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Cardiology > Differentials > Flashcards

Differentials Flashcards

1
Q

Where can chest pain radiate?

A

Epigastrium
Arm
Neck
Jaw

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2
Q

What is the character of pneumothorax chest pain?

A

Sudden onset pleuritic pain either left or right-sided with associated dyspnoea and syncope. Often young males.

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3
Q

What is the character of musculoskeletal chest pain?

A

Pain typically persistent (typically days or longer), worsened with passive and active motion and sometimes reproducible chest tenderness.

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4
Q

What is the character of angina chest pain?

A

Exertional pain/discomfort in the centre or left side of the chest, throat, neck or jaw is relieved by rest or GTN within a few minutes. May radiate to the neck, jaw or left arm. Sometimes there may not be any pain but breathlessness.

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5
Q

What is the character of pericarditis chest pain?

A

Constant or intermittent central pleuritic sharp pain often aggravated by position (classically worse on lying down and relived by sitting or leaning forward).

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6
Q

What is the character of peptic ulcer disease pain?

A

Recurrent, vague epigastric discomfort, that is relieved by food, anatacids or both.

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7
Q

What is the character of pulmonary embolism chest pain?

A

Sudden onset pleuritic chest pain with associated dyspnoea and tachycardia. Sometimes mild fever, syncope and haemoptysis.

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8
Q

What is the symptoms of ACS?

A
  • Acute, crushing pain radiating to the jaw or arm
  • Exertional pain relieved by rest
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9
Q

What are the clinical signs of ACS?

A
  • Sinus tachycardia
  • Xanthelasma
  • Tar staining on fingers
  • New murmur (mitral regurgitation - pan-systolic)
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10
Q

What are the symptoms of aortic dissection?

A
  • Sudden, tearing pain radiating to the back
  • Some patients have syncope, stroke or leg ischaemia
  • PMH of HTN and/or FHx of connective tissue disease e.g. Marfan syndrome
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11
Q

What are the clinical signs of aortic dissection?

A
  • Pulsus paradoxus (BP falls on inspiration)
  • Difference in BP in both arms
  • Distended neck veins
  • Muffled heart sounds
  • Radio-radial delay
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12
Q

What are the symptoms of myocarditis?

A
  • Fever
  • Dyspnoea
  • Fatigue
  • Chest pain (if myopericarditis)
  • May be pleuritic
  • Recent viral or other infection
  • Fever
  • Tachycardia
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13
Q

What are the clinical signs of pericarditis?

A
  • Tachycardia
  • Pericardial rub
  • Recent viral infection
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14
Q

What are the risk factors for a pulmonary embolism?

A
  • Tachycardia
  • Red, swollen, painful leg
  • Immobile for a long period
  • Inherited conditions such as blood clotting disorders
  • Recent surgery or bone fracture
  • History of cancer or receiving chemotherapy
  • Acute medical illness e.g., DKA, sepsis
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15
Q

What are the clinical signs of pneumothorax?

A
  • Hypotension
  • Neck vein distension
  • Tracheal deviation
  • Unilateral diminished breath sounds
  • Hyperresonance to percussion
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16
Q

What are the symptoms of pneumonia?

A
  • Pleuritic chest pain
  • Fever
  • Productive cough
  • Purulent sputum - green/blood stained
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17
Q

What are the clinical signs of pneumonia?

A
  • Reduced air entry
  • Bronchial breathing
  • Crepitations
  • Immunosuppression or elderly
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18
Q

What are the symptoms of pancreatitis/gallstones/hepatitis?

A
  • Pain in the epigastrium or lower chest that is often worse when lying flat and is relived by leaning forward
  • Vomiting
  • Upper abdominal tenderness
19
Q

What is the pain character in GORD?

A

Recurrent burning pain radiating from epigastrium to throat, exacerbated by bending down or lying down and relieved by antacids.

20
Q

What are the symptoms of shingles?

A
  • Sharp, band-like pain in the thorax unilaterally
  • Classic linear, vesicular rash
  • Pain may precede rash by several days
  • Rash on chest with vesicles - dermatomal distribution
  • Pain made worse by contact with clothing
21
Q

What is the Stanford classification for aortic dissection?

A

Type A - involves ascending aorta
Type B - does not involve ascending aorta

22
Q

What is the underlying pathology of aortic dissection?

A
  • Atherosclerosis
  • HTN
  • Aortic aneurysm
  • Bicuspid aortic valve
  • Connective tissue disease
  • Marfan’s syndrome
23
Q

What can be seen on a CXR for aortic dissection?

A

False lumen - this enlarges and occludes the true lumen, potentially compromising the blood supply of organs distal to dissection tear.

24
Q

Describe unstable angina

A

Patients present with ischaemic symptoms with no elevation in troponins, often treated as NSTEMI due to troponin rise occurring later.

25
Q

What are the symptoms of ACS?

A
  • Chest pain, typically central/left-sided
  • May radiate to the jaw or left arm
  • Certain patients e.g., diabetics/elderly may not experience any chest pain
  • Dyspnoea
  • Sweating, n+v
26
Q

What are the clinical signs of ACS?

A
  • Very few physical signs
  • Potentially tachycardia
  • Pale and clammy
  • If complications of ACS then those signs may show
27
Q

What are the shockable heart rhythms?

A
  • Ventricular fibrillation
  • Pulseless ventricular tachycardia
28
Q

What are the non-shockable heart rhythms?

A
  • Asystole
  • Pulseless electrical activity (PEA)
29
Q

What are the different types of AF?

A
  • Recurrent episodes, when a patient has 2 or more episodes of AF
  • If episodes of AF terminate spontaneously then the term paroxysmal AF is used - last less than 7 days (<24 hrs)
  • If the arrhythmia is not self-terminating then it is persistent AF, this lasts >7 days
  • Permanent AF is continuous and cannot be cardioverted or if attempts to do so are deemed inappropriate
30
Q

What are the symptoms of AF?

A
  • Palpitations
  • Dyspnoea
  • Chest pain
31
Q

What are the common causes of AF?

A

SMITH
- Sepsis
- Mitral valve pathology (stenosis or regurgitation)
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension
- Lifestyle - alcohol and caffeine

32
Q

What are the features for coarctation of aorta?

A
  • Infancy: heart failure
  • Adult: hypertension
  • Radio-femoral delay
  • Mid systolic murmur, maximal over the back
  • Apical click from the aortic valve
    notching of the inferior border of the ribs (due to collateral vessels) is not seen in young children
33
Q

What are the features of pericarditis?

A
  • Fever or recent viral illness
  • Recent MI (associated with Dressler’s syndrome)
  • PMH of RA, SLE, sarcoid or radiotherapy
34
Q

What are other features of peptic ulcer?

A
  • Associated symptoms include dysphagia, acid reflux, weight loss and melaena
  • Drug history includes NSAIDs, steroids or any others
  • Can have retrosternal radiation
35
Q

What are the common features associated with AF?

A
  • Elderly patient
  • PMH of IHD, CCF, mitral valve disease
  • Recent onset coinciding with symptoms suggestive of LRTI
36
Q

What are the common features associated with SVT?

A
  • PMH of COPD (predisposes to multifocal atrial tachycardia)
  • Associated with symptoms of compromise e.g. chest pain, SOB, pre-syncope
  • Previous episodes terminated by vagal manoeuvres e.g. blowing the nose
37
Q

What are the common features associated with VT?

A
  • Symptoms of compromise e.g. chest pain, SOB, pre-syncope, cold peripheries, sweating
  • Hx of recent MI
  • PMH of IHD
  • FH of sudden death, known long QT syndrome
38
Q

What are the common features associated with thyrotoxicosis?

A
  • Sinus tachycardia or AF
  • PMH of thyroid disease
  • PMH of other autoimmune disease (insulin-dependent diabetes, vitiligo, Addison’s, pernicious anaemia etc)
39
Q

What are the symptoms of thyrotoxicosis?

A
  • Weight loss
  • Increased appetite
  • Heat intolerance
  • Diarrhoea
  • Tremor
  • Mood disturbance
40
Q

What are the common features associated with HOCM?

A
  • FH of sudden death or HOCM
  • Collapse while playing sport
41
Q

What are the common features associated with phaeochromocytoma?

A
  • Triad of episodic headache, sweating, fast palpitations
  • Weight loss
  • Symptoms of anxiety
42
Q

What are the common features associated with simple anxiety or GAD?

A
  • Associated with important/stressful event
  • No symptoms of compromise or hx of cardiac/thyroid disease
  • PMH of depression
  • Avoidance of predisposing situations (GAD)
43
Q

What are the common features associated with ventricular ectopics?

A
  • Recent MI
  • PMH of IHD
  • Description of missed beat followed by heavier beat
44
Q

What are the common features associated with hypoglycaemia?

A
  • Associated with sweating, anxiety, hunger, tremor, dizziness
  • PMH of diabetes
  • DH of hypoglycaemic medication (not metformin)
  • Hx of liver disease, Addison’s disease

Cardiology (5 decks)

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