Cardiology Quiz: Palpitation Diagnosis

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Questions and Answers

What is the primary focus of detailed history taking in patients with palpitation?

Distinguishing between different types of palpitation (correct)

Ruling out underlying cardiac conditions

Determining the frequency of palpitation episodes

Identifying the exact location of the palpitation

What type of information should be obtained when inquiring about the nature of the palpitation?

Rhythmic pattern and irregularity of the heartbeat (correct)

Factors that exacerbate or relieve the palpitation

Family history of similar symptoms

Duration and intensity of the palpitation

What is the benefit of asking about the nature of the palpitation?

To identify the underlying cause of the palpitation

To assess the patient's overall cardiovascular health

To determine the severity of the condition

To distinguish between different types of palpitation (correct)

Why would you ask the patient to roll onto their left side during an apex beat assessment?

To locate the apex beat more easily Signup and view all the answers

What information should be obtained from the patient to understand the palpitation?

Characteristics of the palpitation, such as rapidity and irregularity Signup and view all the answers

Why is it important to ask about the palpitation's nature?

To accurately diagnose the type of palpitation Signup and view all the answers

What should you do if you are unable to feel the apex beat?

Ask the patient to roll onto their left side Signup and view all the answers

In what direction should your fingers be laid on the chest to locate the apex beat?

Parallel to the rib spaces Signup and view all the answers

What should you assess in addition to the location of the apex beat?

The character of the apex beat Signup and view all the answers

Why is it important to note the position of the apex beat?

To aid in the diagnosis of cardiac conditions Signup and view all the answers

What is a common consequence of trivial injuries in individuals with impaired blood flow?

Ulceration and tissue loss Signup and view all the answers

What is the primary source of thromboembolism in acute limb ischemia?

Left atrium Signup and view all the answers

Which of the following is NOT one of the '6 Ps' of acute limb ischemia?

Polyuria Signup and view all the answers

What is the likely outcome of acute limb ischemia if left untreated?

Amputation and/or death Signup and view all the answers

Which of the following is a symptom of severe ischemia in acute limb ischemia?

Paralysis of the affected limb Signup and view all the answers

What is the likely cause of a 'crunching' noise heard during auscultation?

Pneumopericardium Signup and view all the answers

Which of the following patients are more likely to have an 'innocent' murmur?

A patient with fever Signup and view all the answers

What is the most important step in the examination sequence for auscultation?

Making sure the room is quiet Signup and view all the answers

What is the primary difference between a murmur and a normal heart sound?

The velocity of flow Signup and view all the answers

Which of the following is NOT a cause of an 'innocent' murmur?

Patient with a septal defect Signup and view all the answers

What is the most common symptom of abdominal aortic aneurysm (AAA) prior to rupture?

No symptoms at all Signup and view all the answers

What is the significance of the 'wave sign' in abdominal aortic aneurysm (AAA) patients?

It is a incidental finding in some patients Signup and view all the answers

What is the most common cause of digital ischemia leading to blue toes?

Emboli from abdominal aortic aneurysm (AAA) Signup and view all the answers

What is the primary difference between primary and secondary Raynaud's phenomenon?

Presence of underlying disease Signup and view all the answers

What is the indication for investigating underlying peripheral arterial disease (PAD) in patients with Raynaud's phenomenon?

All of the above Signup and view all the answers

What is the usual finding in patients with digital ischemia?

Full set of pedal pulses Signup and view all the answers

What is the third phase of Raynaud's phenomenon?

Redness Signup and view all the answers

Why is it important to ask about a patient's past medical history in the context of peripheral vascular disease?

To identify if they have established peripheral vascular disease Signup and view all the answers

Study Notes

Palpitation History Taking

Nature of palpitation: rapid, forceful, or irregular heartbeat
Locate apex beat by laying fingers on the chest parallel to rib spaces
Assess character of apex beat and note its position

Auscultation

Ensure a quiet room for auscultation
Murmurs: turbulent flow across abnormal valve, septal defect, or outflow obstruction
'Innocent' murmurs: increased velocity of flow through a normal valve in pregnancy, athletes, or patients with fever

Acute Limb Ischemia

Classical features: '6 Ps'
- Pallor
- Pulselessness
- Perishing cold
- Pain (worse when muscle squeezed)
- Paralysis (inability to move toes/fingers) → SEVERE ISCHEMIA
- Paresthesia (numbness or tingling over the forefoot or dorsum of the hand) → SEVERE ISCHEMIA
Causes: Thromboembolism usually from the LA (in atrial fibrillation → often diagnosed incidentally

Abdominal Aortic Aneurysm (AAA) Rupture

Classical features: abdominal/back pain, pulsatile abdominal mass, syncope, and shock (hypotension)
Patients may observe ripples in the water when in the bath (wave sign)
Most patients are asymptomatic until the aneurysm ruptures

Digital Ischemia

Blue Toes: patchy bluish discoloration over the toes and forefoot of one or both feet
Causes: emboli (e.g. from AAA) or alternative proximal embolic source (popliteal aneurysm / atherosclerotic plaque)
Usually has a full set of pedal pulses
Should be taken seriously → risk of acute limb ischemia & even limb loss

Vasospastic Symptoms (Raynaud's Phenomenon)

Digital ischemia induced by cold and emotion
Primary (Raynaud's disease) or secondary (Raynaud's syndrome) to drugs, connective tissue disease, hyperviscosity syndromes, use of power tools
Three phases:
- Pallor: due to digital artery spasm and/or obstruction
- Cyanosis: due to deoxygenation of static venous blood (this phase may be absent)
- Redness: due to reactive hyperemia
Patients over 40 presenting with unilateral Raynaud's phenomenon should be investigated for underlying PAD, especially if they have cardiovascular risk factors, diabetes, or a smoking habit

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Description

Test your knowledge on identifying the nature of palpitations and understanding the importance of detailed history taking in cardiology. Questions cover the characteristics of palpitations and their diagnosis.