Podcast
Questions and Answers
What is a characteristic of chest pain in unstable angina?
What is a characteristic of chest pain in unstable angina?
- Only relieved by rest
- Abrupt onset (correct)
- Only occurs with exertion
- Gradual onset
What is a symptom associated with myocardial infarction?
What is a symptom associated with myocardial infarction?
- Itching
- Pallor
- Restlessness (correct)
- Numbness
What is a characteristic of pericardial pain?
What is a characteristic of pericardial pain?
- Constant anterior central chest pain (correct)
- Relieved by movement
- Radiates to the back
- Radiates to the arms
What is a characteristic of aortic dissection?
What is a characteristic of aortic dissection?
What is the most common cardiovascular cause of dyspnea?
What is the most common cardiovascular cause of dyspnea?
What is a common feature of angina pectoris?
What is a common feature of angina pectoris?
What is a characteristic of autonomic stimulation?
What is a characteristic of autonomic stimulation?
What is a risk factor for unstable angina?
What is a risk factor for unstable angina?
What should you ask about in patients who present with syncope?
What should you ask about in patients who present with syncope?
What is oedema?
What is oedema?
What is a common cause of bilateral lower limb oedema?
What is a common cause of bilateral lower limb oedema?
What is a cause of unilateral oedema?
What is a cause of unilateral oedema?
What is a cause of non-pitting oedema?
What is a cause of non-pitting oedema?
What should you ask about in a patient's past medical history?
What should you ask about in a patient's past medical history?
Why should you enquire about other symptoms of fluid overload?
Why should you enquire about other symptoms of fluid overload?
What is a side effect of vasodilating calcium channel antagonists?
What is a side effect of vasodilating calcium channel antagonists?
What is an occupation that may be affected by limiting exertional symptoms?
What is an occupation that may be affected by limiting exertional symptoms?
What is a factor that can cause arrhythmias?
What is a factor that can cause arrhythmias?
What is the first step in the CVS examination sequence?
What is the first step in the CVS examination sequence?
What should you examine in the face to look for signs of cardiovascular disease?
What should you examine in the face to look for signs of cardiovascular disease?
What is an observation that can be made during the eye examination?
What is an observation that can be made during the eye examination?
What is an observation that can be made during the hands examination?
What is an observation that can be made during the hands examination?
What is the purpose of measuring capillary refill time during the hands examination?
What is the purpose of measuring capillary refill time during the hands examination?
What is an observation that can be made during the general examination?
What is an observation that can be made during the general examination?
What is the term for dyspnoea caused by myocardial ischaemia?
What is the term for dyspnoea caused by myocardial ischaemia?
What is the term for dyspnoea on lying flat?
What is the term for dyspnoea on lying flat?
What can cause sudden breathlessness that wakes the patient from sleep?
What can cause sudden breathlessness that wakes the patient from sleep?
What is palpitation?
What is palpitation?
What is the purpose of detailed history taking in palpitation?
What is the purpose of detailed history taking in palpitation?
What is syncope?
What is syncope?
What is presyncope?
What is presyncope?
What is a common cause of syncope?
What is a common cause of syncope?
What is a potential cause of bacteraemia in patients with suspected infective endocarditis?
What is a potential cause of bacteraemia in patients with suspected infective endocarditis?
Which of the following systemic disorders is associated with aortic dissection?
Which of the following systemic disorders is associated with aortic dissection?
What is a common side effect of non-steroidal anti-inflammatory drugs (NSAIDs) that patients should be aware of?
What is a common side effect of non-steroidal anti-inflammatory drugs (NSAIDs) that patients should be aware of?
What is the significance of asking about premature coronary artery disease in first-degree relatives?
What is the significance of asking about premature coronary artery disease in first-degree relatives?
What is the association between familial hypercholesterolaemia and cardiovascular disease?
What is the association between familial hypercholesterolaemia and cardiovascular disease?
What is the strongest risk factor for coronary and peripheral arterial disease?
What is the strongest risk factor for coronary and peripheral arterial disease?
What is the association between obesity and cardiovascular disease?
What is the association between obesity and cardiovascular disease?
What is the significance of asking about a family history of sudden unexplained death at a young age?
What is the significance of asking about a family history of sudden unexplained death at a young age?
Study Notes
Acute Chest Pain
- Abrupt onset or worsening of chest pain episodes that may occur on minimal exertion or at rest with no definable exacerbating or relieving factors
- Associated features include restlessness, breathlessness, and a feeling of impending death (angor animi)
- Autonomic stimulation may result in sweating, pallor, nausea, and vomiting
Myocardial Infarction
- Causes symptoms that are similar to, but more severe and prolonged than, those of angina pectoris
- Associated features include restlessness, breathlessness, and a feeling of impending death (angor animi)
Pericardial Pain
- Typically a constant anterior central chest pain that may radiate to the shoulders
Aortic Dissection
- Abrupt onset of very severe, tearing chest pain that radiates to the back (typically the interscapular region)
- May be associated with profound autonomic stimulation and radiolradial delay
Dyspnea (Breathlessness)
- Cardiovascular causes of dyspnea include:
- Heart failure (most common cardiovascular cause of both acute and chronic dyspnea)
- Pulmonary embolism
- Arrhythmia
- Dyspnea caused by myocardial ischaemia is known as 'angina equivalent'
Orthopnoea
- Dyspnea on lying flat, may occur in patients with heart failure
- Lying flat increases venous return and in patients with left ventricular impairment may precipitate pulmonary oedema
- Severity can be graded by the number of pillows used at night ('three-pillow orthopnoea')
Paroxysmal Nocturnal Dyspnoea
- Sudden breathlessness that wakes the patient from sleep, caused by the same mechanism as orthopnoea
Palpitation
- Unexpected or unpleasant awareness of the heart beating in the chest
- Detailed history taking can help to distinguish the different types of palpitation
Syncope and Presyncope
- Syncope is a transient loss of consciousness due to transient cerebral hypoperfusion
- Causes include postural hypotension, dehydration, neurocardiogenic syncope, arrhythmias, and mechanical obstruction to cardiac output
- Presyncope is a sensation of lightheadedness and impending loss of consciousness without progressing to actual loss of consciousness
Oedema
- Excess fluid in the interstitial space causes oedema (tissue swelling)
- Causes include:
- Heart failure (common cause of bilateral lower limb oedema)
- Deep vein thrombosis (unilateral, non-pitting oedema)
- Chronic venous disease
- Vasodilating calcium channel antagonists
- Hypoalbuminaemia
Cardiovascular Examination
- CVS examination sequence:
- General examination (vital signs, appearance, awareness, body built, color)
- Examination of the neck veins
- Examination of the precordium (chest region, heart)
- Examination of peripheral vascular system
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Description
This quiz covers the differences between unstable angina and myocardial infarction, including symptoms, triggers, and severity of chest pain episodes.
