W4 Cardiac Symptoms (Quiz 2)

Question 1

What are some cardiac conditions that present with dyspnea?
How an you distinguish cardiac SOB from pulm SOB?
(Keep this list for OSCE differentials)

Answer 1

—related to hypoxia from pulmonary edema (d/t CAD, left sided heart disease, arrhythmias
—ischemia
—LV systolic failure (backs up into pulm🫁)
—aortic stenosis/regurg, mitral stenosis/regurg, MVP
—flash pulm edema💧 secondary to HTN emergency (acute SOB, bilateral renal stenosis can also cause flash pulm edema)
—Afib > loss of atrial kick🦵
—stiff ventricle, HOCM, restrictive cardiomyopathy, constrictive pericarditis
—tamponade (medical emergency🚑)

—usually starts w/exertion and as it progresses, SOB will occur with less activity and at rest

—a/w orthopnea and PND 💤

—ischemia can be present w/ SOB 😮‍💨and worsens w/ exertion

Question 2

What are the chest pain descriptions for these diagnoses?
—ACS/ischemia
—Coronary vasospasm/prinzmetal’s angina
—Aortic stenosis
—HOCM (hypertrophic obstructive cardiomyopathy)
—Pericarditis
—Aortic dissection
—Aortic regurgitation

Answer 2

ACS/ischemia
—worse w/ exertion, relieved w/ rest
—“substernal pressure/squeeze”
—intense
—radiates to left arm/neck
—SOB, palps and nausea

Coronary vasospasm/prinzmetal’s angina
—similar to ischemia but occurs at rest
—could be d/t recreational stimulant use

Aortic stenosis
—similar to ASC, supply demand O2 mismatch
—do not give these patients nitro!

HOCM (hypertrophic obstructive cardiomyopathy)
—similar to ASC
—worse w/ exertion, increased muscle mass + narrowed coronaries
—volume loss from dehydration or diarrhea

Pericarditis
—sharp chest pain
—worse laying flat & alleviated laying forward
—intensifies w/ inspiration

Aortic dissection
—sudden tearing pain chest and back
—persistent, intense
—check bilateral pulses

Aortic regurgitation
—low coronary perfusion d/t supply/demand mismatch
—low aortic diastolic pressure
—increased LV wall stress

Question 3

Palpitations
Associated with which conditions?

Answer 3

—arrhythmias or ectopic caused by underlying valve disease (MVP, ischemia)
—atrial arrhythmias: afib/flutter, SVT, MAT, atrial tachy
—ventricular arrhythmias: tachy/fib, torsades
—ectopic: PAC, PVC
—sinus tachy
—SSS

Question 4

Fatigue, weakness, dizziness (presyncope), syncope associated with?

Answer 4

—low cardiac output w/ decrease in cerebral perfusion

—Arrhythmias: VT/VF, heart block
—Mechanical obstruction: Aortic stenosis and HOCM
—LV Failure/Systolic Heart Failure
Valve disease: Aortic stenosis/regurgitation, mitral stenosis/regurgitation
Ischemia
HTN
DIlated Cardiomyopathy
—Restrictive cardiomyopathy/Constrictive pericarditis
—Ischemia
—Tamponade
—Vasovagal (prodrome)

Question 5

Edema is related to which conditions?

Answer 5

Right sided heart failure:
—Elevated JVP, abdominal distention/ascites, early satiety, peripheral edema
—Left sided heart disease is main cause of pulmonary hypertension/R sided heart failure
—Systolic/Diastolic Heart Failure
—Tricuspid Regurgitation/Stenosis
—PE

Question 6

Fever — which conditions is it associated with? 3

Answer 6

inflammatory/infectious disease

—Pericarditis/Myocarditis
—Infective Endocarditis
—Post MI/SIRS

Question 7

GI symptoms associated with? (5)
Dysphagia why?

Answer 7

GI symptoms: pain, nausea/emesis, distention/bloating, and ascites

—Ischemia (atypical presentation; women)
—Low output > intestinal ischemia
—Right sided heart failure
—AAA
—Descending aortic dissection

Also dysphagia from enlargement of heart pressing on esophagus