CV and chest pain Flashcards
what is ankle oedema a sign of and give some characteristics?
R ventricular/congestive cardiac failure
pitting, symmetrical, worse in evenings
what is intermittent claudication and what is it a symptom of?
pain in thighs, calves, buttocks after walking and relieved by rest
peripheral vascular disease
is fatigue a symptom of cardiac failure?
Y
what past conditions neeed to be asked about in CV hx and why?
previous angina or MI: risk of further CV and cerebrovascular events
htn, hypercholesterolemia and dm rf for ihd
rheumatic fever predisposes to valvular disease
strokes: could be due to ischaemic event
asthma: contra-indicates use of BB
what fhx is important in cv hx?
MI/stroke of relative under 65
what is the typical character of chest pain with a cardiac cause?
central and crushing
however in angina may describe discomfort not pain
MI usually severe pain
where does cardiac pain typically radiate to?
left arm, neck, jaw,
occassionally: teeth, back or abdomen
why is the duration of the pain important?
over 30 mins is likely to be associated with damage to the heart muscle
why are exacerbating and relieving factors important in cardiac chest pain?
stable angina bought on by exercise and relived by rest. nitrates tend to relieve the pain
why is leg swelling important in cardiac history?
usually bilateral
with hf may report ankle swelling that is worse in evenings
what are some associated symptoms with an MI?
dyspnoea, sweating, anxiety, nausea, faintness, chest pain
which RF should be asked about for an MI?
fhx, htn, diabetes, smoking, hypercholesterolaemia
describe the basic management of an MI.
bed rest, oxygen, opiate, monitor, anticoagulate, reeduce clot size
why is the onset of palpitations important?
cardiac arrhythmias=sudden
sinus tachycardia=insidious
what are some triggers for palpitations/
anxiety
ectopic beats more noticeable if background rate slow e.g. at rest
paroxysmal tachycardia: exercise, specific movements
coffee, tea, alcohol
what may relieve palpitations?
coughing or swallowing
Valsalva manoevre may terminate supraventricular tachycardia
why is the medical hx important in palpitations?
can caused by MI, valvular disease cardiomyopathy, myocarditis, aberrant conduction pathways
htn risk of AF
why is it important to ask about wt loss, heat intolerance, increased stool frequency and irritability in palpitations?
can be caused by thyrotoxicosis
why is medication important in the history of palpitations?
many drugs can cause arrhythmias, particularly in overdose
why is it important to ask which part of the leg is affected in intermittent claudication?
calf pain=disease in superficial femoral artery
thigh pain=external iliac
buttock pain=lower aorta or common iliac
why would you ask whether bending forward relieved the pain in suspected intermittent claudication?
more likely to be spinal canal stenosis in the lumbar region
what skin changes are seen in intermittent claudication/
hairless, dry, ulcers
what causes Raynauds disease?
blood disorders, arterial (atherosclerosis), drugs (BB), connective tissue disorders (SLE, RA), traumatic (vibration injury)
what general clues can you get from a patient regarding CV disease/
colour and resp pattern any oxygen or GTN spray present Cachexia: malignancy or severe cardiac failure Marfans syndrome: aortic regurgitation Downs syndrome: congenital heart disease Turners syndrome: coarction of aorta
what hand and nail changes can be seen in CV disease?
clubbing: cyanotic congenital heart disease, subacute infective endocarditis spinter hemorrhages: infective endocarditis koilonychia: iron deficiency anaemia oslers nodes (painful): infective endocardiits janeway lesions (not painful): infective endocardiits tendon xanthomata (yellow lipid in tendon): type II hyperlipidaemia
what causes a collapsing pulse/
aortic regurgitation, patent ductus arteriosus, hyperdynamic circulation
what does radio-radial delay suggest?
large arterial occlusion
what does radio-femoral delay suggest/
coarction of aorta
what signs in the face indicate CV diseas?
jaundice: prosthetic heart valve induced haemolysis
pallor: anaemia
petechal hemorrhages in conjunctiva: embolic phenomena
xanthelasma: hyperlipidaemia
malar flush: pulmonary htn, low cardiac output (severe mitral stenosis)
what signs in the tongue and lips indicate cv disease/
cyanosis
mucosal petechiae: infective endocarditis
high arched palate: marfans
what can cause and increased JVP?
RV failure, tricuspid stenosis or regurgitation, pericardial effusion, constrictive pericarditis,, SVC obstruction, fluid overload
what changes in the carotid pulse indicate cv disease?
slow rising=aortic stenosis
collapsing=aortic regurgitation, hyperdynamic circulation, patent ductus arteriosus
small vol=aortic stenosis, pericardial effusion
pulsus alternans: diseased LV
what lung sounds may be heard in heart failure?
pan-inspiratory crackles, pleural effusion
give some features of ischaemic legs.
pulseless, pale, painful, paralysed, perishingly cold, ulcerated/gangrenous
what is Becks triad?
for cardiac tamponade
distant heart sounds
distended jugular veins
decreased arterial pressure
why is it important to check for scars on the chest?
CABG or valvel replacement
pacemakers
where is the apex beat/
5th L intercostal space, 1cm medial to midclavicular line
what causes changes in the apex beat/
displaced due to marfans
thrusting quality: vol overload e.g. mitral or aortic regurgitation
heaving: pressure overload e.g. aortic stenosis
impalpable: COPD, obesity, pleural or pericardial effusion, dextrocardia
what are parasternal heaves and thrills:
heaves=heel of hand: RV or LA enlargement
thrills=flat hand: palpable murmurs
when are murmurs loudest?
R=inspiration
L=expiration
