Cardiovascular symptoms

Chest pain

Serious causes

• MI
• Dissecting aortic aneurysm
• Pericarditis
• Pulmonary embolism

Description

• Character
• Constricting (angina, oesophageal spasm, anxiety)
• Sharp (pleura, pericardium)
• Prolonged dull central chest pain (MI)
• Radiation
• Shoulder/both arms or epigastric (cardiac ischaemia)
• Instantaneous, tearing, interscapular or retrosternal (aortic dissection)
• Precipitants
• Cold, exercise, palpitations or emotion (cardiac or anxiety)
• Food, lying flat, hot drinks, alcohol (oesophageal spasm but may still be cardiac)
• Relieving factors
• Rest of GTN (cardiac)
• Antacid (GI)
• Leaning forward (pericarditis)
• Associations
• Dyspnoea (cardiac pain, pulmonary emboli, pleurisy, or anxiety)
• Nausea, vomiting, or sweating (MI)
• Chest pain with tenderness (Tietze's syndrome)
• Pleuritic pain
• Pain exacerbated by inspiration 
• Inflammation of pleura
• Differentials include musculoskeletal (fractured rib) or subdiaphragmatic pathology (gallstones)
• Acutely ill patients
• Admit to hospital
• Check pulse and BP in both arms
• JVP
• heart sounds
• Examine legs for DVT
• Give O2 by mask
• IV line
• Relieve pain (morphine 5-10mg IV slowly 2mg/min + antiemetic)
• Cardiac monitor
• 12 lead ECG
• ABG
• Think about: dissection, zoster, ruptured oesophagus, cardiac tamponade with shock, opiate addiction

Dyspnoea

• Causes
• LVF
• Pulmonary embolism
• Any respiratory cause
• Anxiety
• History
• SOB at rest or exertion
• Exercise tolerance
• Episodic or triggered by lying flat
• Heart failure: orthopnoea (pillows at night), paroxysmal noctural dyspnoea (waking up at night gasping for breath), and peripheral oedema
• Pulmonary embolism: acute onset of dyspnoea and pleuritic chest pain, risk factors for DVT

Palpitations

• Causes
• Ectopics
• AF
• SVT
• Ventricular tachycardia
• Thyrotoxicosis
• Anxiety
• Phaeochromocytoma
• History
• Previous episodes
• Precipitating/relieving factors
• Duration of symptoms
• Chest pain
• Dyspnoea
• Dizziness
• Patient's pulse?

Syncope

• Cardiac or CNS events
• Vasovagal 'faints' are common (pulse decreased, pupils dilated)
• Cardiac cause: Chest pain, palpitations, dyspnoea
• CNS cause: Aura, headache, dysarthria, limb weakness
• Ask observer:
• Was there pulse?
• Limb jerking?
• Tongue biting?
• Urinary incontinence?
• Rapid (arrhythmia)?
• Prolonged (seizure)?