Signs and Symptoms

Question 1

What are the symptoms of heart failure?

Answer 1

• Dyspnoea (reduced lung compliance or increased respiratory rate)
• Orthopnea
• PND
• Loss of energy and tiredness

Question 2

What suggests right sided heart failure?

Answer 2

• Peripheral oedema
• Hepatomegaly
• Elevated JVP
• Ascites
• Nausea
• Anorexia
• Facial engorgement
• Epistaxis

Question 3

What suggests left sided heart failure?

Answer 3

• dyspnoea
• poor exercise tolerance
• fatigue
• orthopnea
• PND
• nocturnal cough (+/-pink frothy sputum)
• wheeze
• nocturia
• cold peripheries
• weight loss
• Bibasal crepitations (pulmonary oedema)

Question 4

What causes pulmonary oedema?

Answer 4

The normal pooling of blood in the lungs in the supine position is added to the chronically congested vasculature; increased venous return cannot be compensated for by the left ventricle.

Question 5

What is the NYHA scale for heart failure?

Answer 5

NYHA1: no symptoms and no limitation in ordinary physical activity

2: mild symptoms and slight limitation
3: marked limitation in activity due to symptoms, even during less than ordinary activity
4: severe limitations, experiences symptoms even while at rest

Question 6

What are the signs for heart failure?

Answer 6

• Pulmonary oedema/pleural effusion (basal crepitations)
• Elevated JVP
• Pitting oedema
• Ascites
• Tachycardia
• S3 gallop
• Enlarged liver

Question 7

What are the peripheral signs of infective endocarditis?

Answer 7

• Petechial
• Sublingual (splinter) haemorrhages: dark red linear lesions in the nail beds
• Osler nodes: tender subcutaneous nodules usually found in distal pads of digits
• Janeway lesions: non-tender maculae on the palms and soles
• Roth spots: retinal haemorrhages with small, clear centres

Question 8

What is the presentation of infective endocarditis?

Answer 8

Fever + new murmur = endocarditis until proven otherwise

Any fever lasting >1 week in those known to be at risk must prompt blood cultures

Question 9

What are the septic signs of infective endocarditis?

Answer 9

• Fever
• Rigors
• Night sweats
• Malaise
• Anaemia
• Splenomegaly
• Clubbing

Question 10

What are the cardiac lesions signs of infective endocarditis?

Answer 10

• Any new murmur or change in pre-existing murmur
• Vegetations may cause valve destruction and severe regurgitation or valve obstruction

Question 11

What are the immune complex depositions in IE?

Answer 11

• Vasculitis
• Microscopic haematuria
• Glomerulonephritis
• AKI
• Roth spots
• Splinter haemorrhages
• Osler’s nodes