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Flashcards in Symptoms of heart disease Deck (17):
1


symptoms of heart disease


■ chest pain
■ dyspnoea
■ palpitations
■ syncope
■ fatigue
■ peripheral oedema.

2


differentials of chest pain

CENTRAL

Cardiac

  1. Ischaemic heart disease (infarction; angina)
  2. Coronary artery spasm
  3. Pericarditis/myocarditis
  4. Mitral valve prolapse
  5. Aortic aneurysm/dissection

Non-cardiac

  1. Pulmonary embolism
  2. Oesophageal disease
  3. Mediastinitis
  4. Costochondritis (Tietze's disease)
  5. Trauma (doft tissue, rib)

LATERAL/PERIPHERAL

Pulmonary

  1. Infarction
  2. Pneumonia
  3. Pneumothorax
  4. Lung cancer
  5. Mesothelioma

Non-pulmonary

  1. Bornholm disease
  2. Herpes zoster
  3. Trauma (ribs/muscular)

3


Chest pain types

■retrosternal heavy or gripping sensation with radiation to the left arm or neck that is provoked by exertion and eased with rest or nitrates – angina (p. 748)
■ similar pain at rest – acute coronary syndrome (p. 752)
■ severe tearing chest pain radiating through to the back – aortic dissection (p. 808)
■ sharp central chest pain that is worse with movement or respiration but relieved with sitting forward – pericarditis pain (p. 795)
■ sharp stabbing left submammary pain associated with anxiety – Da Costa’s syndrome

4


Dyspnoea

LV failure causes oedema of pulmonary interstitium + alveoli >>  ↓compliace

Tachypnoea - ↑resp. rate often due to stimulation of pulmonary stretch receptors

Orthopnoea - breathlessness when lying flat: blood from legs to torso -> ↑central&pulmn blood volume

Paroxysmal nocturnal dyspnoea - as orthopnoea

Hyperventilation + alternating episodes of apnoea (Cheyne-Stokes) - severe heart fail

Central sleep apnoea syndrome - if hypopnoea occurs rather than apnoea >> malfunction in brain resp centre due to poor cardiac output with concurrent cerebrovascular disease +SX: daytime somnolence and fatigue

 

5


Syncope

Vascular

  1. Vasovagal attack
  2. Postural (orthostatic) hypotension - drop of SBP of >=20mmHg standing from sitting/lying
  3. Postprandial hypotension
  4. Micturition syncope
  5. Carotid sinus syncope

Obstructive

  1. Aortic stenosis
  2. Hypertrophic cardiomyopathy
  3. Pulmonary stenosis
  4. Tetralogy of Fallot
  5. Pulmonary hypertension/embolism
  6. Atrial myxoma/thrombus
  7. Defective prosthetic valve

Arrhythmias

Stokes-Adams attacks - intermittent high grade AV block

6


Peripheral oedema

Water and salt retention due to renal underperfusion and subsequent activation of rening-angiotensin-aldosterone syst.

7


Jugular venous pressure elevation occurs in...

Heart failure

Pericarditis

Cardiac tamponade

Fluid overloads (renal disease, overtransfusion)

SVC obstruction

8

JVP reduced in

hypovolemia

9

JVP pressure wave

Peaks: a, c, v waves

Troughs: x,y descents

a wave = atrial systole; ↑ in RV hypertrophy due to pulmonary hypertension or pulmonary stenosis. Fiant canon waves are in complete heart block and ventricular tachycardia

x descent = atrial contraction finishes

c wave = during the x descent due to transmission of RV systolic pressure before the tricuspid valve closes

v wave = venous return filling the RA. Giant waves = tricuspid regurgitation

y descent = when trcuspid opens. It's steep in constrictive pericarditis and tricuspid incompetence

10

what is HOCM and its prevalence


is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500.
 

11

what is the typical pathology?


Abnormal thickening of the myocardium in the interventricular septum (asymmetric septal hypertrophy), other patterns possible.

Often have elongated mitral valve leaflets
 

12

features of HCM (Sx)

 

  • often asymptomatic
  • dyspnoea, angina, syncope
  • sudden death, arrhythmias, heart failure
  • jerky pulse, large 'a' waves, double apex beat
  • ejection systolic murmur: increases with Valsalva manoeuvre and decreases on squatting


 

13

HCM can be associated with hat conditions?

Friedreich's ataxia

WPW syndrome

14

HCM typical findings on echo

mnemonic - MR SAM ASH

  •  
  • mitral regurgitation (MR)
  • systolic anterior motion (SAM) of anterior mitral valve leaflet
  • asymmetric hypertrophy (ASH)

15

ECG findings with HCM

 

  • AF occasionally
  •  LVH ↑ precordial voltages and non-specific ST segment and T-wave inversion
  • Asymmetrical septal hypertrophy produces deep, narrow (“dagger-like”) Q waves in the lateral (V5-6, I, aVL) and inferior (II, III, aVF) leads. These may mimic prior MI, but the Q-wave morphology is different: infarction Q waves are typically > 40 ms duration while septal Q waves in HCM are < 40 ms. Lateral Q waves are more common than inferior Q waves in HCM.
  • LV diastolic dysfunction → compensatory LA hypertrophy  (“P mitrale”)









 

16

what murmur is present in HCM?

high-pitched, midsystolic

best heard at LLSB

does not radiate to carotids (nunlike AS)

 

17

how to distinguish AS murmur from HCM

by dynamic auscultation:

valsalva: HCM gets louder (decresed LV filling, less blood to compress the muscle bulk), AS gets softer

standing from squatting: HCM louder (blood is pooling in legs, less is in the ventricle, so wont compress the muscle bulk)