Cardiovascular medicine Flashcards
(15 cards)
What is orthopnoea?
What are its associations?
How could you check for it in a consultation?
Orthopnoea is shortness of breath (dyspnoea) when lying flat, leading patients to sleep propped up in bed or sitting in a chair. This occurs because blood is redistributed to the pulmonary circulation when supine (when standing gravity pulls extra fluids away from the lungs, thus reducing congestion).
Associated with LVF (late manifestation) and/or PE.
Note: Also occurs with asthma, chronic bronchitis, sleep apnoea, panic disorder, polycystic liver disease, severe diaphragmatic weakness—other clinical features are key for differential diagnosis.
Ask: How many pillows do you sleep with under your head?
What is heart failure?
A pathophysiologic state in which the heart fails to pump blood at a rate commensurate with the requirements of the metabolising tissues or is able to do so only with an elevated diastolic filling pressure. This occurs due to cardiac abnormality.
Constricting chest pain may suggest…
Angina, oesophageal spasm, or anxiety.
Sharp chest pain may suggest…
Pleural (pleurisy/pleuritis), pericardial, or chest wall associated pathology.
A prolonged, dull (20-30 minutes) [sometimes described as a central crushing pain or pressure] may suggest…
Myocardial Infarction (heart attack)
Define ischaemia…
Cite potential causes of ischaemia.
Chest pain associated with cardiac ischaemia may radiate to which parts of the body?
Ischaemia, a vascular disease, describes restriction in blood supply to tissues. May be cardiac, bowel, brain, limb, or cutaneous. This leads to oxygen shortage impeding cellular metabolism potentially leading to cell/tissue death. There will also be a nutritional deficit and a build up of metabolic wastes, leading to local anaemia.
Interruption in arterial blood supply
Shoulder, either or both arms, neck and jaw.
Explain the difference between thrombosis and an embolism…
A thrombosis is a blood clot
Coronary Artery Disease, also known as Ischaemic Heart Disease, refers to which diseases?
Stable angina, unstable angina, myocardial infarction and sudden cardiac death/cardiac arrest.
Patient reports instantaneous, tearing pain between their scapulae. What must you investigate?
Possibility of dissecting aortic aneurysm.
How might precipitants to pain be used in the differential?
Cardiac pain or anxiety can be differentiated from oesophageal spasm/disease in that the former may arise from cold, exercise, palpitations, or emotion whereas the latter may arise from food, lying flat, hot drinks, or alcohol (meals, however, may also cause angina).
In presentation patient is found to be leaning forwards or bending over in order to revive pain. What is suspected?
Pericarditic pain.
Patient reports pain relief after taking oral glyceryl trinitrate. How does this aid the diagnosis?
Suspect angina, helps to rule out myocardial infarction. Rest may serve similar purpose to GTN.
Dyspnoea is associated with which pathologies?
Cardiac pain (angina/MI), PE (potential orthopnoea), pleurisy/pleuritis, anxiety.
What are potential causes of angina?
Hypertrophic cardiomyopathy, aortic stenosis, paroxysmal supraventricular tachycardia.
Patient presents with chest pain and odd neurological symptoms. What is suspected?
Self-limiting Tietze’s syndrome.
