Common Cardiac Complaints

Question 1

what are the most common cardiac complaints?

Answer 1

Chest pains  
Palpitations 
Shortness of breath 
Swelling 
Syncopal Episode

Question 2

if a pt presents with a cardiac complaint & there is low suspicion for ACS, what are some possible differential diagnoses?

Answer 2

non-cardiac: 
pulmonary & GI 
-GERD
-pneumonia
-pulmonary embolism

skin
-shingles d/t neuropathic pain

MSK

• pleurisy
• costochondritis

Question 3

what is the most common symptom assoc. with CAD & why is it dangerous?

Answer 3

chest pain
-Leading cause of mortality in men and women
 Black ethnicity is highest
1 in every 7 deaths

Question 4

True or False:

Chest discomfort does not mean chest pain.

Answer 4

False.

Chest discomfort described as tightness & pressure = chest pain

Question 5

what are the classic exertional symptoms in chest pain?

Answer 5

pain
pressure
tightness

Question 6

what are some atypical symptoms that can be used to describe chest pain?

Answer 6

Cramping
grinding
burning
ripping
tearing

Question 7

what is the most concerning differential diagnosis assoc. w/ chest pain?

Answer 7

ACS

• acute MI
• unstable angina
• STEMI
• NSTEMI

Question 8

True or false:

A CXR showing cardiomegaly is pertinent in assessing for ACS.

Answer 8

False

Question 9

What should be ordered when ACS is suspected?

Answer 9

EKG
CXR
Labs: 
 >CBC: r/o infection/anima
 > CMP: electrolyte abnormalities
 > cardiac enzymes

Question 10

what is the true definition of palpitations?

Answer 10

Awareness of heartbeat

Question 11

what are descriptors of palpitations?

Answer 11

 Pounding
 Skipping
 Racing
 Fluttering

Question 12

what differential diagnoses should be considered when a pt presents w/ palpitations?

Answer 12

 Arrhythmia
 >> Atrial Fibrillation
 >> PAC/PVC 
 Anxiety 
 Hyperthyroidism 
 Medication Side effects 
 Recreational Drugs

Question 13

if a pt presents w/ palpitations, what should you look for upon inspection of the neck?

Answer 13

thyroid abnormalities such as nodules & goiters

-hyperthyroidism

Question 14

if there is a suspicion for drug side effects in a pt w/ palpitations, what should you inspect for?

Answer 14

HEENT
-pupils 
 > dilation
-mucus membranes
-nasal mucosa 
 > ulcerations w/ cocaine use

Question 15

What should be ordered when working up palpitations?

Answer 15

 EKG 
 CXR -> only if indicated
 Labs:
 CBC
 Chemistry Panel
 Thyroid panel
 Cardiac Enzyme -> will reflect damage of the heart in afib, cocaine use

Question 16

what rhythm abnormalities are associated with a regularly irregular rhythm?

Answer 16

trigeminy- every 3 beats

bigeminy- couplets

Question 17

what rhythm abnormalities are associated with an irregular rhythm?

Answer 17

sinus arrhythmias
PAC
PVC

Question 18

what rhythm abnormalities are associated with a irregularly irregular rhythm?

Answer 18

afib

atrial flutter

Question 19

what is dyspnea?

Answer 19

uncomfortable awareness of breathing that is inappropriate for the level
of exertion

Question 20

what is orthopnea & when s it noticeable?

Answer 20

dyspnea that occurs when patient is supine
-improves when
patient sits up

Question 21

what is paroxysmal nocturnal dyspnea?

Answer 21

Sudden dyspnea and orthopnea that awaken the

patient from sleep

Question 22

True or False: A patient that experiences paroxysmal nocturnal dyspnea will start with orthopnea

Answer 22

False

Question 23

what systems should be considered when a pt c/o SOB?

Answer 23

cardiac, pulmonary, GI, psychiatric causes

Question 24

which type of CHF is associated with SOB?

Answer 24

left sided heart failure

-d/t lack of blood from from left side of the heart

Question 25

if a pt c/o SOB, what differentials should be considered?

Answer 25

```  CHF (left sided heart failure)  PE  PTX  Anxiety  COPD  Asthma  Anemia ```

Question 26

if a pt c/o SOB and you suspect CHF, what other findings do you expect to find on exam?

Answer 26

pitting edema in the lower extremities

Question 27

what should be ordered when evaluating a pt with SOB?

Answer 27

 EKG  Imaging: CXR vs VQ scan vs CT chest  Labs: ? CBC, cardiac enzymes, d-dimer

Question 28

if you have a high suspicion for a pt having a PE, what is the best test to order?

Answer 28

VQ scan | >> D-Dimer is better to evaluate for blood clots

Question 29

in a pt that has pitting edema on exam, how much fluid is accumulated in the extravascular interstitial space?

Answer 29

> 5L fluid

Question 30

in a pt with R sided CHF, what is the first symptom they will present with?

Answer 30

peripheral edema/leg swelling

Question 31

in a pt with L sided CHF, what is the first symptom they will present with?

Answer 31

SOB

Question 32

what conditions can cause build up of edema?

Answer 32

``` Right or left ventricular dysfunction  Pulmonary HTN  COPD  Nutritional  Positional (dependent)  Nephrotic syndrome  Liver disease  Metastatic disease  autoimmune issues ```

Question 33

how does right sided heart failure cause swelling?

Answer 33

dysfunction of the right atrium/ventricle -> | prohibits blood from returning to the heart = back up of blood in periphery

Question 34

how does left sided heart failure cause swelling?

Answer 34

dysfunction of left atrium/ventricle - prohibits blood from returning to the heart from the lungs - pt w/ L CHF will still develop SOB first then swelling as it progresses

Question 35

what is the most common cause of R sided heart failure?

Answer 35

left sided heart failure

Question 36

what should be ordered for a pt when heart failure is suspected?

Answer 36

```  EKG  ECHO  CXR  Labs: ?CBC CMP -> LFTs UA -> protein urea ```

Question 37

True or False: | A pt w/ a known hx of CHF presents w/ increased swelling in the legs. An EKG is not necessary to order.

Answer 37

True | -Echo should be ordered instead

Question 38

what is syncope?

Answer 38

Transient loss of consciousness, followed by recovery

Question 39

what is the most common cause of syncope?

Answer 39

neuro-cardiogenic -> vasovagal

Question 40

why do vasovagal syncopes occur?

Answer 40

reflex withdrawal of sympathetic tone and increased vagal tone causing drop in blood pressure and heart rate ex) blood drawn, trauma/injury/ emotional issues, immunization (HPV)

Question 41

what pathology can cause syncope?

Answer 41

Cardiac arrhythmias