clinical presentations Flashcards
sudden pain between scapulae
type B aortic dissection
Sudden severe sharp tearing anterior cheat pain
type A aortic dissection
sudden dull chest pain
MI
BP is different on the L and the R arm
aortic dissection
limb pain brought on by exercise, relieved by rest
diminished or lost distal pulses
bruits
pallor or cyanosis
peripheral arterial disease
mottled right foot
thromboembolus from illiac or popliteal artery aneurysm
leg ulcer
peripheral arterial disease
in the legs... pain pallor paralysis parasthesia pulselesness
acute arterial occlusion
SE 29 year old SE asian with Hx of smoking has gangrene fingers, ulcers, cold feet, or raynauds phenom
buerger’s disease
PND and orthopnea with dyspnea and fatigue with elevated BNP
CHF
PND and orthopnea with dyspnea and fatigue with S4 (atrial) gallop
HTN heart disease causing CHF
male 75 yo HTN, angina pectoris, syncope, and dyspnea upon exertion. with a weak delayed pulse, atrial (S4) gallop crescendo-decrescendo systolic murmur
aortic stenosis
dyspnea with sudden decrease in SV, S3 gallop, apical holosystolic murmur
acute mitral regurgitation
fatigue, PND, orthopnea, decrease in SV, S3 gallop, apical holosystolic murmur
chronic mitral regurgitation
5 yo child with fever, high WBC, polyarthritis (autoimmune joint pain), pericardial friction rub, sore throat
acute rheumatic fever
28 year old rigid, calcified mitral valve, thickening and fusion of chordae tendinae
rheumatic heart disease
55 year old WM with no complaints but a mid syslolic click an late systolic murmur is heard on physical exam
mitral valve prolapse
69 yo WM with fatigue, decreased exercise tolerance, dyspnea, wide pulse pressure, collapsing pulse
decompensated aortic regurgitation
23 yo AAF with pericarditis and Hx of lupus
Libman Sacks endocarditis
45 ye WM with adenocarcinoma, no fever, normal WBC, no murmurs heard, presents with gross hematuria or left upper quadrant pain
marantic endocarditis
hematuria = renal infarct
LUQ pain = splenic infarct
A 58-year-old smoker has a stroke but before that had three weeks of fever, soaking sweats, and negative blood cultures
marantic endocarditis
48 yo AAM with Hx of HTN, and prosthetic valve implanted in 2002 presents with a fever, elevated ESR, positive blood culture
infective endocarditis
62 yr old male walks his dog and gets tightness in chest with SOB. He sits down and the pain goes away.
chronic stable angina
pt that woke up in middle of the night with an elephant on chest with normal ECG
CAD
severe prolong contriction of chest (may last an hour or 2)
very pale
very diaphortetic
difficulty breathing
acute MI
72 yo WM smoker with emphysema has pedal edema to knees edema, ascites, JVD
RHF
33 yo AAF with cardiac arrythmia due to a heart block
cardiac sarcoidosis
VT with delayed afterpolarizations
familial catecholeminergic polymorphic VT (Ryanodine R mut)
VT with phase 2 reentry
Brugada syndrome (Na cannel mut)
Infection with parovirus B19, fever, chest pain, dyspnea, tachycardia, pericardial friction rub
viral myocarditis
inverted T wves, epsilon wave, fatty replacement of myocytes with fibrous scarring
RT ventricular cardiomyopathy (desmosome mut)
62 yo WM Hx of HTN, smoking, complianed of back pain before suddenly dropping dead
AAA
42 yo AAM complains of sharp pain between his shoulder blades
type B aortic dissection
57 yo WM hx smoking, HTN, hyerlipidemia, complains of a sharp pain in his chest
type A aortic dissection
58 yo WM complains of left leg pain when he runs but is relieved when he stops, no edema, physical reveals diminished or lost posterior tibial pulse on left leg
peripheral arterial disease
58 yo WM complains of left leg pain and sometimes numbness, the leg looks pale, and has no pulse
cute arterial occlusion
36 yo SE asianF Hx of smoking presents with ulcerations on her left fingers
berger’s disease (chronic thrombosing inflammatory disease of small and medium arteries and veins of arms and legs)
palpable purpura
vasculitis
1 yo child with red eyes, red tongue, and erythomatous rash on face and feet
kawasaki
A 45-year-old woman has had worsening shortness of breath for 3 years. She now has to sleep sitting up on two pillows. She has had difficulty swallowing for the past year. She has no history of chest pain. A month ago, she had a “stroke” with resultant inability to move her left leg and difficulty moving her left arm. She is afebrile. A chest radiograph reveals a near-normal left ventricular size with a prominent left atrial border. ``
mitral valve stenosis (possibly from past rheumatic fever)
A 16-year-old healthy adolescent is involved in a schoolyard gang fight and stabbed in the chest with a knife in the left midclavicular line. He is taken to the emergency department and on arrival his blood pressure is barely obtainable. His lungs are clear to auscultation. His heart sounds are barely audible. Which of the following is the most likely acute condition that may preclude his survival?
A Myocardial contusion
B Aortic laceration
C Pericardial tamponade
D Endocarditis
E Acute infarction
C
A 49-year-old woman had atrial fibrillation that was poorly controlled, even with amiodarone therapy. She suffered a “stroke” and died. At autopsy, her 600 gm heart is noted to have a mitral valve with partial fusion of the leaflets along with thickening and shortening of the chordae tendineae. There is an enlarged left atrium filled with mural thrombus. `
Rheumatic fever with mitral stenosis
A 23-year-old woman has had worsening malaise along with a malar skin rash persisting for 3 weeks. On physical examination, she has an audible friction rub on auscultation of the chest, along with a faint systolic murmur. An echocardiogram reveals small vegetations on the mitral valve and adjacent ventricular endocardium. Laboratory studies show a positive antinuclear antibody test, with a titer of 1:2048.
What is the most likely cause of her fibrinous pericarditis?
uremia from renal failure (failure to remove damage inducing agent)
A 27-year-old G2 P1 woman has a screening ultrasound performed at 18 weeks gestation. The fetus is appropriate in size for 18 weeks. The fetal kidneys, liver, head, and extremities appear normal. However, the fetus has a heart with a membranous ventricular septal defect, overriding aorta, and marked pulmonic atresia. If the baby were to be liveborn, which of the following characteristics on physical examination would most likely result from these cardiac defects?
WHat is the cause?
tetrology of fallot causing cyanosis
The features are those of tetralogy of Fallot, which producces a right-to left shunt with cyanosis from mixing of right heart blood with left heart blood.
hyperplastic arteriosclerosis vs atherosclerosis
malignant HTN vs lipid deposition
A 20-year-old primigravida delivers a term baby girl following an uncomplicated pregnancy. No anomalies are noted at the time of birth. Five weeks later, the mother brings the baby to the clinic because she has difficulty breathing and occasionally turns pale. On physical examination a pansystolic murmur is audible. Which of the following congenital cardiac anomalies is most likely to be present in this infant?
A Hypertrophic subaortic stenosis
B Hypoplastic left heart syndrome
C Coarctation of the aorta
D Ventricular septal defect
E Bicuspid aortic valve
(D) CORRECT. The most common cardiac defect is a VSD. The baby may first become symptomatic when the pulmonary arteries dilate after the first month of life and the shunting from left-to-right increases.
When does a VSD typically present with cyanosis?
The baby may first become symptomatic when the pulmonary arteries dilate after the first month of life and the shunting from left-to-right increases.
A 60-year-old man had chest pain and was hospitalized. On the first day of admission, his CK-MB fraction was 9.8% of a total CK of 423 U/L. A coronary angiogram revealed 75% stenosis of the left anterior descending artery. Four days later he suddenly becomes worse, with marked hypotension. A pericardiocentesis is performed and returns 150 cc of bloody fluid. Despite aggressive resuscitative measures, he expires.
He has had an acute myocardial infarction complicated by rupture.
This is a typical complication about 3 to 5 days following the onset. 75% arterial narrowing is the point at which coronary occlusion becomes very serious.
A 74-year-old man has had increasingly severe headaches for 2 months, centered on the right. He sees his physician, who records vital signs of T 36.9 C, P 82/minute, RR 15/minute, and BP 130/85 mm Hg. There is a palpable tender cord-like area over his right temple. His heart rate is regular with no murmurs, gallops, or rubs. Pulses are equal and full in all extremities. A biopsy of this lesion is obtained, and microscopic examination reveals a muscular artery with luminal narrowing and medial inflammation with lymphocytes, macrophages, and occasional giant cells. He improves with a course of high-dose corticosteroid therapy.
Dx
Lab finding
Tx
These are classic findings for temporal arteritis, the most typical involvement with giant cell arteritis.
Corticosteroid therapy typically produces a diminution in the symptoms.
The elevation of the sed rate is way out of proportion to the extent and amount of inflammation in this one arterial segment.
myofiber disarray
hypertrophic cardiomyopathy
drop dead with exercise
A 58-year-old man has had an enlarging abdomen for 5 months. He has experienced no abdominal or chest pain. On physical examination he has a non-tender abdomen with no masses palpable, but there is a fluid wave. An abdominal CT scan shows a large abdominal fluid collection with a small cirrhotic liver. A chest radiograph shows a globally enlarged heart. He has vital signs showing T 37.1 C, P 78/minute, RR 16/minute, and BP 115/75 mm Hg.
dilated cardiomyopathy
