W01L01 History Taking: The Cardiovascular System

Question 1

Cardiovascular system enquiry

Answer 1

Chest Pain
Palpitation
Dyspnoea (SOB)
Syncope (LOC)
Dizziness
Oedema
Fatigue

Question 2

Peripheral venous insufficiency symptoms

Answer 2

Ulcers
Venous eczema
Varicose veins
Oedema
Discolouration

Question 3

Peripheral arterial insufficiency symptoms

Answer 3

Hair loss
Necrotic areas
6 P (pain, pallor, perishing cold, pulselessness, paresthesia, paralysis)
Could be caused by emboli

Question 4

People with peripheral arterial disease likely to also have…

Answer 4

Cerebrovascular and coronary artery diseases

Question 5

Intermittent claudicaiton

Answer 5

calf pain due to inadequate blood supply

Question 6

Claudication distance

Answer 6

the distance you can walk before you get calf pain

Question 7

Acute limb ischaemic

Answer 7

5P (pain, pallor, perishing cold, paraesthesia, paralysis)

Commonly caused by embolic disease

Question 8

Critical limb ischaemia

Answer 8

Blood supply is so narrowed, the patient develops minimal symptoms
In very severe cases, the pain comes on during rest

Question 9

Clarifying symptoms

Answer 9

Speed of onset
Duration/frequency
Severity/character
Radiation
Associated symptoms
Aggravating/relieving factors
Impact on quality of life

Question 10

Past medical history (points to consider)

Answer 10

History of vascular disease
Diabetes
Hyperthyroidism
Renal disease (eGFR, urea, creatinine)
Hypertension
Hypercholesterolaemia

Question 11

Angina

Answer 11

A clinical syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress which increase myocardial oxygen demand

Question 12

Angina key symptom

Answer 12

Central chest tightness - not necessarily pain, but discomfort or heaviness

Question 13

Stable angina episodic central

Answer 13

tight/heavy/retrosternal or left side of chest/crushing/band-like

Question 14

Stable angina radiation

Answer 14

to jaw, neck, back, one or both arms

Question 15

Stable angina associated symptoms

Answer 15

sweating, nausea, breathlessness

Question 16

Stable angina aggravating and relieving factors

Answer 16

aggravated by exertion, cold, emotion

ALWAYS relieved by rest and GTN (Nitroglycerin) spray

Question 17

Is stable angina predictable?

Answer 17

Yes, similar to intermittent claudication
Appears with exercise and goes away with rest/GTN spray
Different from unstable angina

Question 18

Key features of stable angina

Answer 18

Predictable in onset
Reproducible
Relieved by rest or GTN
Stable angina is NOT an acute coronary syndrome

Question 19

Acute myocardial infarction

Answer 19

Sustained chest pain not relieved by GTN
ECG changes and cardiac enzyme release
Silent MI in diabetics and elderly

Question 20

Acute coronary syndromes

Answer 20

Unstable Angina
Non St elevation myocardial infarction (NSTEMI)
ST elevation myocardial infarction (STEMI)

Question 21

Unstable Angina

Answer 21

On minimal exertion or rest
Worsening in intensity, frequency, duration
ECG may be normal
Clinically difficult to distinguish from acute MI

Question 22

NSTEMI (non ST elevation myocardial infarction)

Answer 22

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

Question 23

STMI (ST elevation myocardial infarction

Answer 23

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

Question 24

Only difference between NSTEMI and STEMI

Answer 24

ECG

Question 25

Pericarditis

Answer 25

Inflammation of pericardium | Relieved by sitting forwards

Question 26

Aortic dissection

Answer 26

Sudden and severe tearing and deep pain Radiates to left shoulder/back Surgical emergency

Question 27

Non modifiable cardiovascular risk factors

Answer 27

``` Age Ethnicity Sex Personal/Family history Low birth weight ```

Question 28

Modifiable cardiovascular risk factors

Answer 28

``` Hypertension Hyperlipidaemia Diabetes Obesity Smoking Sedentary lifestyle ```

Question 29

Dysponea

Answer 29

Shortness of birth

Question 30

Orthopnoea

Answer 30

Shortness of breath when lying flay

Question 31

Paroxysmal nocturnal dyspnoea

Answer 31

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

Question 32

Dyspnoea - causes

Answer 32

Cardiac failure or angina or MI | Respiratory

Question 33

Palputation

Answer 33

Awareness of heartbeat | Causes could be premature beats (ectopics), tachy or bradycardia

Question 34

Dizziness

Answer 34

Lightheadedness vs vertigo

Question 35

Syncope

Answer 35

Sudden/brief loss of consciousness

Question 36

Red Flags

Answer 36

``` Chest pain Palpitation Dyspnoea Syncope Dizziness Oedema Fatigue ```