Common Cardio Diagnoses Flashcards
Symptoms of ANGINA
Heavy/tight/squeezing chest pain
- May radiate retrosternally, to jaw, arms, neck
- Possible SOB
History/signs in ANGINA
Patients often point out pain with closed fist
Precipitated/exacerbated by
- Physical exertion, emotional stress
- Relieved by rest
- Predictable onset
Relieved by GTN in 5 mins indicates oesophageal spasm)
Physical examination in ANGINA
Signs of associated RISK FACTORS
- Hyperlipidaemia - xanthelasma, tendon xanthoma
- Vascular disease - Carotid bruits, low peripheral pulses
Investigations for ANGINA
Physiological - Exercise stress test - Stress echo - Stress MRI Anatomical - CT coronary angiogram - CT catheterisation
Symptoms of ACUTE CORONARY SYNDROME
Chest pain that is:
- Crushing
- Lacking obvious precipitant (often occurs at rest)
- Not relieved by GTN
- Associated with sweating, nausea, vomiting
- Lasts longer than angina attack
3 categories of ACUTE CORONARY SYNDROME
Unstable angina
NSTEMI
STEMI
- Clinical features of all 3 are the same
- Differentiated based on ECG & troponin findings
5 things to evaluate on physical examination of ACUTE CORONARY SYNDROME
Heart rate Blood pressure JVP - elevated in RV infarction Heart Sounds - 3rd or 4th - LV ischaemia - Mid-late systolic - ischaemic mitral regurgitation - Pan-systolic - papillary muscle rupture/acute ventricular septal defect - Pericardial rub Evidence of LVF
Symptoms of AORTIC DISSECTION
Chest pain is: - Severe - Sudden onset - Interscapular - 'Tearing' Often presents atypically i.e. not all symptoms present
Risk factors for AORTIC DISSECTION
HTN Marfan's syndrome Chest trauma (e.g. blunt injury from car crash) Pregnancy Biscupid aortic valve Aortic coarctation Syphilitic aortitis
Features that may be present in patients with AORTIC DISSECTION
MI/ischaemia Neurological deficits Renal ischaemia Mesenteric ischaemia Aortic regurgitation Cardiac tamponade
Investigations for AORTIC DISSECTION
CXR - widened mediastinum
Direct imaging of aorta - MRI, CT angiography, transoesophageal echocardiography
Symptoms of LEFT VENTRICULAR FAILURE
SOBOE, orthopnoea, PND
Cough (sometimes with pink frothy sputum)
Fatigue
Types of HEART FAILURE
Left and/or right ventricular
Systolic and/or diastolic
Acute or chronic
High output or low output
Symptoms of RIGHT VENTRICULAR FAILURE
Ankle swelling Abdominal symptoms (due to hepatic congestion and/or ascites) - Loss of appetite - Abdominal discomfort - Abdominal swelling
Signs of LEFT VENTRICULAR FAILURE
Tachycardia Tachypnoea Alternating pulse Hypotension with narrow pulse pressure Displaced, volume-loaded apex beat S3 and/or S4 Inspiratory crackles at lung bases (sometimes) pleural effusion
Signs of RIGHT VENTRICULAR FAILURE
Elevated JVP
Ankle and/or sacral oedema
Hepatomegaly
Ascites
Investigations for HEART FAILURE
Echo (ejection fraction, ventricular size)
CXR - pulmonary venous congestion, pulmonary oedema, pleural effusion/s.
Causes of SYSTOLIC HEART FAILURE
CAD HTN Valvular disease Viral myocarditis Cardiomyopathy Cardiotoxic drugs Alcoholism
Symptoms of HYPERTROPHIC CARDIOMYOPATHY
SOB Chest pain Palpitations Pre-syncope/syncope (Sudden cardiac death)
Signs of HYPERTROPHIC CARDIOMYOPATHY
‘Jerky’ pulse
Double impulse apex beat
S4
Ejection systolic murmur
Investigations for HYPERTROPHIC CARDIOMYOPATHY
Echocardiogram
- LV hypertrophy, usually asymmetrical
- Impaired diastolic function with preserved systolic function
Symptoms of HYPERTENSION
Usually asymptomatic and discovered incidentally. Majority is ‘essential’ - no known cause.
Causes of SECONDARY HYPERTENSION
Renal parenchymal disease Renovascular disease (e.g. renal artery stenosis) Pheochromocytoma Acromegaly Cushing's Steroids NSAIDs OCP
Symptoms of ATRIAL FIBRILLATION
Palpitations - irregular, often fast SOB Fatigue Dizziness/syncope Reduced exercise tolerance
