Cardiac Symptoms & Signs

Question 1

How many people die from coronary heart disease (CHD) annually in the UK?

Answer 1

110,000 people

Question 2

How many people suffer from angina in the UK?

Answer 2

1.4 million people.

Question 3

How many myocardial infarctions (MI) occur per year in the UK?

Answer 3

275,000 per annum.

Question 4

How many cardiac arrests occur outside hospitals each year in the UK?

Answer 4

12,000 cardiac arrests.

Question 5

What percentage of CHD deaths are attributable to smoking?

Answer 5

20%.

Question 6

What is the incidence of new heart failure cases per 1000 population per year?

Answer 6

1 new case per 1000 population per year.

Question 7

What percentage of medical admissions is due to heart failure?

Answer 7

5% of all medical admissions.

Question 8

What percentage of admissions for heart failure are in people over 65?

Answer 8

20% of admissions.

Question 9

What is the readmission rate within 3 months for heart failure patients?

Answer 9

50%.

Question 10

What proportion of NHS expenditure is attributed to heart failure?

Answer 10

2%.

Question 11

List 8 common cardiac symptoms.

Answer 11

Chest pain, breathlessness, palpitations, syncope, haemoptysis, oedema, cough, fatigue.

Question 12

What is the difference between a symptom and a sign?

Answer 12

A symptom is subjective, experienced by the patient; a sign is objective, detectable by examination.

Question 13

What are typical features of anginal pain?

Answer 13

Central, crushing/tight/heavy/squeezing; provoked by exertion/stress; relieved by rest/GTN; lasts 2–10 minutes.

Question 14

How does myocardial infarction pain differ from angina?

Answer 14

Occurs at rest; builds over minutes; not relieved by rest/GTN; lasts 30+ minutes; with breathlessness, sweating, nausea.

Question 15

What are key features of pericarditis pain?

Answer 15

Sharp, stabbing; worse lying flat or with inspiration; eased by sitting up; lasts hours to days.

Question 16

What pain description suggests aortic dissection?

Answer 16

Sudden, tearing, knife-like; radiates to back; excruciating; may include abdominal pain.

Question 17

What pain is typical of pulmonary embolus?

Answer 17

Pleuritic pain over infarcted area, associated with shortness of breath.

Question 18

What is dyspnoea?

Answer 18

Abnormal, uncomfortable awareness of breathing.

Question 19

What are hallmark symptoms of pulmonary oedema?

Answer 19

Abrupt onset; pink frothy sputum; orthopnoea; cold, clammy skin.

Question 20

What is paroxysmal nocturnal dyspnoea (PND)?

Answer 20

Waking 2–4 hours after sleep with breathlessness, coughing, wheezing; needing to sit up; lasts 15–30 minutes.

Question 21

What does NYHA Class III indicate?

Answer 21

Symptoms on modest exertion.

Question 22

What is orthopnoea?

Answer 22

Breathlessness when lying flat, relieved by sitting up.

Question 23

Define palpitations.

Answer 23

Unpleasant awareness of the heartbeat.

Question 24

What is syncope?

Answer 24

Brief, transient loss of consciousness and postural tone, with rapid recovery.

Question 25

What are features of cardiac syncope?

Answer 25

Sudden onset; no aura; no jerks/incontinence; injury common; immediate recovery.

Question 26

What are features of vasodepressor syncope?

Answer 26

Gradual faintness after prolonged standing; grey-out vision; often triggered by stress.

Question 27

What does pink frothy sputum indicate?

Answer 27

Pulmonary oedema.

Question 28

What conditions cause rusty sputum?

Answer 28

Pneumococcal pneumonia.

Question 29

Name 4 cardiac causes of haemoptysis.

Answer 29

Pulmonary oedema, mitral stenosis, pulmonary infarction, lung carcinoma.

Question 30

Name 4 causes of peripheral oedema.

Answer 30

Cardiac failure, chronic venous insufficiency, hypoalbuminaemia, drugs (e.g., NSAIDs).

Question 31

What is cyanosis?

Answer 31

Bluish discoloration from increased deoxygenated haemoglobin (>4g/dl or SaO2 <85%).

Question 32

Name 3 cardiac causes of clubbing.

Answer 32

Cyanotic congenital heart disease, infective endocarditis, atrial myxoma.

Question 33

What is a splinter haemorrhage indicative of?

Answer 33

Infective endocarditis.

Question 34

What is arcus senilis associated with?

Answer 34

Familial hypercholesterolemia.

Question 35

What is xanthelasma a sign of?

Answer 35

Lipid disorders.

Question 36

What are key features to assess in an arterial pulse?

Answer 36

Rate, rhythm, volume, character.

Question 37

What does the JVP “a wave” represent?

Answer 37

Atrial systole.

Question 38

What does the JVP “v wave” represent?

Answer 38

Venous filling of right atrium during ventricular systole.

Question 39

What causes an S3 (“Kentucky”) sound?

Answer 39

Early diastole; due to failing left ventricle or rapid ventricular filling.

Question 40

What causes an S4 (“Tennessee”) sound?

Answer 40

Late diastole; atrial contraction into stiff ventricle; sign of LV failure.

Question 41

What murmur is heard in aortic stenosis?

Answer 41

Ejection systolic murmur at right upper sternal edge; radiates to neck.

Question 42

What murmur is heard in mitral regurgitation?

Answer 42

Pan-systolic murmur at apex, radiates to axilla.

Question 43

A patient has a collapsing pulse, displaced apex, early diastolic murmur at 4th ICS LSE. Diagnosis?

Answer 43

Aortic regurgitation.

Question 44

What are Janeway lesions?

Answer 44

Non-tender erythematous lesions on palms/soles, associated with infective endocarditis.

Question 45

What are Osler nodes?

Answer 45

Tender nodules on fingertips or toes, associated with infective endocarditis.

Question 46

What retinal sign is associated with infective endocarditis?

Answer 46

Roth spots (retinal microhaemorrhages).

Question 47

A patient has chest pain radiating to jaw, ECG shows LVH and T-wave inversion V3–V6, and transient blindness in one eye. Likely diagnosis?

Answer 47

Aortic dissection.