Reasons behind signs and symptoms of cardiac and peripheral artery diseases

Question 1

What causes ischaemic muscle pain

Answer 1

pH drops which stimulates pain afferent (nociceptors) in muscle

Substance P is released locally which increases sensitivity of pain afferents in muscle

Question 2

Why might a patient with thyrotoxicosis develop angina or MI

Answer 2

Thyroid hormone stimulates SNS, increasing heart rate and oxygen demand

Oxygen supply cannot meet demand so patient then develops angina or MI

Question 3

What words can be used to describe ischaemic muscle pain

Answer 3

Tight, vice like

Constriction

Heavy/crushing

Cramping

Pressing

Tearing

Pressure

Choking feeling in the throat

Question 4

What brings on cardiac pain in angina

Answer 4

Exercise

Stress

Emotions

Cold weather

Eating a meal

Question 5

What medication can be given to relieve symptoms of angina and why

Answer 5

GTN

Causes vasodilation of vein to reduce workload on the heart

Does not work on unstable angina

Question 6

Why does a patient suffering MI often appear sweaty, nauseated and pale

Answer 6

Becuase of the activation of the SNS

Question 7

What are palpitations

Answer 7

A noticeably rapid, strong or irregular heartbeat

Question 8

What are the causes of palpitations

Answer 8

Heightened awareness of normal heartbeat

Sinus tachycardia

Atrial or ventricular ectopic beats

Atrial tachycardias

Ventricular tachycardia/fibrillation

Question 9

What is the term for shortness of breath when lying down

Answer 9

Orthopnea

Question 10

What is the term for attacks of severe shortness of breath and coughing that occur a night

Answer 10

Paroxsymal nocturnal dyspnoea

Question 11

What other disease can cause dyspnoea and why is it worse at night

Answer 11

Asthma

Increased parasympathetic drive at night which causes airways to become constricted

Question 12

Why might a patient collapse or lose consciousness

Answer 12

Occur in low/no output cardiac tachy or brady arrhythmias

Caused by cerebral hypoperfusion

Question 13

Which cardiac tachyarrhythmias and bradyarrhythmias might lead to collapse/loss of consciousness

Answer 13

Atrial fibrillation

Ventricular fibrillation

Question 14

What are we feeling when we feel the pulse

Answer 14

The wave being transmitted before the blood arrives

Question 15

What are the different types of pulse rhythm and name some conditions which cause them

Answer 15

Regular

Regularly irregular - 2nd degree heart block

Irregularly irregular - ventricular or artrial ectopics, atrial fibrillation

Question 16

Name the types of pulse character/quality and give an example of a condition which causes them

Answer 16

Thready pulse - shock, LV failure

Bounding pulse - conditions with low peripheral resistance, bradycardia, aortic regurgitation (collapsing/water-hammer pulse)

Slow rising pulse - aortic stenosis

Question 17

What is Buerger’s test

Answer 17

Where you elevate the foot to see if it goes pale - shows ischaemia

If it goes pale then drop the foot, this allows flow to return and the foot becomes flushed