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Questions and Answers
Which factor is considered a non-modifiable cardiovascular risk factor?
Which factor is considered a non-modifiable cardiovascular risk factor?
What is the blood sugar level indicating diabetes in fasting blood glucose (FBG)?
What is the blood sugar level indicating diabetes in fasting blood glucose (FBG)?
Which of the following symptoms is NOT typically associated with cardiovascular diseases?
Which of the following symptoms is NOT typically associated with cardiovascular diseases?
Obesity is primarily classified as which type of cardiovascular risk factor?
Obesity is primarily classified as which type of cardiovascular risk factor?
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Which of the following is not classified as a 'non-classic' cardiovascular risk factor?
Which of the following is not classified as a 'non-classic' cardiovascular risk factor?
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What does claudication of the lower limbs primarily indicate?
What does claudication of the lower limbs primarily indicate?
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Which characteristic is NOT included in the acronym MISTIDRATS for chest pain?
Which characteristic is NOT included in the acronym MISTIDRATS for chest pain?
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Which measure indicates a blood pressure level classified as hypertension?
Which measure indicates a blood pressure level classified as hypertension?
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Which of the following symptoms is NOT associated with stable angina pectoris?
Which of the following symptoms is NOT associated with stable angina pectoris?
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What characterizes unstable angina pectoris?
What characterizes unstable angina pectoris?
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Which symptom is NOT associated with myocardial infarction?
Which symptom is NOT associated with myocardial infarction?
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In which functional class does angina occur with minimal effort?
In which functional class does angina occur with minimal effort?
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What is a primary characteristic of unstable angina pectoris?
What is a primary characteristic of unstable angina pectoris?
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Which type of pain is associated with stable angina pectoris?
Which type of pain is associated with stable angina pectoris?
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Which symptom is commonly associated with aortic dissection?
Which symptom is commonly associated with aortic dissection?
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Which symptom is considered a trigger for stable angina?
Which symptom is considered a trigger for stable angina?
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Which of the following is a common aggravating factor of pericarditis?
Which of the following is a common aggravating factor of pericarditis?
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Which of the following is NOT typically associated with pulmonary embolism?
Which of the following is NOT typically associated with pulmonary embolism?
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What is an example of a non-cardiovascular cause of chest pain?
What is an example of a non-cardiovascular cause of chest pain?
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How does the intensity of angina differ among the functional classes?
How does the intensity of angina differ among the functional classes?
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What is the duration of chest pain typically associated with classic angina pectoris?
What is the duration of chest pain typically associated with classic angina pectoris?
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What is a common associated symptom of chest pain due to cardiovascular causes?
What is a common associated symptom of chest pain due to cardiovascular causes?
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Which condition is characterized by acute onset and variable intensity of chest pain?
Which condition is characterized by acute onset and variable intensity of chest pain?
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What type of chest pain is associated with aortic dissection?
What type of chest pain is associated with aortic dissection?
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Which symptom is characterized by an abnormal perception of heartbeats?
Which symptom is characterized by an abnormal perception of heartbeats?
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What characteristic is associated with atrial fibrillation?
What characteristic is associated with atrial fibrillation?
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Which of the following is NOT a cause of shortness of breath?
Which of the following is NOT a cause of shortness of breath?
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Which stage of dyspnea is defined as having no limitation of physical activity?
Which stage of dyspnea is defined as having no limitation of physical activity?
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What is the immediate treatment indicated for junctional tachycardia?
What is the immediate treatment indicated for junctional tachycardia?
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Which type of dyspnea occurs specifically when lying down and is relieved by sitting up?
Which type of dyspnea occurs specifically when lying down and is relieved by sitting up?
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Which of these conditions is characterized by violent heartbeats that are intermittent?
Which of these conditions is characterized by violent heartbeats that are intermittent?
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Which classification indicates that shortness of breath occurs at rest?
Which classification indicates that shortness of breath occurs at rest?
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Which symptom is commonly associated with vasovagal syncope?
Which symptom is commonly associated with vasovagal syncope?
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What is a classic trigger for orthostatic hypotension?
What is a classic trigger for orthostatic hypotension?
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Which condition is characterized by a rapid recovery post-syncope?
Which condition is characterized by a rapid recovery post-syncope?
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Which arrhythmia is mentioned as a cause of syncope?
Which arrhythmia is mentioned as a cause of syncope?
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In which situation would you most likely observe symptoms of hypoglycemia?
In which situation would you most likely observe symptoms of hypoglycemia?
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What symptom is commonly associated with panic attacks?
What symptom is commonly associated with panic attacks?
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Which of the following is NOT a type of cardiac cause for syncope?
Which of the following is NOT a type of cardiac cause for syncope?
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What is a symptom of aortic stenosis during an effort?
What is a symptom of aortic stenosis during an effort?
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What is a key characteristic of paroxysmal nocturnal dyspnea?
What is a key characteristic of paroxysmal nocturnal dyspnea?
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What symptom is associated with acute pulmonary edema?
What symptom is associated with acute pulmonary edema?
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Which condition is linked with expiratory bradypnea and wheezing?
Which condition is linked with expiratory bradypnea and wheezing?
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In which condition is cough typically absent during an acute episode?
In which condition is cough typically absent during an acute episode?
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What defines syncope as opposed to lipothymia?
What defines syncope as opposed to lipothymia?
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Which of the following is a common cause of lipothymia?
Which of the following is a common cause of lipothymia?
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What is a probable auscultation finding in a patient with heart failure?
What is a probable auscultation finding in a patient with heart failure?
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What symptom is specifically associated with anaphylactic reactions causing shortness of breath?
What symptom is specifically associated with anaphylactic reactions causing shortness of breath?
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Study Notes
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.
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Description
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.
