Clinical Features of Ischaemic and Valvular Heart Disease

Question 1

What are clinical features?

Answer 1

Things we use to diagnose a patient.

Signs and symptoms

Question 2

What are symptoms?

Answer 2

What the patient tells you - history

Question 3

What are signs?

Answer 3

What you can see/hear/feel - examination

Question 4

List the 5 symptoms of heart disease and what causes them in a cardiac context?

Answer 4

Chest pain - ischemia 
Breathlessness - heart failure
Ankle swelling - heart failure
Palpitations - arrhythmia
Faintness - low blood pressure, arrhythmia

Question 5

List 5 signs in clothed patient?

Answer 5

General appearance - breathlessness, sweating
Pulse - rate, rhythm
Pulse pressure
Jugular Venous Pressure (JVP)
Peripheral oedema

Question 6

List other signs in unclothed patient?

Answer 6

Heart sounds - murmurs

Lung sounds - inspiratory crackles, reduced breath sounds

Question 7

What is ischaemic heart disease?

Answer 7

Heart disease caused by coronary artery narrowing and blockage

Question 8

what 2 pathological process can lead to ischaemic heart disease?

Answer 8

Atherosclerosis = narrowing
Thrombosis = blockage

Question 9

What are the consequences of heart disease?

Answer 9

Angina due to narrowing, and myocardial infarction (blockage)

Question 10

How to manage angina?

Answer 10

Stop and rest
GTN spray
Regular anti-anginas drugs 
Percutaneous coronary intervention
Coronary artery bypass graft

Question 11

What is primary prevention of MI?

Answer 11

In patients without heart disease

Question 12

What is secondary prevention?

Answer 12

In patient in evidence of disease - angina

Question 13

What precipitates angina?

Answer 13

Exercise, stress, cold

Question 14

List some risk factors of heart disease?

Answer 14

Smoking, diabetes, hypertension, Increase clotting, poor diet, lack of exercise, age, male

Question 15

List some prevention strategies of heart disease?

Answer 15

Primary - lifestyle (lose weight, reduce fat, stop smoking)
Treat hypertension
Anti-platelet groups
Secondary - ACE inhibitors and beat blockers post MI
Coronary intervention - bypass

Question 16

What 3 cardiac investigations can be carried out?

Answer 16

ECG
Chest X-ray
Echocardiagram

Question 17

What does an ECG show?

Answer 17

Changes during angina or MI and heart rhythm

Question 18

What does a chest X-ray show?

Answer 18

Heat enlargement and pulmonary oedema

Question 19

What does an echocardiogram show?

Answer 19

Structure and movement of valves and heart muscle , flow across valves

Question 20

List 5 acute complications of MI

Answer 20

Arrhythmias - cardiac arrest
Heart failure - Cardiogenic shock (severe heart failure
Rupture of valve, septum
Aneurysm of left ventricle

Question 21

List 4 chronic complications of MI

Answer 21

Chronic heart failure
Recurrent arrhythmias/risk of arrest
Angina
Further MI

Question 22

Name 4 valves in the heart?

Answer 22

Mitral
Aortic
Tricuspid
Pulmonary

Question 23

List 2 problems that can occur in heart valves?

Answer 23

Narrowing and leaking

Question 24

What is the term used to describe a valve that has become narrow and can’t open properly?

Answer 24

Stenosis

Question 25

What term is used to describe a leaking heart valve as they cant close properly ?

Answer 25

Regurgitation

Question 26

List 3 symptoms of valvular heart disease?

Answer 26

Heart failure - breathlessness, fatigue and oedema
Palpitations - on exercise or with arrhythmia
Faintness due to low BP especially in aortic stenosis

Question 27

List 4 signs of valvular heart disease?

How it changes in stenosis vs regurgitation

Answer 27

Pulse - altered volume, high in regurgitation, slow in stenosis
Pulse - irregular in arrhythmias
BP, low in stenosis high in regurgitation
Signs of endocarditis - arise from oral flora

Question 28

How to treat valvular heart disease?

Answer 28

Surgical valve replacement

Treat symptoms - anti-arrhythics, diuretics