Questions on symptoms of cardiovascular disease

CVS

  • What are the common presentations of cardiovascular diseases? H1

Chest pain

  • What are the causes of chest pain? H2
  • What is the central chest pain? H3
  • What are the causes of retrosternal chest pain? H4
  • What are the differences between angina and MI chest pain? H5
  • What are the causes of cardiac chest pain? H6
  • How can you differentiate between ischemic cardiac chest pain and nonischemic/noncardiac chest pain? H7
  • How can you differentiate between ischemic cardiac chest pain and nonischemic/noncardiac chest pain? H8
  • What are the causes of sudden severe chest pain? h70

Congenital heart diseases

  • Please name some congenital heart diseases. H182
  • Which are cyanotic congenital heart diseases? H183
  • Which are acyanotic congenital heart diseases? H184
  • Which is the most common congenital heart disease? H185

Rimikri

SOLVES


Symptoms of cardiovascular disease

What are the common presentations of cardiovascular diseases?

Common presentations are:

  • Chest pain
  • Palpitation
  • Breathlessness (dyspnoea)
  • Fatigue
  • Edema
  • Hypertension
  • Cardiogenic shock
  • Syncope
 * Pre-exam preparation for medicine, HN Sarker

Chest pain

What are the causes of chest pain?

Causes of chest pain are:

Central chest pain:

  1. Cardiac chest pain:
    • Myocardial ischemia (angina)
    • Myocardial infarction
    • Pericarditis
    • Mitral valve prolapse
  2. Aortic
    • Aortic dissection
    • Aortic aneurysm
  3. Pulmonary/mediastinal
    • Massive pulmonary embolism
    • Tracheitis
  4. Esophageal—Esophagitis
  5. Musculoskeletal—Osteoarthritis
  6. Anxiety/cardiac neurosis

Peripheral chest pain:

  1. Lung/pleura:
    • Pneumonia
    • Pneumothorax
    • Pulmonary infarction
    • Tuberculosis
    • Malignancy
  2. Chest wall disorders:
    • Rib fracture/injury
    • Intercostal muscle injury
    • Costochondritis (Tietze’s syndrome)
    • Epidemic myalgia (Bornholm disease)
  3. Psychogenic—Anxiety
  4. Neurological:
    • Herpes zoster
    • Prolapsed intervertebral disk
* Pre-exam preparation for medicine, HN Sarker; Davidson’s Principles and Practice of Medicine, 22nd edition Page: 541

Figure: Cardiovascular causes of chest pain and their characteristics
* Macleod’s Clinical Examination, 13th Edition Page: 101
What is the central chest pain?

Pain behind the sternum is known as central chest pain.

* Pre-exam preparation for medicine, HN Sarker
What are the causes of retrosternal chest pain?

The causes of retrosternal chest pain are:

  • Myocardial ischemia (angina)
  • Myocardial infarction
  • Pericarditis
  • Aortic dissection
  • Esophageal spasm.
* Pre-exam preparation for medicine, HN Sarker
What are the differences between angina and MI chest pain?
Characteristics Angina Myocardial infarction
Duration Short, usuallyLong, usually>20 min
Precipitated By exercise or emotion Often spontaneous
Relieved by Rest, nitrates Not by rest or nitrates
Sympathetic activity None Increased (e.g. sweating)
Nausea or vomiting Unusual Common
* Pre-exam preparation for medicine, HN Sarker
What are the causes of cardiac chest pain?

The causes of cardiac chest pain are:

  • Stable angina
  • Unstable angina
  • Myocardial infarction
* Pre-exam preparation for medicine, HN Sarker
How can you differentiate between ischemic cardiac chest pain and nonischemic/noncardiac chest pain?

Figure: Identifying ischaemic cardiac pain: the ‘balance’ of evidence.

* Davidson’s Principles and Practice of Medicine, 22nd edition Page: 540
What are the causes of sudden severe chest pain?

The causes of sudden severe chest pain are:

  • Dissecting aortic aneurysm
  • Tension pneumothorax
  • Pulmonary embolism.
 * Pre-exam preparation for medicine, HN Sarker

Breathlessness / dyspnoea

What is dyspnea?

Dyspnea (breathlessness) is an uncomfortable subjective awareness of increased drive to breathe.

* Pre-exam preparation for medicine, HN Sarker
What are the causes of acute dyspnea?
  1. Cardiac causes:
    • Acute pulmonary edema
    • Myocardial ischemia.
  2. Respiratory causes:
    • Acute severe asthma
    • Acute exacerbation of chronic obstructive pulmonary disease
    • Pneumonia
    • Pneumothorax
    • Pulmonary embolism
    • Acute respiratory distress syndrome
    • Laryngeal edema (e.g. anaphylaxis).
  3.  Others:
    • Psychogenic hyperventilation,
    • Metabolic acidosis (e.g. diabetic ketoacidosis, lactic acidosis, uremia, overdose of salicylates, ethylene glycol poisoning).

Read more about dyspnoea at Presenting problems of respiratory system

* Pre-exam preparation for medicine, HN Sarker; Box: Davidson’s Principles and Practice of Medicine, 22nd edition Page: 543
What are the causes of chronic dyspnea or dyspnea on exertion?
  1. Cardiac causes:
    • Chronic congestive cardiac failure.
    • Chronic pulmonary thromboembolism.
  2. Respiratory causes:
    • Chronic obstructive pulmonary disease.
    • Chronic asthma.
    • Bronchial carcinoma.
    • Interstitial lung diseases: Sarcoidosis, fibrosing alveolitis.
    • Large pleural effusion(s).
  3.  Others:
    • Severe anemia.
    • Obesity
 * Pre-exam preparation for medicine, HN Sarker
What is orthopnea?

Orthopnea is dyspnea on lying flat.

Lying down increases the venous return to the heart and in patients with left ventricular impairment may precipitate pulmonary oedema and provokes breathlessness. Patients may prop themselves up with pillows to prevent this. The severity can be graded by the number of pillows used at night, e.g. ‘three-pillow orthopnoea’.

* Pre-exam preparation for medicine, HN Sarker; Davidson’s Principles and Practice of Medicine, 22nd edition Page: 543; Macleod’s Clinical Examination, 13th Edition Page: 102
What is paroxysmal nocturnal dyspnoea?

Paroxysmal nocturnal dyspnoea is sudden breathlessness waking the patient from sleep.

It is caused by accumulation of alveolar fluid. In patients with severe heart failure, fluid shifts from the interstitial tissues of the peripheries into the circulation within 1–2 hours of lying down. Pulmonary oedema supervenes, causing the patient to wake and sit upright, profoundly breathless.

Patients may choke or gasp for air, sit on the edge of the bed and open windows in an attempt to relieve their distress. It may be confused with asthma, which can also cause night-time dyspnoea, chest tightness, cough and wheeze but patients with heart.

* Davidson’s Principles and Practice of Medicine, 22nd edition Page: 543; Macleod’s Clinical Examination, 13th Edition Page: 102, 142
What are the causes of PND?

The causes are as follows:

  • Venous return increases while lying down.
  • Mobilization of edema fluid from extravascular to intravascular compartment in supine position.
  • Low adrenergic drive at sleep.
  • Heart rate increases during rapid eye movement (REM) sleep.
  • Vital capacity is reduced in supine position.
  • Left atrial pressure is elevated and PaO2 is reduced during sleep.
  • Abdominal contents are al so pushed up giving pressure on diaphragm.
* Long Cases in Clinical Medicine, ABM Abdullah Page: 166

Palpitation

What is palpitation?

Palpitation is an unexpected awareness of the heart beating in the chest.

It may be rapid, forceful or irregular, and described as thumping, pounding, fluttering, jumping, racing or skipping. The patient may be able to mimic the rhythm by tapping it out.

* Macleod’s Clinical Examination, 13th Edition Page: 102
What are the causes of palpitation?

The causes of palpitations are:

  • Irregular—Atrial fibrillation and ectopics.
  • Regular—Paroxysmal—SVT/ VT.
  • Sustained—Sinus tachycardia, anemia, anxiety, and valve disease.
 * Pre-exam preparation for medicine, HN Sarker

Syncope

What is syncope?

Syncope is a loss of consciousness due to cerebral hypoperfusion.

* Macleod’s Clinical Examination, 13th Edition Page: 103

Edema

What are the causes of peripheral edema? / What are the causes of generalized edema?

As follows:

  1. Pitting edema occurs in:
    • Cardiac failure (right or combined left and right heart failure, pericardial constriction, cardiomyopathy)
    • Hypoalbuminemia (nephrotic syndrome, protein loosing enteropathy or less protein intake, CLD, often widespread, can affect arms and face)
    • Chronic venous insufficiency (varicose vein)
    • Drugs
      • Sodium retention: fludrocortisone, NSAIDs
      • Increasing capillary permeability: calcium channel blockers, e.g. nifedipine, amlodipine
    • Idiopathic (also called ‘Fluid retention syndrome’, women>men).
  2. Non-pitting edema occurs in:
    • Myxedema.
    • Chronic lymphatic obstruction or lymphedema (e.g. filariasis, Milroy’s disease).
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 204; Davidson’s Principles and Practice of Medicine, 22nd edition Page: 549
What are the causes of lymphedema?

As follows:

  1. Primary:
    • Secondary to agenesis or hypoplasia
    • Hereditary (Milroy’s disease)
    • Associated with Turner’s syndrome, Noonan syndrome and  yellow nail syndrome.
  2. Secondary
    • Recurrent lymphangitis or cellulitis
    • Filariasis
    • Tuberculosis
    • Burn
    • Trauma
    • Neoplasm
    • Surgery (in the arm, it may be due to mastectomy)
    • Radiation
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 204
What are the causes of bilateral leg swelling?

As follows:

  • Edema due to any cause (CCF, nephrotic syndrome and hypoproteinemia)
  • Myxedema
  • Some cases of lymphedema
  • Acromegaly
  • Inferior vena caval (IVC) obstruction (dilated tortuous veins in the lower limbs with upward flow)
  • Iliac vein thrombosis
  • Pregnancy
  • Drugs (calcium channel blockers, such as nifedipine or amlodipine).
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 204
What are the causes of unilateral leg swelling?

As follows:

  • Lymphedema
  • Chronic venous insufficiency
  • DVT
  • Ruptured Baker’s cyst
  • Angioneurotic edema
Note:
Unilateral swelling in arm may occur following mastectomy or radiation.
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 204
What are the causes of acute unilateral leg swelling?

As follows:

  • Deep venous thrombosis
  • Ruptured Baker’s cyst
  • Angioedema
  • Cellulitis
  • Trauma
 * Long Cases in Clinical Medicine, ABM Abdullah Page: 205
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