Lecture 1 - Cardio The heart Flashcards
(26 cards)
What are the common presenting complaints of a person with a heart problem?
Chest Discomfort Breathlessness Palpitation Pre-syncope/syncope Peripheral Oedema
What are some red flags for chest pain?
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
What are 4 cardiovascular causes of chest pain and how would you differentiate between them?
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
How can the respiratory system cause chest pain?
Pleuritic Pain
Sharp/stabbing pain; aggravated by inspiration; associations depends on cause
Describe two ways the Gastrointestinal
Gastro-oesophageal reflux:
Buring discomfort rising from stomach or lower chest towards neck; aggravated by bending over/straining/lying down especially after a meal
How can the Musculoskeletal system cause chest pain?
Costochondritis or Rib fracture
What features of pain should you explore to differentiate causes of chest pain?
Location and Radiation
When is dyspnoea normal and when is it abnormal?
Dyspnoea is normal on exertion, but abnormal if disproportional to level of activity undertaken.
What are the 4 main causes of Dyspnoea?
Increased ventilatory demand:
What type of heart condition is a common source of dyspnoea?
LHF
What are the red flags for dyspnoea?
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
When are palpitations concerning?
Palpitations in a patient with structural heart disease or an abnormal ECG may be a sign of a serious problem
What are some red flags for palpitations?
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
Describe the difference between syncope and near syncope?
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
Whats are some conditions that blocks or impedes the blood flow to the brain?
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
What are some red flags for syncope?
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
What is Orthostatic Hypotension and why does it occur?
The inability of the body to cope with the change in pressure dynamics on standing.
Occurs because:
Hypovolemia
Autonomic failure
Drugs (e.g. vasodilators).
What can be the consequences of Vertebrobasilar Insufficiency ?
Artery ischemia causing syncope
What are some signs and symptoms of VBI?
Diplopia
Dysarthria (difficulty with speech)
Dysphagia (difficulty with swallowing)
Drop attacks (sudden loss of power with no loss of consciousness)
Nausea and vomiting
What are the two types of Peripheral Oedema ?
Pitting and Non Pitting
What is pitting oedema and what causes it?
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
Describe non pitting oedema and when does it occur?
Excess protein in the interstitium (e.g. fibrinogen) or excess intracellular fluid causes non-pitting oedema
Occurs in:
Hypothyroidism
What do uni and bilateral oedema suggest?
Unilateral oedema suggests a local cause, whereas bilateral suggests a systemic issue
What are some Oedema Red Flags ?
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
