Lecture 1 - Cardio The heart

Question 1

What are the common presenting complaints of a person with a heart problem?

Answer 1

Chest Discomfort
Breathlessness
Palpitation
Pre-syncope/syncope
Peripheral Oedema

Question 2

What are some red flags for chest pain?

Answer 2

Abnormal vital signs (tachycardia, bradycardia, tachypnea, hypotension)
Signs of hypoperfusion (eg, confusion, ashen color, diaphoresis)
Shortness of breath
Asymmetric breath sounds or pulses
New heart murmurs
Pulsus paradoxus > 10 mm Hg

Question 3

What are 4 cardiovascular causes of chest pain and how would you differentiate between them?

Answer 3

Angina :
Tight/heavy central chest discomfort , Radiating to left/right arm, neck or jaw; associated with breathlessness

MI:
Similar to angina but more severe; often occurs at rest; associated with breathlessness, sweating, nausea and vomiting

Question 4

How can the respiratory system cause chest pain?

Answer 4

Pleuritic Pain

Sharp/stabbing pain; aggravated by inspiration; associations depends on cause

Question 5

Describe two ways the Gastrointestinal

Answer 5

Gastro-oesophageal reflux:
Buring discomfort rising from stomach or lower chest towards neck; aggravated by bending over/straining/lying down especially after a meal

Question 6

How can the Musculoskeletal system cause chest pain?

Answer 6

Costochondritis or Rib fracture

Question 7

What features of pain should you explore to differentiate causes of chest pain?

Answer 7

Location and Radiation

Question 8

When is dyspnoea normal and when is it abnormal?

Answer 8

Dyspnoea is normal on exertion, but abnormal if disproportional to level of activity undertaken.

Question 9

What are the 4 main causes of Dyspnoea?

Answer 9

Increased ventilatory demand:

Question 10

What type of heart condition is a common source of dyspnoea?

Answer 10

LHF

Question 11

What are the red flags for dyspnoea?

Answer 11

Dyspnea at rest
Decreased level of consciousness or agitation or confusion
Accessory muscle use and poor air excursion
Chest pain
Crackles
Weight loss
Night sweats
Palpitations

Question 12

When are palpitations concerning?

Answer 12

Palpitations in a patient with structural heart disease or an abnormal ECG may be a sign of a serious problem

Question 13

What are some red flags for palpitations?

Answer 13

Chest pain
Dyspnea
Light-headedness or syncope (particularly if injury occurs from syncope)
New onset of irregularly irregular heart rhythm
Heart rate >120 beats/min or < 45 beats/min while at rest
Significant underlying heart disease
Family history of sudden death

Question 14

Describe the difference between syncope and near syncope?

Answer 14

Syncope:
A sudden, brief LOC with full recovery
Results from global cerebral hypoperfusion

Near syncope:
light-headedness and a sense of an impending faint without LOC

Question 15

Whats are some conditions that blocks or impedes the blood flow to the brain?

Answer 15

Cardiac disorders that obstruct outflow
e.g. aortic stenosis, hypertrophic cardiomyopathy esp. with exercise

Cardiac disorders of systolic dysfunction

Cardiac disorders of diastolic dysfunction

Arrhythmias (too fast or too slow)

Conditions that decrease venous return

Question 16

What are some red flags for syncope?

Answer 16

Syncope during exertion
Multiple recurrences within a short time
Heart murmur or other findings suggesting structural heart disease (eg, chest pain)
Older age
Significant injury during syncope
Family history of sudden unexpected death

Question 17

What is Orthostatic Hypotension and why does it occur?

Answer 17

The inability of the body to cope with the change in pressure dynamics on standing.

Occurs because:
Hypovolemia
Autonomic failure
Drugs (e.g. vasodilators).

Question 18

What can be the consequences of Vertebrobasilar Insufficiency ?

Answer 18

Artery ischemia causing syncope

Question 19

What are some signs and symptoms of VBI?

Answer 19

Diplopia
Dysarthria (difficulty with speech)
Dysphagia (difficulty with swallowing)
Drop attacks (sudden loss of power with no loss of consciousness)
Nausea and vomiting

Question 20

What are the two types of Peripheral Oedema ?

Answer 20

Pitting and Non Pitting

Question 21

What is pitting oedema and what causes it?

Answer 21

Usually, water in the interstitial space is bound to a proteoglycan matrix to form a gel. Excess interstitial fluid is unbound and therefore moves away with compression forming a ‘pit

Causes: 
Congestive heart failure
Constrictive pericarditis
 DVT 
Chronic Venous Insufficiency 
Venous compression by pelvic/abdominal mass
Inferior vena cava obstruction
 Cirrhosis of the liver
 Immobility

Question 22

Describe non pitting oedema and when does it occur?

Answer 22

Excess protein in the interstitium (e.g. fibrinogen) or excess intracellular fluid causes non-pitting oedema
Occurs in:
Hypothyroidism

Question 23

What do uni and bilateral oedema suggest?

Answer 23

Unilateral oedema suggests a local cause, whereas bilateral suggests a systemic issue

Question 24

What are some Oedema Red Flags ?

Answer 24

Sudden onset
Significant pain
Dyspnoea
Hemoptysis
Hepatomegaly
Splenomegaly
Jaundice
Ascites,
Unilateral leg swelling with tenderness
History of a heart disorder or an abnormal cardiac examination

Question 25

What are some Modifiable Risk Factors for CV health?

Answer 25

Hypertension
Diabetes Mellitus
Hyperlipidemia
Smoking
Diet
Physical Inactivity

Question 26

What are some Non-modifiable Risk Factors for CV health?

Answer 26

Gender:
More common in males

Age:
CVD becomes increasingly common with advancing age.
The muscle of the aged heart may relax less completely between beats, and as a result, the chambers become stiffer and may work less efficiently.

Family history of heart disease:
If a first-degree blood relative has had coronary heart disease or stroke before the age of 55 years (for a male relative) or 65 years (for a female relative), the risk increases

Others:
Marfan’s syndrome
Hypertrophic cardiomyopathy
Familial hypercholesterolaemia