Nadida Kachkouche; Week 10 MED1022; Clinical Skills
Chest pain causes can be ischaemic or non-ischaemic, or caused by problems that are not CV (GI, MSK, psychogenic, neurologic, pulmonary). Angina is retrosternal anterior chest discomfort, crushing, tightening, squeezing or pressure lasting 2-20 minutes. May radiate. Pain can be brought on by exertion, emotional stress, heavy metals, cold, air. MI has same location, quality as angina but with feeling of impending death.
Aortic dissection can have a sudden onset, very severe, tearing, central to chest and radiates to the back, persists for hours, may be mistaken for MI. Non-ischaemic can be pericardial pain which is not brought on by exertion, relieved by leaning forwards. Dyspnoea is unpleasant sensation of difficulty breathing, can be at rest or low levels of physical exertion. Exertional dyspnoea can be due to heart failure/stenosis. Orthopnoea is manifestation of heart failure. PND is symptom of left heart failure, increases pulmonary venous pressure from mobilisation of ISF while lying flat, there is choking, air hunger, and feelings of imminent death. Palpitation can be brought on by caffiene, chocolate, nicoteine.
Intermittent claudication is pain in lower limbs from walking and relieved by rest, most commonly involves calves due to increased workload of mechanics of normal walking. Quality is aching or cramping. Syncope occurs usually after peeing/cough/exertion, has an aura. Is caused by inadequate cerebral flow. Oedema results from increased venous pressure and abnormal salt retaining hormones, in CCF it occurs throughout the day and diminishes at night, is also a side effect of Ca channel blockers. Can be seen in the sacrum.
Fatigue can be due to beta blockers, diuretics, can be a symptom of CHF. Measure JVP with the head turned slightly left.