W01L01 History Taking: The Cardiovascular System Flashcards
Cardiovascular system enquiry
Chest Pain Palpitation Dyspnoea (SOB) Syncope (LOC) Dizziness Oedema Fatigue
Peripheral venous insufficiency symptoms
Ulcers Venous eczema Varicose veins Oedema Discolouration
Peripheral arterial insufficiency symptoms
Hair loss
Necrotic areas
6 P (pain, pallor, perishing cold, pulselessness, paresthesia, paralysis)
Could be caused by emboli
People with peripheral arterial disease likely to also have…
Cerebrovascular and coronary artery diseases
Intermittent claudicaiton
calf pain due to inadequate blood supply
Claudication distance
the distance you can walk before you get calf pain
Acute limb ischaemic
5P (pain, pallor, perishing cold, paraesthesia, paralysis)
Commonly caused by embolic disease
Critical limb ischaemia
Blood supply is so narrowed, the patient develops minimal symptoms
In very severe cases, the pain comes on during rest
Clarifying symptoms
Speed of onset Duration/frequency Severity/character Radiation Associated symptoms Aggravating/relieving factors Impact on quality of life
Past medical history (points to consider)
History of vascular disease Diabetes Hyperthyroidism Renal disease (eGFR, urea, creatinine) Hypertension Hypercholesterolaemia
Angina
A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase myocardial oxygen demand
Angina key symptom
Central chest tightness - not necessarily pain, but discomfort or heaviness
Stable angina episodic central
tight/heavy/retrosternal or left side of chest/crushing/band-like
Stable angina radiation
to jaw, neck, back, one or both arms
Stable angina associated symptoms
sweating, nausea, breathlessness
Stable angina aggravating and relieving factors
aggravated by exertion, cold, emotion
ALWAYS relieved by rest and GTN (Nitroglycerin) spray
Is stable angina predictable?
Yes, similar to intermittent claudication
Appears with exercise and goes away with rest/GTN spray
Different from unstable angina
Key features of stable angina
Predictable in onset
Reproducible
Relieved by rest or GTN
Stable angina is NOT an acute coronary syndrome
Acute myocardial infarction
Sustained chest pain not relieved by GTN
ECG changes and cardiac enzyme release
Silent MI in diabetics and elderly
Acute coronary syndromes
Unstable Angina
Non St elevation myocardial infarction (NSTEMI)
ST elevation myocardial infarction (STEMI)
Unstable Angina
On minimal exertion or rest
Worsening in intensity, frequency, duration
ECG may be normal
Clinically difficult to distinguish from acute MI
NSTEMI (non ST elevation myocardial infarction)
Symptoms suggest acute MI
ECG may be normal or non-specific abnormalities such as ST segment depression or T wave inversion
Blood test will show troponin release and usually elevated cardiac enzymes such as creatine kinase or lactate dehydrogenase
STMI (ST elevation myocardial infarction
Symptoms suggest acute MI
ECG show acute ST segment elevation and Q waves likely to develop to represent the full thickness of the myocardium being damaged
Blood test will show troponin release and elevated cardiac enzymes
Early effective treatment may limit myocardial damage
Only difference between NSTEMI and STEMI
ECG
Pericarditis
Inflammation of pericardium
Relieved by sitting forwards
Aortic dissection
Sudden and severe tearing and deep pain
Radiates to left shoulder/back
Surgical emergency
Non modifiable cardiovascular risk factors
Age Ethnicity Sex Personal/Family history Low birth weight
Modifiable cardiovascular risk factors
Hypertension Hyperlipidaemia Diabetes Obesity Smoking Sedentary lifestyle
Dysponea
Shortness of birth
Orthopnoea
Shortness of breath when lying flay
Paroxysmal nocturnal dyspnoea
Waking up in the middle of the night with shortness of breath
When lying down, venous return is increased and if the heart has trouble clearing the fluid, pressure builds up in the lungs and fluid leaks into the lungs space (pulmonary oedema), causing chest pain
Dyspnoea - causes
Cardiac failure or angina or MI
Respiratory
Palputation
Awareness of heartbeat
Causes could be premature beats (ectopics), tachy or bradycardia
Dizziness
Lightheadedness vs vertigo
Syncope
Sudden/brief loss of consciousness
Red Flags
Chest pain Palpitation Dyspnoea Syncope Dizziness Oedema Fatigue
