Cardiac Conditions Differential Diagnosis OSCE PDF

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Summary

CONDITION DESCRIPTION RISK FACTOR HISTORY INVESTIGATION MANAGEMENTAtheroscleroticDiseaseHardening & Thickening of arteries due to build-up of fatty plaques on arterial wall. Causing loss in perfusion and rupture. 3 Types: Coronary Heart Disease, Stroke, Peripheral Vascular DiseaseIncreased A...

Description

CONDITION

Atherosclerotic Disease

DESCRIPTION Hardening & Thickening of arteries due to build-up of fatty plaques on arterial wall. Causing loss in perfusion and rupture. 3 Types: Coronary Heart Disease, Stroke, Peripheral Vascular Disease

Common Exertional chest pain

Stable Angina

Indicates myocardial ischaemia without infarct: due to narrowing of coronary artery Occurs when insufficient O2 to heart to meet demand

RISK FACTOR Increased Age Men Genetics Smoking Hypertension T1DM & T2DM Hyperlipidaemia Lack of Exercise Obesity & Diet

HISTORY

Mild = No symptoms Blood flow block = blood clot can cause heart attack or stroke

X Ray – show heart failure signs EKG – detect & record electrical activity of heart Angiogram – see plaque blocking arteries and how severe plaque

Relieved by rest nitrate (GTN Spray) Hypertension Diabetes Obesity Family history Smoking Age

INVESTIGATION Blood Test to check Cholesterol, Fats, Proteins level

Central/LS Chest pain Tight crushing Pain

History Taking ECG often normal: ST Depression, T wave flatten, Ventricular Ectopic Beat

Maybe dyspnoea/ SOB

CT Angiogram – look for narrowing

With/Without radiation to neck, arm or jaw

If NO Chest Pain relief in 5 mins of stopping activity or GTN Spray use = Acute Coronary Syndrome

Quick – few mins

Infective Endocarditis

Caused by infection of endocardium by bacteria Affects heart valves mostly can affect lining Commonly occurs at site of previous damage Endocardial damage causes thrombi formation at damaged site (made of platelet & fibrin)

Valvular Damage: Previous Rheumatic Heart Disease Valvular degeneration Prosthetic valve IV Drug user

New Murmur and Fever Can be acute infection Petechiae (red/purple spots 1-2mm diameter) Low platelet count Night sweats Janeway lesions : nontender Osler Nodes Anaemia

+ve blood culture for infective org Echocardiogram: stricture, unusual blood flow, abscess Fever > 38oC, IV Drug use Transthoracic Echocardiography: see vegetations ECG shows signs of MI New AV Block suggests abscess formation

MANAGEMENT Stop Smoking Reduce Weight Loss, BP control, exercise, Low sat. fat diet Long use after MI: ACE Inhibitor, Aspirin, B Blocker or Statin (COBRA) Stop smoking = >2 yr risk of MI same = as no smoke Control hypertension Weight, Exercise Acute = treat with Sublingual GTN Spray (Increase Heart blood flow – dilate CA) Long term = (Decrease heart workload) : B-blocker (Atenolol), Ca2+ Channel Blocker (Diltiazem), less thrombus formation (aspirin) & statin High concentration of antibiotics are required for long time

Acute presentation – flucloxacillin, gentamycin Subacute presentationbenzylpenicillin,gentamycin May need surgery if IE resistant to Antibiotic via valve replacement

Heart Failure

Right Side

Inability of RV to pump adequate amount of blood leading to systemic venous congestion

Inability of heart to pump enough blood 4 body needs

Left Side

Inability of LV to pump blood causing pulmonary circulation congestion & pulmonary oedema

Deep Vein Thrombosis

Pulmonary Embolism

Clot in any vein, more likely in pelvic/ leg vein

Complication of DVT that becomes dislodged and goes to blood via Right side of heart and gets lodged in pulmonary circulation Not just clot that causes it; fluid & air, can cause

Immobility Dehydration Obesity, Age Trauma

Age Malignancy Infection Family History Immobility Surgery Previous DVT

Abdomen Discomfort Peripheral Oedema

ACE Inhibitors If there is fluid overload : diuretics and GTN used Improve systolic function = B blocker

Dyspnoea Hypotension Poor Peripheral Perfusion

Smoking cessation Reduce Alcohol Diet control: Fluid restrict, Less Salt Manage Diabetes

Red, Swollen leg Tenderness Pitting Oedema Fever

Cyanosis Tachypnoea (RR>16) Raised JVP Pleuritic chest pain (worse on inhaling) Breathlessness Cough Haemoptysis Dizziness

WELL’S SCORE Score > 3 – treat as DVT : perform compression USS to confirm Score 1-2 treat as DVT : perform compression USS to confirm Score 0 – do D-Dimer (if neg then not DVT)

Prevent embolism: LMWH – as soon as diagnosed for 5 days then stop when normal INR Warfarin after

PERC Score and WELLs Score D Dimer test (negative = unlikely) Chest X ray -often normal ECG – T wave change, new onset AF ABG = O2 low, Co2 normal/low

Anticoagulat with LMWH and Warfarin

Localised dilation x 1.5 normal True = wall of artery forms wall of aneurysm

Aortic Aneurysm

False = surrounding tissue form aneurysm wall

Hypertension Smoking Age Diabetes Obesity

>65 Sudden persistent chest pain Pain radiate to back Low BP, SOB, LOC

Ultrasound to find site and assess development

Surgery

ECG : No P Wave Irregular QRS – 75-190bpm Normal T wave Blood – Cardiac Enzymes

Identify risk factor and reversible cause Find structural heart disease Manage Ventricular Rate (B blocker – bisoprolol) Anticoagulation

Fusiform = shape tapered at both ends

Obesity, Hypertension, T2DM, Smoking, CAD, Heart failure, Valve Disease, PE

Atrial Fibrillation

> 140/90 Increase peripheral vascular resistance, high bp in arteries

Hypertension

Myocardial Infarction

Systolic = top = pressure in arteries when heart contract bottom = diastolic = pressure in arteries when heart relax between beat Heart Attack When flow of blood to heart = blocked, usually due to build-up of fat, cholesterol and other, which form plaque in coronary artery Often plaque can rupture and form clot that blocks flow. This destroys heart muscle

FHX Obesity Alcohol Na+, stress

Palpations Chest Pain Dyspnoea Dizziness Irregularly Irregular Pulse

Ambulatory blood pressure monitor = 24 hour monitor

Asymptomatic Headache, seizure, chest pain, nausea, low limb weakness

Urine test = to check for protein

Pressure Tightness, Chest Pain, SOB, Sweaty, Palpitations Fever Fatigue

Acute Coronary Syndrome: ECG: ST Elevation, inverted T wave, Q wave Elevated Troponin CXR normal but may have pneumothorax Coronary Angiography: find narrowing

Diet (less salt) and exercise Try medication to come up with most suitable

Blood test to check kidney, cholesterol and glucose MONAC : Morphine: Oxygen: Nitrates: Aspirin: Clopidogrel: Angioplasty: to dilate...