ALS Lecture 8 - Cardiac Symptoms and Signs DONE Flashcards
(112 cards)
1
Q
spectrum for acute coronary syndrome (3)
A
unstable angina, NSTEMI MI, STEMI
2
Q
unstable angina
A
angina without exertion
3
Q
NSTEMI (3)
A
non-ST elevation MI, partial blockage coronary artery, raised troponin
4
Q
STEMI (2)
A
ST elevation MI, completely blocked artery
5
Q
cardinal symptoms of acute coronary syndrome (8)
A
chest pain, breathlessness, palpitations, syncope, haemoptysis, oedema, cough, fatigue
6
Q
acute coronary syndrome chest pain character
A
crushing ischaemic pain
7
Q
acute coronary syndrome radiation
A
left arm, jaw
8
Q
SOCRATES
A
site, onset, character, radiation, associated symptoms, time course, exacerbating/alleviating factors, severity
9
Q
cardiac chest pain
A
site
10
Q
character of cardiac chest pain (2)
A
tight, crushing
11
Q
time course of MI
A
always there
12
Q
time course of angina
A
comes with stress/exertion
13
Q
label the diagram of cardiac chest pain (A)
A
done
14
Q
chest pain is not likely to be stable angina (4)
A
prolonged, unrelated to activity, brought on by breathing in, other symptoms
15
Q
fill in the table of classification of chest pain (B)
A
done
16
Q
fill in the table of classification of angina (C)
A
done
17
Q
fill in the table of angina vs MI pain (D)
A
done
18
Q
pericarditis pain character (2)
A
sharp, stabbing
19
Q
pericarditis is worse with (2)
A
inspiration, lying flat
20
Q
pericarditis is eased by (2)
A
sitting up, NSAIDs
21
Q
pericarditis comes on (2)
A
hours, days
22
Q
pericarditis causes (2)
A
infection, pericardial infusion
23
Q
pericarditis changes on ECG (2)
A
concave scooped ST elevation on all leads, PR depression
24
Q
look at the ECG example of pericarditis (E)
A
done
25
aortic dissection pain character (4)
sudden, tearing, knife-like, excruciating
26
aortic dissection radiates to
back
27
aortic dissection is often seen in (3)
elderly, hypertension, stressful job
28
aortic dissection associated symptoms (20-40%)
abdo pain
29
pulmonary embolus pain character
pleuritic pain
30
pulmonary embolus associated symptoms (4)
SOB, tachycardia, AF, tachypnoea
31
look at the diagram of the diagnostic algorithm (F)
done
32
acute coronary syndrome is an umbrella term that encompasses (3)
unstable angina, NSTEMI, STEMI
33
bretahlessness can be (2)
dyspnoea, tachypnoea
34
dyspnoae
uncomfortable awareness of breathing
35
tachypnoea
faster breathing than normal, >24breaths per minute
36
pulmonary oedema time course (2)
abrupt, minutes
37
pulmonary oedema breathlessness associated symptoms (4)
pink frothy sputum, orthopnoea, cold, clammy
38
pulmonary oedema causes (3)
MI, left ventricular dysfunction, renal artery stenosis
39
pulmonary embolism chest x-ray (3)
cardiomegaly, bats appearance (fluid/congestion), fluid in interstitial space (kerley B lines)
40
paroxysmal nocturnal dyspnoea (5)
breathless, wake from sleep, frightening, cough, wheeze
41
how long does PND last?
15-30mins
42
PND relevant question
do they have to sit up whilst sleeping?
43
PND causes (2)
reduced respiratory drive, adrenergic activity of myocardium at night
44
chronic heart failure symptoms (5)
exertional breathlessness, orthopnoea, nocturnal cough, PND, ankle oedema
45
classes of chronic heart failure symptoms (1-4)
1. none
2. severe exertion, more than normal
3. modest exertion
4. at rest
46
sensitivity is the probability of a
positive test in patients with disease
47
specificity is the probability of a
negative test in patients without disease
48
palpitations
unpleasant awareness of heart beat
49
syncope (3)
fainting, collapse, due to cerebral hypoperfusion
50
exertional syncope worrying in young people as it could indicate
underlying heart disease
51
in syncope it is important to try and get
witness account
52
defining characteristic symptoms of syncope (5)
transient, self-limited loss of consciousness, falling, rapid onset, prompt spontaneous recovery
53
questions about circumstances prior to syncope attack (5)
position, activity, situation, predisposing factors, precipitating events
54
questions about onset of syncope attack (5)
nausea, vomiting, cold feeling, sweating, aura
55
questions about syncope attack, eye witness (4)
skin colour, duration, movements, tongue biting
56
questions about end of syncope attack (7)
nausea, vomiting, cold feeling, confusion, skin colour, wounds, aches
57
questions about background of syncope patient (5)
happened before, fh, cardiac disease, medication, neuro history
58
pink frothy sputum (1)
pulmonary oedema
59
clear white mucoid sputum (2)
viral, longstanding bronchial irritation
60
thick, yellowish sputum (1)
bacterial
61
rusty sputum (1)
pneumococcal pneumonia
62
blood streaked sputum (4)
TB, bronchiectasis, lung cancer, pulmonary infarction
63
haemoptysis causes (4)
pulmonary oedema, mitral stenosis, pulmonary infarction, lung cancer
64
haemoptysis
expectoration of blood, streaked or lots
65
peripheral oedema causes (4)
cardiac failure, chronic venous insufficiency, hypoalbuminaemia, drugs
66
ankle oedema isn't
specific/sensitive for coronary heart failure
67
peripheral oedema can also be caused by
low protein states
68
low protein states that can cause peripheral oedema (5)
nephrotic syndrome, cirrhosis, low albumin, drugs, pregnancy
69
jugular venous pulse is a measure of
right atrial pressure
70
JVP normal height
2-3cm, elevated >4cm
71
label the graph of JVP height with time (G)
done
72
causes of elevated JVP (5)
heart failure, constrictive pericarditis, cardiac tamponade, renal disease, SVC obstruction
73
large A waves in JVP causes (3)
pulmonary hypertension, tricuspid stenosis, cannon waves in CHB or VT
74
JVP no A wave cause (1)
atrial fibrillation
75
JVP giant V wave causes (3)
complete heart block, VT, tricuspid regurgitation
76
JVP steep Y descent cause (1)
constrictive pericarditis
77
schamroth window test (3 steps)
1. pt holds nails against each other
2. should be diamond space
3. if missing = clubbing
78
clubbing of toes but not fingers indicates (1)
patent ductus arteriosus
79
clubbing causes (3)
infective endocarditis, congenital cyanotic heart disease, atrial myxoma
80
splinter haemorrhage causes (5)
gardening, infective endocarditis, vascular disease, rheumatoid arthritis, systemic lupus erythematous
81
palmar erythema causes (2)
high oestrogen, liver disease
82
peripheral cyanosis cause (1)
deoxygenated Hb rises
83
capillary refill should be
<2-3secs
84
general inspection steps (3)
breathless, hands/nails, face
85
in the face look for (5)
central cyanosis, anaemia, poor oral hygiene, high arched palate, malar flush
86
look at the pictures (H)
done
87
pulse rate
count for 15secs, times 4
88
tachycardia
>100bpm
89
bradycardia
<50bpm
90
1st heart sound
closure of mitral and tricuspid valves
91
2nd heart sound
closure of aortic and pulmonary valves
92
breath sounds (4)
crackle, wheeze, rhonchi, pleural rub
93
crackles (3)
explosive, sharp, discrete bursts
94
wheeze (3)
continuous, high-pitched through respiration
95
rhonchi (3)
low-pitched, disappear after cough, no consequence
96
pleural rub (3)
sound of inflamed pleurae, vibrations, PE
97
palpation (3)
apex beat, thrills, heaves
98
where is the apex beat?
5th intercostal space, mid-clavicular line
99
osler nodes (2)
painful lesions on fingers, deposition of immune complexes
100
janeway lesions (2)
black spots on thenar/hypothenar eminence, septic emboli
101
roth's spot (2)
retinal haemorrhage, infective endocarditis
102
when auscultating, listen to (3)
heart sounds, added sounds, murmurs
103
S3 sounds like
ken-tuc-ky
104
S4 sounds like
ten-es-see
105
gallop rhythms
S3, S4
106
S3 is
start of diastole after S2
107
S4 is
end of diastole before S1
108
S3 causes
failing left ventricle (dilated congestive heart failure)
109
S4 causes (4)
blood into hypertrophic ventricle, aortic stenosis, hypertension, hypertrophic cardiomyopathy
110
S4 is best heard at
cardiac apex
111
heart murmur is very common in
prosthetic valves
112
label the table of aortic stenosis vs. sclerosis (I)
done
