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CR - Signs + Symptoms in CV Medicine (Hx (pain (central, crushing (angina,…
CR - Signs + Symptoms in CV Medicine
origins of cardiac dysfunction
damaged myocardium
atherosclerosis (vasc disease)
ischaemia (demand-supply mismatch)
valvular heart disease
stenosis (decreased diameter)
regurg (inadequate seals)
cardiomyopathy
dilated (usually acquired)
hypertrophic (often inherited)
restrictive
arrhythmias
irregular contactions + suboptimal filling
v fib
unstable sinus ventricular tachycardia (most common)
heart's requirements
O2
electrolytes
K+
Mg2+
inhibits absorption of other electrolytes (e.g. K+) if hyper/hypo
electrical dysfunction (arrhythmias) if hyper/hypo
blood + BP
appropriate filling
overfilling -> dilation
appropriated expulsion
inadequate expulsion -> compensatory hypertrophy
intact electrical circuits (if not arrhythmias)
ischaemia symptoms
chest tightness
radiation to left arm + jaw
anxiety
fear of dying
sense of impending doom
pallor
symps -> cold, clammy, diaphoresis
parasymps -> nausea, vomiting
LVF symptoms
dyspnoea
bibasal rales/creps
due to pul oedema
creps also in pneumonia (unilateral) + fibrosis (velcro)
orthopnoea (ask how many pillows @ night)
PND
fluid retention/overload
due to decreased renal perfusion (perceived dehydration)
sign = left-sided S3/4 gallop
RVF symptoms
peripheral oedema
ascites
hepatomegaly
increased JVP
hepatojugular reflex
fluid retention/overload (decreased renal perfusion, right-sided S3/4 gallop)
Hx
pain
central, crushing
angina
MI
+/- Levine's sign (clenched fist)
socrates
elderly + those with DM (neuropathy) often don't feel pain during an MI)
ripping back pain = aortic dissection
pleuritic
pneumonia
PE
pneumothorax
elderly
bullae
COPD
trauma
young tall man
Ehlers-Danlos / Marfan's
palpitations (fluttering)
stress/anxiety
caffeine
drugs
arrhythmia
dyspnoea
usually progresses from exertional to @ rest
fatigue
intermittent claudication (indicates atherosclerosis)
orthopnoea/PND (pul oedema)
stress/anxiety
can be a symptom
or can exacerbate symptoms (by activating symps)
nausea + vomiting
pallor/ashen skin
ankle swelling
anaemia can exacerbate cardiac disease
examination
mitral faecies (sign of mitral stenosis)
ABC
vitas (HR, BP, RR, SaO2)
signs of hypoperfusion (cardiogenic shock)
hypotension
tachycardia
impaired cognition
cool clammy pale ashen skin
murmur (sign of mechanical complication - e.g. regurg/VSD)
carotid bruit
AAA in abdo
assess peripheral pulses
arrhythmias
can be asymptomatic
palpitations
lightheadedness, syncope
low energy
angina
SOB
SCD
irregular pulse
can cause CHF
biggest killer in renal filature = CV complications
valvular heart disease
causes RHF/LHF
aortic stenosis
angina
syncope
indicates severe untxed stenosis - poor prognosis
CHF
death
pulsus parvus (weak) + tardus (delayed)
sys murmur radiating to carotids
displaced apex beat (LVH due to increased left ventricular pressure from stenotic valve)
S4
aortic regurg
LHF
blowing (high frequency/pitch) dias murmur @ left sternal border)
widened pulse
demusset's sign (head bobbing with heartbeat)
Corrigan's water hammer pulse (rapidly increasing+collapsing)
duroziez's sign (femoral bruit)
mitral regurg
SOB
orthopnoea
fatigue
holosys (begins @ S1 + continues into S2, high pitched) murmur radiating to axilla