2

What is a cardiac murmur?

Answer 2

An added sound on auscultation caused by abnormal or turbulent blood flow across a valve or septum

Question 3

What does aortic stenosis result in?

Answer 3

Reduced opening of the valve causing turbulent blood flow and increased pressure
This causes an ejection systolic murmur

Question 4

How does valve disease manifest clinically?

Answer 4

Ejection systolic murmur with chest pain, shortness of breath, dizziness/syncope

Question 5

What triad of symptoms points to decompensated heart failure?

Answer 5

Exertional chest pain
Shortness of breath
Pitting oedema

Question 6

What may be heard on auscultation in decompensating heart failure?

Answer 6

Bi-basal crepitations

Question 7

What is the main method of imaging for suspected valve disease?

Answer 7

ECG

Question 8

What symptoms suggest vascular pain?

Answer 8

Oedema
Worse on exertion
Peripheral pain
Numbness (with gradual onset)
Claudication
Cramping pain

Question 9

In vascular disease what is loss of hair a sign of?

Answer 9

Pooling of blood

Question 10

What are differential diagnoses to consider when vascular disease is suspected?

Answer 10

MSK
DVT
PAD
Chronic pain at CABG harvest site
Diabetic neuropathy
Spinal stenosis

Question 11

What is ABPI

Answer 11

The ratio of ankle systolic blood pressure to brachial systolic blood pressure

Question 12

What is ABPI used to detect?

Answer 12

Arterial insufficiency

Question 13

What is a bad value for ABPI?

Answer 13

The lower it is the more severe the vascular disease, below 0.4 indicates they are at high risk and need to be referred

Question 14

What are the 6 ps of a critically ischaemic limb?

Answer 14

Pain
Pallor (pale)
Pulselessness
Parasthesia
Perishingly cold
Paralysis

Question 15

What are clinical manifestations of PVD?

Answer 15

Chronic exertional pain with intermittent claudication linked to exercise tolerance
Rest pain and acute limb ischaemia

Question 16

What is claudication?

Answer 16

Pain and/or cramping in the lower leg due to inadequate blood flow to the muscles

Question 17

What imaging method is used in PVD?

Answer 17

DSA is the gold standard

CT angiography used in secondary care in diagnosis due to ease of access

Question 18

What are differentials for someone with sudden sharp chest pain radiating to the back who collapsed?

Answer 18

Aortic dissection (this is top)
MI
Ischaemic stroke 
Bowel ischaemia
Ischaemic limb

Question 19

What happens in an aortic dissection?

Answer 19

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

Question 20

How many types of aortic dissection and there, how common are they and what is the difference?

Answer 20

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