Cardiac History Flashcards
(35 cards)
What are the key diseases we need to know about ?
Angina Acute coronary syndromes Heart failure Hypertension Valvular heart disease Tachyarrhythmias
Questions to ask when someone presents with chest pain?
SOCRATES
What are the main symptoms of ischaemic heart disease?
Angina, ACS and heart failure
However some people may not have symptoms before it is diagnosed
What is another term for ischaemic heart disease?
Coronary heart disease
How can cardiac pathologies present in hospital?
Chest pain Palpitations SOB Syncope (see neuro) Swollen ankles
Chest pain
What are the most common causes of acute chest pain?
CVS: ACS
Stable angina
Pericarditis (better leaning forward)
Aortic dissection (radiates to back)
Coronary spasm
Resp: Pleurisy
PE
Pneumothorax
GI: Oesophagitis (2ndary to GORD or hiatus hernia)
Oesophageal spasm
Peptic ulcer
Cholesystitis
Pancreatitis
Other: Musculoskeletal
Anxiety
Chest pain
What are the CVS risk factors?
Smoking, DM, HTN, hypercholest, FHx
Chest pain
What from the history would indicate an ACS?
Sudden onset Central chest pain Radiates to jaw, neck, arm Previous Hx or angina/ACS CVS risk factors
Chest pain
On examination what may indicate an ACS?
CHOLESTEROL
xanthomata (hands), xanthomata (eyes), corneal arcus (but in elderly is normal)
ATHEROSCLEROSIS
weak pulse, peripheral cyanosis, ulcers, Bruits on carotids
ANAEMIA (can cause or exacerbate IHD)
Koilonychia, Conjunctival pallor, glossitis, angular stomatitis
ARRHYTHMIAS
AF - irregularly irregular
Chest pain
What is a typical ‘aortic dissection’ history?
Sudden onset
Central, ripping/tearing chest pain
Radiates to the back
Chest pain
What might you find O/E that could suggest an aortic dissection?
Absent pulse in one arm
Hypertension (in 50%) or hypotension (in 25%)
Difference in BP of >20mmHg between each arm
Pleural effusion (normally on LHS) -
tracheal deviation away from effusion, reduced chest expansion,
Reduced tactile fremitus, stony dull, reduced/absent breath
sounds
Chest pain
How would a pneumothorax history present?
Sudden onset
Pleuritic chest pain + breathlessness (BUT can be painless sob)
Chest pain
What would be found OE of a patient with a pneumothorax?
Hyperinflated chest wall with impaired chest expansion
Tracheal deviation (away from pneumo in tension)
Hyperresonant to percuss
Absent breath sounds
Trauma
Chest pain
Typical history of a PE?
A diagnosis of exclusion!! Very vague presentation so exclude everyone else first.
Sudden onset
SOB +/- haemoptysis +/- pleuritic chest pain +/- tender calf +/- risk factors
Chest pain
What are the risk factors of a PE
Immobility Surgery DVT/Previous emboli Pill Malignancy
Chest pain
What might you find OE of a patient with a PE?
Signs of hypoxia: pale, Cold hands, Lethargic/confused Raised JVP (right heart strain)
WELLS CRITERIA to diagnose a suspected PE
Chest pain
What history would a patient with oesophagitis typically have?
Heartburn - retrosternal pain that may radiate. Worse after eating, lying down, straining. Relieved by antacids
Acid brash
Odynophagia
Chest pain
How might you investigate oesophagitis?
Endoscopy
Barium swallow - may show hernia or stricture
Chest pain
How might you treat oesophagitis?
Lose weight Stop smoking Reduce alcohol intake Avoid eating late at night Sleep with pillows Drugs - PPIs, antacids Surgery - if severe. Make a new functional sphincter
Chest pain
History from a patient with peptic ulcer disease?
Chest + epigastric pain
Duodenal - pain worse at night. Better during eating.
Gastric - pain worse when eating or just before.
Will have some of the risk factors: A - alcohol S - smoking S - steroids H - H pylori O - blood group O N - NSAIDS
Chest pain
What signs and symptoms would make you more concerned about a patient presenting with peptic ulcer disease?
A - anaemia L - weight loss A - anorexia R - recent onset or progressive symptoms M - malaena or haematemesis S - swallowing difficulties
Chest pain
What would you find OE and on investigation of a patient with perforated peptic ulcer?
Signs of hypovolaemic shock
Generalised peritonitis - 1. rebound tenderness, 2. involuntary guarding, 3. washboard rigidity, 4. distended abdo, 5. absent bowel sounds
Pneumo peritoneum on CXR
+ve urea breath test - h pylori
Chest pain
How would you manage a patient with perforated peptic ulcer ?
- Treat the generalised peritonitis
IV Fluids, ABx, analgesia - Laparotomy/laparoscopy
Peritoneal washout
Repair ulcer
Chest pain
What discharge meds would you give a patient with a perforated peptic ulcer?
A PPI = omeprazole + an H2 R antagonist
