CVS

Question 1

Chest discomfort

Answer 1

Myocardial infarction
Angina
Pericarditis
Aortic dissection

OTHER:
Oesophageal spasm
Pneumothorax
Musculoskeletal pain

Question 2

Breathlessness

Answer 2

Heart failure
Valvular disease
Angina
Pulmonary embolism
Pulmonary hypertension

OTHER:
Respiratory disease
Anaemia
Obesity
Anxiety

Question 3

Palpitation

Answer 3

Tachyarrhythmias
Ectopic beats

OTHER:
Anxiety
Hyperthyroidism
Drugs

Question 4

Syncope/ presyncope

Answer 4

Arrhythmias
Postural hypotension
Aortic stenosis
Hypertrophic cardiomyopathy
Atrial myxoma

OTHER:
Simple faints
Epilepsy
Anxiety

Question 5

Oedema

Answer 5

Heart failure
Constrictive pericarditis
Venous stasis
Lymphoedema

OTHER:
Nephrotic syndrome
Liver disease
Drugs
Immobility

Question 6

stable angina STAGES

Answer 6

1 :Ordinary physical activity, such as walking and climbing stairs, does not cause angina. Angina with strenuous, rapid or prolonged exertion at work or during recreation

2 :Slight limitation of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or climbing stairs after meals, in cold, in wind, or when under emotional stress, or only during the few hours after awakening

3 :Marked limitation of ordinary physical activity. Walking 1–2 blocks on the level and climbing less than one flight in normal conditions

4 :Inability to carry on any physical activity without discomfort; angina may be present at rest

Question 7

Angina

Answer 7

Site: Retrosternal

onset: Progressive increase in intensity over 1–2 minutes

character:Constricting, heavy

radiation:Sometimes arm(s), neck, epigastrium

associated features:Breathlessness

timing:Intermittent, with episodes lasting 2–10 minutes

exacerbating/relieving:Triggered by emotion, exertion, especially if cold, windy
Relieved by rest, nitrates

severity:Mild to moderate

cause: Coronary atherosclerosis, aortic stenosis, hypertrophic cardiomyopathy

Question 8

MI

Answer 8

Site: Retrosternal
onset: Rapid over a few minutes

character: Constricting, heavy

radiation:Often to arm(s), neck, jaw, sometimes epigastrium

associated features:Sweating, nausea, vomiting, breathlessness, feeling of impending death (angor animi)

timing: Acute presentation; prolonged duration

exacerbating/relieving: ’Stress’ and exercise rare triggers, usually spontaneous
Not relieved by rest or nitrates

severity:sually severe

cause:Plaque rupture and coronary artery occlusion

Question 9

Aortic dissection

Answer 9

Site: Interscapular/retrosternal

onset:Very sudden

character:Tearing or ripping

radiation:Back, between shoulders

associated features:Sweating, syncope, focal neurological signs, signs of limb ischaemia, mesenteric ischaemia

timing:Acute presentation; prolonged duration

exacerbating/relieving:Spontaneous
No manœuvres relieve pain

severity:Very severe

cause:Thoracic aortic dissection rupture

Question 10

Pericardial pain

Answer 10

Site: Retrosternal or left-sided

onset:Gradual; postural change may suddenly aggravate

character:Sharp, ‘stabbing’, pleuritic

radiation:Left shoulder or back

associated features:Flu-like prodrome, breathlessness, fever

timing:Acute presentation; variable duration

exacerbating/relieving:
Sitting up/lying down may affect intensity NSAIDs help

severity:Can be severe

cause:Pericarditis (usually viral, also post myocardial infarction)

Question 11

Oesophageal pain

Answer 11

Site: Retrosternal or epigastric

onset:Over 1–2 minutes; can be sudden (spasm)

character:Gripping, tight or burning

radiation:Often to back, sometimes to arms

associated features:Heartburn, acid reflux

timing:Intermittent, often at night-time; variable duration

exacerbating/relieving:Lying flat/some foods may trigger
Not relieved by rest; nitrates sometimes relieve

severity:Usually mild but oesophageal spasm can mimic myocardial infarction

cause:Oesophageal spasm, reflux, hiatus hernia

Question 12

mechanisms and causes of heart failure:Reduced ventricular contractility (systolic dysfunction)

Answer 12

Myocardial infarction
Dilated cardiomyopathy, e.g. genetic, idiopathic, alcohol excess, cytotoxic drugs, peripartum cardiomyopathy
Myocarditis

Question 13

Impaired ventricular filling (diastolic dysfunction)

Answer 13

Left ventricular hypertrophy
Constrictive pericarditis
Hypertrophic or restrictive cardiomyopathy

Question 14

Increased metabolic and cardiac demand (rare)

Answer 14

Thyrotoxicosis
Arteriovenous fistulae
Paget’s disease

Question 15

Valvular or congenital lesions

Answer 15

Mitral and/or aortic valve disease Tricuspid and/or pulmonary valve disease (rare)
Ventricular septal defect
Patent ductus arteriosus

Answer 16

site:
onset:
character:
radiation:
associated