Cardiovascular Disease Risk Factors Quiz

Introduction to Cardiovascular Medicine: Clinical Methods

• The presentation was given by Dr. Ahmadou M. Jingi and Professor Gloria Ashuntantang of the Department of Clinical Sciences, Faculty of Health Sciences, University of Bamenda.
• The objectives of the presentation included listing characteristics of chest pain, describing the stages of dyspnea, explaining the differences between syncope and lipothymia, illustrating heart auscultation areas, enumerating heart murmur characteristics, and explaining the difference between systolic and diastolic heart murmurs.
• The presentation also covered risk factors for cardiovascular disease (CVD), symptoms of CVD, signs of CVD, and investigations of CVD.
• Other topics included an approach to patients with CVD, including history and physical examination procedures, followed by a detailed discussion of history identification and physical exam features.

Risk Factors for Heart Diseases

• Non-modifiable CVD risk factors: Age (over 50 in males, over 60 in females), sex, and family history (of heart attack or sudden death in a first-degree relative, or stroke before age 55 in a male, or 65 in a female).

• Modifiable CVD risk factors: Diabetes (fasting blood glucose >1.26g/L, OGTT >2 g/L after 2 hours post 75g oral glucose, RBG >2 g/L with symptoms), Hypertension (systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg ), Dyslipidemia(Hypercholesterolemia, Hypo HDLC, HyperLDLC), Obesity (BMI ≥ 30 kg/m2), Tobacco use (pack-years), Sedentary lifestyle and alcohol consumption (grams per day).

Risk Factors for Heart Diseases (Non-Classical CVD Risk Factors)

• Recurrent sore throat/rheumatic fever
• HIV infection
• Cancer
• Anti-cancer chemotherapy
• Illicit IV drug use
• Autoimmune disease (SLE, RA)
• Other organ diseases (CKD, liver disease, sleep apnea syndrome)
• Cardiorenal syndrome
• Hepatorenal syndrome

Symptoms (Cardiovascular Diseases)

• Cardiac Symptoms: Chest pain, palpitations, dyspnea or shortness of breath, syncope/lipothymia, cough and exertional hepatalgia.
• Peripheral Vessels' Symptoms: Lower limb pain, claudication of the lower limbs, redness and swellings, trophic changes.

Symptoms (1): Chest Pain (Characteristics)

• Mode of onset
• Intensity
• Site
• Type (e.g., constrictive, burning)
• Irradiation
• Duration
• Relieving factors
• Associated symptoms
• Time
• Sensitivity to nitroglycerin

Symptoms (1): Chest Pain (Causes) (Cardiovascular)

• Angina Pectoris
• Myocardial Infarction
• Pericarditis
• Aortic dissection
• Pulmonary embolism
• Pulmonary Hypertension
• Pneumothorax
• Pneumonia
• Esophageal spasm (with GERD or Candida)
• Chest wall disorders (Tietze Syndrome)

Cardiovascular Disease Symptoms (1): Stable Angina Pectoris

• Mode: Chronic, intermittent crises
• Intensity: Variable (Canadian heart association scale)
• Site: Diffuse, retrosternal, left mediothoracic, epigastric, interscapular, left scapular
• Type: Constrictive, oppresion, tightness
• Irradiation: Neck, mandibules, shoulders, arm, forearm, wrist.
• Duration: Few minutes and disappears 5 minutes post trigger
• Rythme/Trigger factors: Effort+++, post prandial, cold, anemia, awakening
• Relieving factor: End of trigger (generally 2-3 minutes), nitroglycerin+++

Cardiovascular Disease Symptoms (1): Unstable Angina Pectoris

• Angina at rest lasting > 20 minutes
• Severe: Class III and IV
• Worsening angina pectoris: Class and duration of pain
• Poor short-term prognosis
• Evolves towards Acute MI (SCA)

Cardiovascular Disease Symptoms (1): Prinzmetal Angina

• Unstable angina pectoris in relatively young patients
• Spontaneous angina at rest
• Second half of the night
• Due to coronary spasm on an atheromatous coronary artery

Cardiovascular Disease Symptoms (1): Myocardial Infarction

• Classical angina pectoris with particularities: Lasts >20 minutes; Very intense.
• Associated symptoms/findings: Malaise, Vomiting, Epigastric pain.
• Typical ECG changes: S-T segment elevation.
• Raised cardiac enzymes: Troponin I, CPK, CPK-MB, LDH.

Cardiovascular Disease Symptoms (1): Pericarditis

• Mode: acute onset
• Intensity: Variable
• Site: Precordial, medithoracic
• Type: Burning
• Irradiation: Rarely, left shoulder, tip of scapular
• Duration: Prolonged and continuous
• Rhythm/Trigger: None
• Aggravating factors: Cough, deep inspiration, dorsal decubitus
• Relieving factor: Leaning forward
• Associated symptoms: Prior common cold.

cardiovascular Disease Symptoms (1): Aortic Dissection

• Mode: acute onset, Continuous
• Intensity: Violent and prolonged
• Site: Retrosternal
• Type: Tearing
• Radiation: Dorsal, interscapular, migratory to the loins
• Duration: Prolonged and continuous
• Rhythm/Trigger: None.
• Aggravating factors: None
• Relieving factor: None
• Associated symptoms: Neurologic deficits (stroke/paraplegia), Pulse asymmetry

Cardiovascular Disease Symptoms (1): Pulmonary Embolism

• Mode: acute onset, Continuous
• Intensity: Variable
• Site: Basitoracic (lung infarction/pleurisy), medithoracique (pulm HTN)
• Type: Blow to the chest, Constrictive (mediothorax)
• Irradiation: Rare
• Duration: Prolonged and continuous
• Rhythm/Trigger: None
• Aggravating factors: Inspiration, cough.
• Relieving factor: None
• Associated symptoms: Cough, Tachycardia, syncope (massive PE).

Symptoms (1): Non-Cardiovascular Causes of Chest Pain

• Pleuropulmonary (pneumonitis, pleurisy)
• Chest wall injury (traumatic, non-traumatic/Tietze syndrome, CYRIAX syndrome)
• Digestive tract (esophagitis/GERD/Candida, esophageal spasm)

Symptoms (2): Palpitations

• Definition: Abnormal perception of the heart beat (uncomfortable)
• Characteristics: Continuous (permanent tachycardia), Sporadic (extrasystoles), Paroxysmal (crises)
• Trigger: Spontaneous, Effort, Emotions, Meal

Symptoms (2): Palpitations (Causes)

• Atrial fibrillation
• Extra-systoles/Premature contractions
• Junctional Tachycardia
• Ventricular tachycardia
• Associated symptoms: Lipothymia/Syncope
• Treatment options: Cardioversion (electrical shock).

Symptoms (3): Shortness of Breath (SOB) or Dyspnea

• Definition: subjective feeling of respiratory discomfort.
• Classification of Dyspnea according to NYHA (Severity): Stage I: No limitation of physical activity; Stage II: SOB with normal daily activities; Stage III: SOB with mild effort; Stage IV: SOB at rest.
• Other forms: Orthopnea, Paroxysmal Dyspnea, Acute Pulmonary Edema, Cardiac Asthma, Cheyne Stokes respiration.

Symptoms (3): Causes of Shortness of Breath: Cardiac and Non-Cardiac

• Table summarizing causes of SOB categorized by cardiac and non-cardiac conditions includes detailed symptoms, severity, and possible associated clinical findings including chronological information, worsening factors, positions and symptom response and intervention notes.

Symptoms (4): Syncope and Lipothymia (Dizziness)

• Definition: Syncope: sudden and complete loss of consciousness (brief, few minutes), cerebral anoxia.
• Lipothymia/Dizziness: altered vigilance (pseudo vertigo), no loss of consciousness (brief cerebral anoxia).
• Causes: Vascular (vasovagal, orthostatic hypotension, carotid artery stenosis); Cardiac (arrhythmia, conduction defects, aortic valve stenosis, hypertrophic obstructive cardiomyopathy); Other (hypoglycemia, panic attacks).

Symptoms (4): Causes of Syncope and Lipothymia (Details)

• Comprehensive table showcasing triggers for each cause of dizziness and syncope (e.g., orthostatic hypotension, panic attack, atrial fibrillation), prodromes (early symptoms), postural associations, and recovery periods, including a sample table with these columns.

Symptoms (5): Intermittent Claudication of the Lower Limbs

• Characteristics (PAD): Onset of lower limb pain/discomfort with exertion, repeatable pattern occurring during exertion, pain relieved by rest/standing, and unilateral/bilateral occurrence.
• PAD Stages: Stage 1: Asymptomatic; Stage 2: intermittent claudication (2a > 250 m, 2b <250 m); Stage 3: Pain at rest; Stage 4: Trophic changes (arterial); Acute Limb Ischemia: Pain, Pulse deficit, Pale, Paralyzed, Paresthesia

Signs (Physical Examinations)

• Overview: Vital signs (blood pressure, pulse, respiratory rate, O2 saturation, temperature), Inspection (general well-being, skin/mucosa, hands and feet), Palpation (pulse—regularity, volume, reduced, abolished—and apex/precordium), and Percussion.

Signs (Physical Examination Cardiovascualr System) (Details)

• Expanded overview of examination components that provide deep understanding of vital signs components (blood pressure, heart rate, respiratory rate). Followed by a more comprehensive table discussing abnormal chest findings and associated causes. The table also covers peripheral and central palpation.

Signs: (Physical examination of the Cardiovascualr System (Inspection))

• Detailed assessment of general well-being, including specific findings like skin/mucosa characteristics, cyanosis, pallor, corneal arcus, xanthoma/xanthelasmata, leg ulcers, and pertinent hand/finger features (e.g., clubbing, splinter hemorrhages, Osler nodes, Janeway lesions).

Signs: (Physical Examination of the Cardiovascualr System (Inspection))

• Comprehensive coverage of chest assessment: apex beat (location, amplitude), parasternal heave, pectus abnormalities (carinatum, excavatum), scoliosis, and relevant venous system findings (e.g., JVP, abdominal distension/ascites, dependent edema, lower limb swelling, sacral edema).

Signs: (Physical Examination of the Cardiovascualr System (Palpation))

• Specific descriptions of pulse characteristics (regularity, volume, strength, and the presence of absent or abnormal pulse).
• Examination of the apex beat with details of pathological findings.
• Description of examining methods for jugular venous pressure (JVP), hepatomegaly and possible pulsatile abdominal masses, and other palpable signs.

Signs: (Physical Examination of the Cardiovascualr System (Percussion))

• In-depth interpretation of percussion findings (e.g., dullness and localized changes associated with cardiac enlargement, pleural effusion, or fluid collection; hyperresonance due to pneumothorax or COPD).

Signs: (Physical Examination of the Cardiovascualr System (Auscultation))

• Comprehensive description of heart sounds (normal heart sounds, abnormalities in heart sounds like murmurs, and additional abnormal sounds), vascular sounds, and respiratory sounds (e.g., coarse and fine crackles).

Signs: Abnormal Heart Sounds (Details)

• Detailed descriptions of various murmurs (characteristics, causes, timing, radiating location, associated symptoms, and severity grading) for several congenital heart defects (e.g., VSD, PDA, ASD) and non-valvular heart conditions including split B2, Mitral opening snap, Mitral mid systolic click, Mitral prolapse, Aortic ejection click, Aortic stenosis and Aortic regurgitation are detailed along with associated sounds.

Signs: Abnormal Heart Sounds (Details) (Friction Rubs and Murmurs)

• Comprehensive coverage of pericardial friction rubs, including the site, radiation pattern, timing, and characteristics (e.g., scratching, creaking or grating sounds).
• Descriptions for pleural friction rubs, including location, characteristics, and the relationship between symptoms like cough or apnea.
• Deep dive into murmur characteristics, factors influencing their transmission, timing, and intensity (grade 1-6) related to systolic and diastolic conditions. Extensive descriptions on aortic stenosis, aortic regurgitation and common congenital defects include information on various murmurs and associated findings.

Signs: Physical examination of the Cardiovascualr System (Ascultation: Abnormal Lung Sounds)

• Detailed description of coarse and fine crackles, including their characteristics (e.g., origin, intensity, timing, and the presence of changes under varying conditions like cough). Also includes information relating symptoms with conditions such as pneumonia, COPD, pulmonary edema and Left Heart Failure.

Signs: (Physical Examination of the Cardiovascualr System (Ascultation): Vessels)

• Descriptions of normal and pathological vascular sounds like bruits. Provide characteristics for systolic and continuous bruits.

Summary

• Importance of complete physical examinations
• Detailed discussion of Heart Failure Syndromes (Acute Coronary Syndrome, Acute Aortic Syndrome, etc.) including details related to possible causes and clinical outcomes.
• Procedures for making diagnoses including primary and differential diagnoses along with aetiologic diagnosis.

Common Case Presentation: Right Heart Failure (RHF)

• Symptoms: Hepatalgia, lower limb edema, fatigue and hemoptysis
• Signs: JVD, Harzer sign (pulsatile abdominal mass), loud B2, functional TR murmur, right-sided S3 or S4 galop, and ascites
• Causes: Acute RHF due to acute LHF, RV infarction, acute pulmonary HTN, possible PE, pneumothorax, cardiac tamponade, and valvular heart disease.
• Chronic RHF due to chronic LHF, RV infarction, chronic pulmonary HTN, and pericarditis, valvular heart disease as possible causes

Common Case Presentation: Left Heart Failure (LHF)

• Symptoms: SOB, Orthopnea, Paroxysmal nocturnal dyspnea, Fatigue, and oliguria,
• Signs: Lung congestion (crackles, wheezes), tachycardia, muffled heart sounds, displaced apex impulse, left-sided S3 or S4 gallop, and presence of the MR murmur.
• Causes: Acute LHF due to LV infarction, valvular heart disease, chronic LHF which is caused by Hypertension, MI, ischemia, valvular heart disease along with alcohol and drug use as possible contributors.

Test your knowledge on cardiovascular disease risk factors and symptoms. This quiz covers non-modifiable risk factors, symptoms associated with various conditions, and classifications of angina. Challenge yourself to see how well you understand this critical area of health.