CDV History Flashcards
Angina lasts for
2-20 minute
Pain of angina is described as
Crushing tightening squeezing pressure like sensation
Angina is of what origin
visceral origin, poorly localised, may radiate to neck jaw arm or shoulder
angina is bought about by
exertion, emotional stress, heavy meals, cold air relieved by sublingual nitroglycerin
Myocardial infarction location and radiation and quality of pain is the same as angina T or F
T
Myocardial infarction comes at ____ and lasts for ____
comes at rest, lasts for more than half an hour
Associated symptoms of Myocardial infarction
dyspnoea, sweating, anxiety, nausea, feeling of impending death
Aortic Dissection
Speed of onset? Character? Location?
Abrupt onset, very severe, ripping tearing character, central to chest radiates to back, persists for hours, may be mistaken for MI
Ischemic causes of chest pain x2
Angina pectoris
Myocardial Infarction
Non ischemic cardiovascular causes of chest pain
Aortic dissection
Pericardial pain
Pericardial pain
Character? Bought on by? Aggravated/relieved? caused?
Stabbing or burning
Not bought on by exertion
Aggravated by coughing, deep breathing and lying down
Relieved by leaning forward
Caused by mvmt of inflamed pericardial surfaces on one another
Orthopnoea definition
Sensation of breathlessness when lying down, manifestation of heart failure. How many pillows do you sleep on? Has this changed?
Paroxysmal nocturnal dyspnoea
Symptom of? Caused by? Relieved by?
LH failure
increased by pulmonary venous pressure from mobilization of interstitial fluid from infra-thoracic locations when lying flat, awakened suddenly with sensation of choking, air hunger, imminent death.
Relieved by sitting upright, may persist for >30min. Precedes orthopnoea.
Palpitations can be provoked by:
increased intake of caffeine, chocolate, nicotine, sympathomimetic drugs
Palpitations ask about:
Precipitants, rate, duration, degree of regularity (tap out), circumstances associated with onset and termination.,
Intermittent Claudication:
Pain in lower limb assoc with walking, relieved by rest. Pain relieved (2-5min), reproduced at distance walked before symptoms begin.
Causes of syncope - three over-riding themes.
What else do you ask about for syncope?
Cardiac - arrhythmias, valvular stenosis
Non cardiogenic - vasovagal, reduced blood volume in acute bleeding
Other - seizures, drugs, psychogenic
Precipating factors, aura (odd sensations immediately precede), AS, circumstances, position.
Ankle Oedema seen:
In patients with RHF
side effect of Calcium channel blockers
Seen over the sacrum in bed-ridden patients.
Detected during day, diminishes during the night.
Fatigue is a side effect of what two cardio drugs
Beta blockers, diuretics.
Also a symptom of congestive heart failure.
History of rheumatic fever could be a risk for?
valvular heart disease
History of valvular heart disease + dental work/ infection could be a risk factor for?
Infective endocarditis
Trisomy 21 Down’s syndrome is associated with what congenital condition?
Ventricular septal defect
Marfan’s syndrome is associated with?
Aortic dissection
Aortic regurgitation
Turner’s syndrome is associated with:
Coarctation of aorta
Aortic stenosis
Three signs of infective endocarditis
Osler’s nodes, Janeway lesions, Splinter haemorrhages
Distal, painful palm
Radio-radial delay indicates
subclavian artery stenosis, dissection of thoracic aorta
radio femoral delay
coarctation of aorta
Difference in xanthomata and xantholesmata
Both hyperlipidaemia
Xanthomata - tendons on dorsum of hand.
Xantholesmata - near eyes, eyelids
Mitral facies is indicative of
Mitral stenosis, pulmonary hypertension
At the carotid pulse what two things are you feeling for?
VOLUME (small = H Failure, large = aortic regurgitation)
CHARACTER (waveform of pulse, normal, slow rising in AS, collapsing or water hamer in aortic regurgitation, bounding in CO2 retention)
Thrills aka- ______ ______
Palpable murmurs
JVP is an indication of :
Right ventricular filling pressure - right internal jugular vein is preferred. head turned slightly to left, 45 degree.
Vertical height above sternal angle should be < 4cm
What four things do you check at the precordium
Inspection
Palpation
Percussion
Auscultation
Inspect for:
Thoracic cage abnormalities Scars Rashes Pacemaker Boxes Apex beats
Heaves are:
Palpable lifting sensation vs thrills - palpable vibrations from murmurs
Bell of stethoscope:
Low pitched sounds - diaphragm for high pitched
Order of auscultation
Mitral - 5th left IC space mid clav - start with bell then diaphragm
Tricuspid - 5th left IC space parasternal - diaphragm
Aortic- 2nd right IC space parasternal - diaphragm
Pulmonary- 2nd left IC space parasternal - diaphragm
What is the acronym HAM in auscultation?
Heart sounds - S1 and S2 normal
Additional (clicks snaps) Abnormal sounds (S3,S4)
Murmurs (Systolic and diastolic )
What are the peripheral lower limb pulses?
Femoral, popliteal, posterior tibial, dorsalis pedis
