LICP questions Flashcards
What would confirm a diagnosis of angina?
Coronary angiography
What would a typical history of stable angina involve?
Gripping, tight crushing chest pain that radiates to the left arm. Exacerbated by exercise and relieved by GTN
What is a possible surgical interventional for angina?
Stent with ballon angiography
What features in the history help to decide whether this is cardiac chest pain, typical or atypical?
Characteristics of the pain -
Location Radiation Severity Duration Frequency Provoking and relieving factors
How to distinguish stable angina from ACS/MI?
Relationship to physical exertion, relieved by rest or glyceryl trinitrate within about 5 minutes
What are the major risk factors for coronary artery disease?
Cardiovascular risk factors -
HTN Hyperlipidaemia DM FH smoking
When do you consider aortic stenosis as a differential for coronary artery disease?
Crescendo-decrescendo systolic murmur
What is secondary prevention, diet and lifestyle measures and medications
Secondary prevention - reducing impact of disease by early identification
Diet - Healthy eating, lower calorie, lower fat diet
Lifestyle: smoking cessation, exercise, weight loss
Medication - DAPT if CHADVASC indicates, beta blockers, flu jab, ACEi for bp
How is angina graded?
Functional status - canadian cardiac society
Outline a cardiac examination?
- Introduction
- General inspection
- Hands
- Pulses and BP
- Eyes and mouth
- Close inspection of the chest
- Palpation
- Auscultation
- Final steps: posterior chest, sacral odema, legs
- Closing
Outline a cardiac examination?
- Introduction
- General inspection
- Hands
- Pulses and BP
- Eyes and mouth
- Close inspection of the chest
- Palpation
- Auscultation
- Final steps: posterior chest, sacral odema, legs
- Closing
What pulses and pressures need to measured in a cardiac examination?
Radial pulse Brachial pulse BP Carotid pulse JVP Hepatojugular reflex
How do you measure JVP?
- Position the patient in a semi recumbent position
- Ask the patient to turn their head to the left
- Inspect for evidence of IJVP from the medial end of the clavicle, under medial SCM and to the ear lobe
- Measure by assessing the vertical distance between the sternal angle and the top of the IJV (≤3)
What is a positive hepatojugular reflex?
Raised JVP when pressure is applied to the liver and ≥4cm
What are the symptoms of left sided heart failure?
BLUE BLOATER
\+Paroxysmal nocturnal cough \+ Elevated pulmonary capillary wedge pressure \+Pulmonary congestions (cough, crackles, wheezes, tachypnoea \+ Restlessness \+ Confusion \+ Orthopnoea \+ Cyanosis \+ Extertional dyspnoea
What are are the symptoms of right sided heart failure?
PINK PUFFER
\+ Fatigue \+ Increased peripheral venous pressure \+Ascities \+ Enlarged liver and spleen \+ Distended jugular veins \+ GI problems and anorexia \+ Weight gain \+ Pitting oedema
With regard to shortness of breath, what suggested that this may be due to right sided heart failure?
Ankle/abdomen swelling, fatigue/tiredness, weight gain ( over 2kg in a week)
What differentials for heart failure should be considered?
Valvular disease Cardiomyopathy Severe HTN ACS Respiratory disorders e.g. COPD
What is the NYHA classification?
A classification that groups patients with heart failure into one of four classes depending on their symptoms during activity and at rest
Explain the NYHA classifications?
II - slight limitation of activity
III - marked limitation of activity but comfortable at rest
IV - unable to carry on without discomfort, symptoms of heart failure at rest
What are the precipitating factors for heart failure?
Arrhythmia Myocardial ischaemia Pneumonia HTN Worsening renal function
Which signs are more specific to heart failure?
Can’t lie flat when sleeping
Sudden weight gain
New onset dizziness or confusion
What are the five main types of arrhythmias?
- Sinus arrhythmia
- Premature beats
- Brady and tachy
- Atrial vs. junctional vs. ventricular
- Heart blocks
What features help distinguish sinus tachycardia from an abnormal heart rhythm
Onset off set of palpitations
May feel like they’ve missed a beat or feel like a thud
