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A
Rapid Review of Viva of Cardiovascular System
SYMPTOMS
RELATED TO MEDICINE
- DYSPNEA
- beta
blockers in pt of asthma
- exacerbation
of heart failure by beta blockers ,Ca antagonists ,and NSAIDS
- DIZZINESS
- Vasodilators
. e.g nitrates , alpha
blockers and ACE inhibitors
- ANGINA
- Aggravated
by thyroxine or drug induced anemia by aspirin and NSAIDS
- EDEMA
- Fluid
retention by NSAIDS or steroids or Ca antagonists
- PALPITATION
Tachycardia and arrhythmia from thyroxine ,beta 2 stim , digoxin
toxicity ,hypokalemia from diuretics , tricyclic anti depressant drugs .
GENETICALLY DETERMINED CVS DISORDERS
SINGLE
GENE DEFECTS
- Hypertrophic
cardiomyopathy
- Marfan
synd.
- Familial
hypercholesterolemia
- Muscular
dystrophies
POLYGENIC INHERITANCE
- IHD
- HRT
- NIDDM
- Hyperlipedemia
Man
1.
CHEST DISCOMFORT due to
Angina,Pericarditis,Aortic
dissection,Esophageal spasm,pneumothorax, musculoskeletal pain
2.
BREATHLESSNESS
- Heart
failure, angina, pulm. Emb, pul. HRT,resp. disease, anemia, obesity
3.
PALPITATION
- Tachyarrythmias,
anxiety, hyperthyroidism, drugs
4.
SYNCOPE AND DIZZINESS
- Postural
hypotension, bradyarrythmias, aortic stenosis, hyp. Obst. Cardiomyopathy,
atrial myxoma, simple faints, epilepsy
5.
EDEMA
- HF,
constrictive pericarditis, venous stasis, ,NS, liver disease , drugs
TYPES OF CARDIAC PAIN
1.
ANGINA
- CAUSE:
coronary stenosis
- CHARACTER:ppt
by exertion , eased by rest .
2.
MYOCARDIAL INFARCT
- CAUSE:coronary
occlusion
- CH:similar
sites to angina more severe and
persists at rest
3.
PERICARDITIC PAIN
- CAUSE:pericarditis
- CH:sharp
raw or stabbing , vary with movement or breathing
- AORTIC
PAIN
- CAUSE:dissection
of aorta,
- Ch:severe
sudden onset and radiates to back
- ---------------------------------------------------------------------------
ASSESS THE SEVERITY OF ANGINA,
QUESTIONS
- how
far can you walk before
having discomfort?
- Do u
feel discomfort climbing stairs, gardening , making bed or other house hold
chores, sexual intercourse, meals
, by cold weather?
FACTORS WORSENING THE ANGINA
- Exertion
- Emotional
excitement
- Cold
weather
- Exercise
after meal
FACTORS RELIEVING THE ANGINA
- Rest
- Nitroglycerin
- Warm
up before exercise
CHARACTERISTIC OF
PERICARDITIC PAIN
- may
be due to viral illness
- no
obvious initial factor
- Retrosternal
, may radiates to back or left
shoulder
- fluc.
In intensity
- may
be stabbing or raw like sand paper . often sharp , rarely as tight or heavy.
- Worsened
by changes in posture or respiration
- Helped
by analgesics as NSAIDS
- Accompanied
by pericardial rub
CHARACTERISTICS
OF PAIN DUE TO DISSECTION OF AORTIC ANEURISM
- Often
ist felt b/w shoulder blades or retrosternally
- Usually
sudden
- Very
severe pain often describes as TEARING “ in nature
- Tends
to persists , pt often restless wth pain
- Accompanied
by HRT , assymetric pulse, unexpected bradycardia,early diastolic murmur, ,
syncope, focal neurological symptoms , and signs
DESCRIPTION
OF ARRYTHMIA
- ATRIAL
OR VENTRICULAR EXTRASYSTOLE
- Pt
description:heart misses a beat, heart jumps or flutters
- Pt
description:heart jumping about or racing , associated breathlessness, may
be unnoticed .
- SUPRAVENTRICULAR
TACHYCARDIA
- Pt.
description:heart racing or fluttering ,ass. polyuria
- Pt
description: heart fluttering or
racing and ass. Breathlessness.
- Ventricular
tachycardia may be as syncope.
QUESTIONS
TO BE ASKED FROM PT OF ARRYTHMIA.
- Is
there a family history of premature heart disease or sudden death,
rheumatic fever , previous
heart attack, or other heart disease?
- Wt
is the daily caffeine and weakly alcohol consumption?
- Are
any drugs being taken ,whether prescribed or OTC or recreational ?
- Are
there any non specific symptoms of recent illness . to consider unusual
causes as infective endocarditis or
limes disease?
- If
attacks are paraoxysmal
1.
are there any ppt factor as exercise , anxiety , stress , ?
2.
wt is nature of onset of attack and are there ass. Symptoms
as presyncope or chest
discomfort , ?
3.
are there any relieving factors as breath holding o exercise?
SCHEME OF CVS EXAMINATION
- get
a general impression of pt
,look for signs of anxiety , breathlessness or pain.
- shake
hands assess peripheral circulation and
sweating , look for clubbing , splinter hemorrhages.
- Palpate
radial pulse , measure rate and assess
rhythm.
- palpate
brachial pulse
- measure
B.P
- palpate
carotid pulse , assess quality and
listen for bruits.
- examine
JVP
- examine
face look for
hypercholesterolemia or anemia
,examine tongue for cyanosis.
- examine
chest , listen for crepitations , look for sacral edema
- examine
abdomen for hepatomegaly and
asites
- assess
femoral pulses , look for radiofemoral delay
- examine
legs palpate pulses
and assess edema
- exam. Optic fundi
CAUSES
OF FAST HEART RATE
Tachycardia ( more than 100 /min)
SINUS
TACHYCARDIA
- exercise
, pain , anxiety , excitement , fever , hyperthyroidism , medication, (sympathomimetics ,
and vasodilators)
ARRYTHMIA
- atrial
fibrillation, atrail flutter , supraventricular tachycardia, ventricular
tachycardia
SLOW
HEART RATE (BRADYCARDIA ,LESS THAN
60 / MIN)
SINUS
BRADYCARDIA
·
sleep , athletic training , hypothyroidism , medication(beta
blockers , digoxin, verapamil, diltiazem)
ARRYTHMIAS
·
Carotid sinus hypersensitivity,
sick sinus syndrome, second
degree heart block , complete heart block
CAUSES OF IRREGULAR
PULSE
1.
sinus arrythmias
2.
atrial extrasystoles
3.
ventricular extrasystoles
4.
atrial fibrillation
5.
atrial flutter
6.
sec. degree heart block
COMMON
CAUSES OF ATRIAL FIBRILLATION
·
HRT
·
Cardiac failure
·
MI
·
Thyrotoxicosis
·
Alcohol related heart disesase
·
Mitral valve disease
·
Acute chest infection
·
Following surgery, esp. cardiac
PRINCIPLE SYMPTOMS OF HEART
DISEASE
SYMPTOMS
|
CVS CAUSES
|
OTHER CAUSES
|
Chest discomfort
|
Angina ,pericarditis,aortic dissection
|
Esophageal spasm,pneumothorax,musculoskeletal pain
|
Breathlessness
|
Heart failure,angina,pulm.hypertension and embolism
|
Resp. disease,anemia,obesity
|
Palpitations
|
Tachyarrythmias,
|
Anxiety,hyperthyroidism,drugs
|
Syncope/dizziness
|
Bradyarrythmias,postural hypotension,aortic
stenosis,hypertrophic obstructive cardiomyopathy
|
|
|
|
|
DIFFERENTIAL
DIAGNOSIS
ANGINA
|
ESOPHAGEAL
PAIN
|
Usually ppt by exertion
|
Same and also present at other times
|
Rapidly relieved by rest
|
Not so
|
Retrosternal and radiates to arms and jaw
|
Retrosternal and
epigastric and radiates to arm and back
|
Seldom wakes pt from sleep
|
Often
|
No relation to heart burn ,often pt have wind”
|
Sometimes rel
. to heart burn
|
Rapidly relieved by nitrates
|
Often
|
Typical
duration:2 to 10 minutes
|
variable
|
DIFFERENTIAL
DIAGNOSIS
ANGINA
|
MYOCARDIAL
INFARCTION
|
Retrosternal ,rad. To arm, neck , and epigastrium
|
As for angina
|
Ppt by exercise or emotion
|
Not so
|
Corrected by rest and nitrates
|
Not
|
Mild / moderate severity
|
Sever /may be silent
|
Anxiety absent or mild
|
Severe
|
No inc. sympathetic activation
|
Inc.
|
No nausea or vomiting
|
yes
|
CVS
DISEASE PRESENTING WITH NON CARDIAC SYMPTOMS
SYSTEM
|
SYMPTOMS
|
CAUSE
|
CNS
|
Stroke
|
Cerebral embolism
Endocarditis
Hypertension
|
GIT
|
Abdominal pain
Jaundice
|
Liver congestion secondary to heart failure
Mesenteric embolism
|
RENAL
|
Oliguria
|
Heart failure
|
FAST
HEART RATE-------TACHYCARDIA >100/MIN
SINUS
TACHYCARDIA
|
ARRYTHMIA
|
Exercise
Pain
Excitement/anxiety
Fever
Hyperthyroidism
Medication
- Sympathomimetics
- vasodilators
|
Atrial
flutter
Atrial
fibrillation
Supraventricular
tachycardia
Ventricular
tachycardia
|
SLOW
HEART RATE—BRADYCARDIA<50/MIN
SINUS
BRADYCARDIA
|
ARRYTHMIA
|
Sleep
Athletic training
Hypothyroidism
Mrdication
- beta
blockers
- digoxin
- verapamil
- diltiazem
|
Carotid sinus hypersensitivity
Sick sinus syndrome
Second degree heart block
Complete heart block
|
CHECKLIST
FOR BLOOD PRESSURE MEASUREMENT
PATIENT
|
Relaxed
Arm supported at heart level
Clothing removed from arm
|
Cuff
|
Neatly applied
Correct size for arm
No leaks
|
Manometer
|
Well supported
Upright
If anerioid manometer then regularly calibrated
|
Operator
|
Check SBP by palpation
Release pressure slowly
Avoid parallex error eye sam level as manometer
Avoid end digit preference ,record to nearest 2 mm Hg
|
DIFFERENCE
B/W CAROTID AND JUGULAR VENOUS PULSATION
CAROTID
|
JUGULAR
|
Rapid outward movement
|
Rapid inward movement
2 peaks
|
1 peak /heart beat
|
2 peaks /heart beat
|
Palpable
|
Impalpable
|
Pulse unaffected by pressure at the root of neck
|
Pulse diminished by pressure at the root of neck
|
Independent of respiration
|
Height of pulsation varies with resp.
|
Independent of position
|
Varies with position of the patient
|
Independent of abdominal pressure
|
Rises with abdominal pressure
|
ABNORMALITIES OF JVP
CONDITION
|
ABNORMALITY
|
Heart failure
|
Elevation ,sustained abdominojugular reflex
|
Pulmonary embolism
|
Elevation
|
Pericardial effusion
|
Elevation,prominent y descent
|
Pericardial constriction
|
Elev.kussmaul,s sign
|
Sup.venacaval obst.
|
Elev.loss of pulsation
|
At.fibrillation
|
Absent a wave
|
Tricuspid stenosis
|
Giant a wave
|
Tricuspid regurgitation
|
Giant v waves
|
Comp.heart block
|
Cannon waves
|
(FROM MACLEOD,S CLINICAL EXAMINATION)
by Waseem Shahzad Sheikh
PMC faisalabad
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