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A Rapid Review of Viva of Cardiovascular System

SYMPTOMS RELATED TO MEDICINE

1. DYSPNEA
• beta blockers in pt of asthma
• exacerbation of heart failure by beta blockers ,Ca antagonists ,and NSAIDS
  
  
2. DIZZINESS
• Vasodilators . e.g  nitrates , alpha blockers and ACE  inhibitors
  
3. ANGINA
   

• Aggravated by  thyroxine or drug induced anemia by aspirin and NSAIDS

4. EDEMA

• Fluid retention by NSAIDS or  steroids  or Ca antagonists

5. 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
• ATRILA FIBRILLATION
• Pt description:heart jumping about or racing , associated breathlessness, may be unnoticed .
• SUPRAVENTRICULAR TACHYCARDIA
• Pt. description:heart racing or fluttering ,ass. polyuria
• VENTRICULAR TACHYCARDIA
• 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 , ?

 SCHEME OF CVS EXAMINATION

1. get a general impression of  pt ,look for signs of anxiety , breathlessness or pain.
2. shake hands assess peripheral circulation and  sweating , look for clubbing , splinter hemorrhages.
3. Palpate radial pulse , measure rate and assess  rhythm.
4. palpate brachial pulse
5. measure B.P
6. palpate carotid pulse , assess quality  and listen for bruits.
7. examine JVP
8. examine face  look for hypercholesterolemia  or anemia ,examine tongue for cyanosis.
9. examine chest , listen for crepitations , look for sacral edema
10. examine abdomen for hepatomegaly  and asites
11. assess femoral pulses , look for radiofemoral delay
12. 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

COMMON CAUSES OF ATRIAL FIBRILLATION

·                    HRT

·                    Cardiac failure

·                    MI

·                    Thyrotoxicosis

·                    Alcohol related heart disesase

·                    Mitral valve disease

·                    Acute chest infection

DIFFERENTIAL DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

CVS DISEASE PRESENTING WITH NON CARDIAC SYMPTOMS

FAST HEART RATE-------TACHYCARDIA >100/MIN

SLOW HEART RATE—BRADYCARDIA<50/MIN

CHECKLIST FOR BLOOD PRESSURE MEASUREMENT

DIFFERENCE B/W CAROTID AND JUGULAR VENOUS PULSATION

ABNORMALITIES OF JVP

(FROM MACLEOD,S CLINICAL EXAMINATION)
by  Waseem Shahzad Sheikh
PMC faisalabad

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