Cardiac assessment and differentials

Question 1

What are some cardiovascular causes for chest discomfort?

Answer 1

Angina, MI, Pericarditus and Aortic distension.

Question 2

What are some other causes for chest discomfort?

Answer 2

MSK pain, Pnemotherax and Oseopharyngeal spasm

Question 3

What are some cardiovascular causes for breathlessness?

Answer 3

Heart Failure, Valvular disease, PE, Angina and pulmonary hypertension.

Question 4

What are some other causes for breathlessness?

Answer 4

Anxiety, COPD, Respiratory disease and obesity.

Question 5

What are some cardiovascular causes for Syncope/ presyncope?

Answer 5

Posteral hypotension, Arrhythmias, aortic stenosis, hypertronic cardiomyopathy (heart muscle becomes thickened).

Question 6

What are some other causes for Syncope/ presyncope?

Answer 6

Simple faints, epilepsy, anxiety

Question 8

What does ischemia cause on an ECG?

Answer 8

ST segment depression depression and t wave inversion. Causes repolarisation to occur along an abnormal pathway

Question 9

What is an infarction?

Answer 9

Where tissue has died

Question 10

Define a STEMI

Answer 10

Portion of the cardiac muscle that is deprived of coronary artery blood flow long enough that sections of the muscle die.

Question 11

What are the clinical features of a STEMI

Answer 11

• Central Chest pain described as heavy, squeezing, crushing or tight
• levines sign (unconsciously clenches a fist when describing pain)
• pain radiating to arm, neck or jaw
• palpitations
• feeling of impending doom
• hypotension
• confusion.
• pale, cold or clammy
• ST elevation

Question 12

What is the management of a STEMI

Answer 12

Aspirin 300mg
GTN 400mcg - check bp before giving
Two pain scores recorded before and after treatment
Analgesia (entonox, paracetamol and morphine)
SATS recorded

Question 13

What is angina pectoris?

Answer 13

Supply of oxygen to the myocardium is insufflent to meet the demands.

Question 14

What is the presentation of unstable angina?

Answer 14

Chest pain while at rest
SOB, sweating, nausea, vomiting and palpitations
ECG showing st depression, and or t wave inversions or normal ecg

Question 15

What are the signs and symptoms of acute dissecting aneurysm of the aorta?

Answer 15

Chest pain
Pain comes on suddenly - ripping, tearing or sharp
ECG changes can mimic an MI

Question 16

What are the signs and symptoms of expanding and ruptured AAA?

Answer 16

Sudden onset of abdominal or back pain.
Pain is constant and cannot be relieved by changing position.
Keep as flat as possible

Question 17

What are the signs and symptoms of cocaine toxicity?

Answer 17

Hypertension
Irregular heart beat
Nausea
Agitation
Tremors
Anxiety
Confusion

Question 18

What is the management for cocaine toxicity?

Answer 18

Diazepam

Question 19

What does diazepam do in cocaine toxicity?

Answer 19

CNS depressant, sedative, anticonvulsant

Question 20

What ECG changes could suggest pericarditus?

Answer 20

Global saddle shape ST elevation

Question 21

What ECG changes indicate a bifasicucular block?

Answer 21

Right bundle branch block with Left axis deviation (left anterior fasicular block)
OR
RBBB with Right axis deviation (Left posterior fasicular block)

Question 22

Why is it important to take notice of the patients medication history?

Answer 22

Can provide insight into their medical history.

Question 23

What locations allow me to listen for heart murmours?

Answer 23

Aortic - 2nd intercostal space, right side sternal boarder
Pulmonary - 2nd intercostal space, left side sternal boarder
Tricuspid - 4th intercostal space, left lower boarder
Mitral - 5th intercostal space mid clavicular

Question 24

What can Mallor flush indicate?

Answer 24

Mitral stenosis or CO2 retention

Question 25

What is mitral stenosis?

Answer 25

Condition where the mitral valve, which separates the left atrium and left ventricle of the heart, narrows, making it difficult for blood to flow from the left atrium into the left ventricle.

Question 26

What causes a MI?

Answer 26

= A thrombus blocks a coronary artery which means theres reduced or no blood flow. = No blood = no oxygen delivery and ischemia = Damages myocardium, the heart still beats and uses ATP leading to injury and infarction and the part of the myocardium dies. = This prevents effective contractions of the cardiac myocytes

Question 27

What are the symptoms of angina:

Answer 27

= Retrosternal, central chest pain = Heavy / crushing = may radiate = breathlessness = relieved by nitrates = mild to moderate pain

Question 28

What are the symptoms of an MI?

Answer 28

= Retrosternal, central chest pain = Radiate to left arm/ jaw = crushing = nausea possible = pale and clammy = SOB = Levines sign = severe pain

Question 29

What are some differentials for ACS?

Answer 29

= Disecting thoracic aortic aneurism - tearing/ ripping severe pain, radiates to back and shoudler blades, may have syncope, sweating/ pale, absent radial pulse and reduced bp. = PE - more pinpoint pain (pleuretic), worse on inspiration, reduced SATS, evidence of DVT. = Pericarditius - Gradual onset, cold/ flu symptoms, fever likely, worse on inspiration/ laying down, eased by leaning forward.

Question 30

What are some differentials for heart failure?

Answer 30

= COPD exacerbation - SOB, tachycardia, crackles (if associated with chest infection), productive cough if associated with with chest infection, dry cough, often leads to right ventricular heart failure = Chest infection - SOB, tachycardia, crackles in lungs, pyrexia, productive cough with green/ yellow phelgm = Mi - Chest pain, SOB and ECG changes.

Question 31

What are some symptoms for left sided heart failure?

Answer 31

= Orthopnea (shortness of breath that occurs while lying flat) = pulmonary congestion (crackles, cough, tachypnoea and SOB) = cyanosis

Question 32

What are some symptoms for right sided heart failure?

Answer 32

Raised JVP peripheral oedema Ascites (fluid collects in spaces in your belly (abdomen) Often follows from chronic respiratory disorders

Question 33

define what endocarditus is:

Answer 33

A rare and potentially fatal infection of the inner lining of the heart (endocardium) -Most commonly caused by bacteria entering the bloodstream and travelling to the heart, inflaming the hearts valves and chambers

Question 34

What are the signs and symptoms of endocarditus?

Answer 34

- Fatigue. - Fever - Joint pain - SOB - Unexplained weight loss - Night sweats - Small red spots on skin

Question 35

What are the symptoms for pericarditus?

Answer 35

- Sharp chest pain that worsens with deep breathing or when lying down. This pain can raidate to the shoulders, arms and abdomen. - SOB - Cough - Fatigue - Fever

Question 36

Define what pericarditus is:

Answer 36

Inflammation of the lining of the heart called the pericardium

Question 37

What causes pericarditus?

Answer 37

Heart conditions Autoimmimmune disorders infections