Cluster questions

Question 1

Infection screen questions

Answer 1

Fever, fatigue, night sweats, unexplained weight loss

Top to toe:
- Headache
- Cough, sore throat
- Abdo pain, diarrhoea, vomiting
- Urinary burning and frequency
- Rashes, ulcers
- Muscle aches

Question 2

ACS:
- Symptoms?
- Risk factors?

Answer 2

Chest pain: central/left, may radiate to jaw/neck/shoulder/arm/back/epigastrium; exertion worsens, however inspiration/palpation does not affect
SOB
N&V, sweating
DIzziness

Do you suffer from or take tablets for high blood pressure, diabetes, high cholesterol?
Have you or anyone in your family ever had a history of heart attacks, stents, or bypasses? (What age)

Question 3

Heart failure
- Symptoms?
- Risk factors?

Answer 3

Right heart failure: ankle swelling (bilateral), weight gain
Left heart failure: SOB (orthopnoea + PND), pink frothy sputum
Chest pain
Fatigue
Syncope/fainting

Past + family history: have you or anyone in your family been diagnosed with heart failure? Have you been prescribed fluid tablets, or been told to restrict your fluids?

Heart conditions: ACS, arrhythmias, valvular diseases, myocardial disease, pericardial disease
Metabolic syndrome
Lung conditions
Kidney disease
Upregulation: hyperthyroidism, anemia, pregnancy
Chemotherapy drugs: doxorubicin, cyclophosphamide
AOD: alcohol, cocaine, methamphetamine

Question 4

Heart failure exacerbations

Answer 4

F: forgot medications/fluid restrictions
A: arrhythmias, sleep apnoea
I: infection, ischemia/infarction
L: lifestyle (too much salt)
U: upregulation of CO (hyperthyroidism, anaemia, pregnancy)
R: renal failure
E: pulmonary embolism

Question 5

Aortic dissection
- Symptoms?
- Risk factors?

Answer 5

Tearing chest pain
- Radiation to back +-neck & shoulders
Tearing down: abdominal pain
Tearing up: neck pain, headache, focal neurological symptoms
Dizziness/syncope

Risk factors:
- As per ACS (come back to this)

Question 6

Myocarditis, pericarditis
- Symptoms?
- Risk factors?

Answer 6

Symptoms
- Chest pain: pleuritic, worse lying down and better sitting up/leaning forward
- SOB
- Systemic symptoms: fever, fatigue, myalgia

Risk factors
- Recent infection (infection screen)
- Systemic conditions: automminue (eg. lupus, RA, vasculitis), CKD, lung cancer
- Recent heart attack (a complication)
- Anticonvulsant drugs (eg. clozapine)

Question 7

Pericardial effusion/tamponade
- Symptoms
- Risk factors

Answer 7

Symptoms
- Chest pain: pleuritic, worse lying down and better sitting up/leaning forward
- SOB
- Dizziness/syncope
- Palpitations

Risk factors
- As per myocarditis/pericarditis
- Chest trauma including heart surgery
- Aortic dissection (screen for separately)

Question 8

Atrial tachyarrhythmias
- Symptoms
- Precipitating factors
- Complicating factors

Answer 8

Symptoms
- Palpitations
- Rest as per AMI

Precipitating factors
- Medication compliance
- Alcohol, caffeine, smoking, drugs
- Infection (do infection screen)
- Stress and exercise
- Hyperthyroid
- PE

Complicating factors
- Embolism: stroke (only if AF; focal neuro symptoms), PE
- Reduced CO: AMI (already asked symptoms of), heart failure

Question 9

Brady arrhythmias
- Symptoms
- Risk factors

Answer 9

Symptoms
- Chest pain
- SOB
- Dizziness/fainting

Risk factors
- Do a lot of physical activity/athlete
- Medications for heart
- Heart muscle conditions: AMI, myocarditis, cardiomyopathy
- Heart surgery
- Infection
- Systemic diseases: SLE, amyloidosis

Question 10

Valvular disease
- Symptoms
- Risk factors

Question 11

Rheumatic heart disease
- Symptoms
- Risk factors

Question 12

Infective endocarditis
- Symptoms
- Risk factors

Question 13

Peripheral vascular disease
- Symptoms
- Risk factors