general Flashcards
ddx of chest pain
CENTRAL Cardiac: IHD - infarct / angina **ACS** aortic aneurysm / dissection takotsubo - octopus pot coronary artery spasm - prinzmetal's MV prolapse Pericarditis / Myocarditis Non-cardiac: PE Oesophageal disease (worse lying down / bending over) costochondritis Soft tissue injury
LATERAL/ PERIPHERAL: Pulmonary: Infarct / pneumonia / pneuomothorax / lung ca / mesothelioma Non-pulm: Herpes / trauma
retrosternal heavy / gripping pain On Extertion
angina
retrosternal heavy / gripping pain at rest
ACS
severe tearing chest pain radiating through to back
aortic dissection
sharp central chest pain
- worse with exp
- relieved by sitting forwards
pericarditis
shrp stabbing LT sub-mammary pain
- assoc with anxiety
da costa sydrome
describe orthopnoea + mechanism
breathlessness on lying flat
1. blood redistributed legs - torso
2. increase in central + pulm blood vol
(same mech as PND)
describe PND + mechanism
patient woken from sleep fighting for breath
1. blood redistributed legs - torso
2. increase in central + pulm blood vol
(same mech as orthopnoea)
describe the mechanism of a vasovagal attack
“simple faint”
most common cause of syncope
1. peripheral vasodil + venous pooling of blood
2. reduction in amount of blood returned to heart
3. near empty heart responds by contracting vigourously
4. stimulates mechanorecpetors (stretch receptors) in wall of LV
5. trigger CNS reflexes to reduce ventr stretch - further vasodilatation + brady
6. further drop in BP
7. SYNCOPE
8. recovery in a few seconds - especially if patient lies down
what is postural hypotension?
drop in sBP of 20/more on standing from a sitting or lying posn
why does postural hypotension occur in fluid depleted patients?
reflex vasoconstriction not effective. same if on diuretics / vasodilators
