Makindo Medical Notes

Related Subjects: |Cardiac Examination |Cardiac History Taking |Respiratory Examination |Gastroenterology Examination |Cardiac Anatomy and Physiology |Coronary Artery Anatomy and Physiology |Cardiac Electrophysiology |Cardiac Embryology

❤️ Cardiac arrest can be the first manifestation of ischaemic heart disease, hypertrophic cardiomyopathy, or other causes of sudden cardiac death. ⚡ Defibrillation for VF/VT can be lifesaving.

📋 Introduction

• Take a detailed history of presenting complaints. ⏱️ Always quantify (e.g., distance walked, no. of cigarettes/day, no. of pillows at night).
• Clarify vague timelines: ❓ Ask “Is that a day, a week, or a month?”
• Risk factors: 🚬 smoking, ⬆️ BP, 🧬 family history, 🍩 diabetes, 🧈 hyperlipidaemia, 🤒 rheumatic fever, 🍺 alcohol.
• Assess daily activity limitation (stairs, housework, self-care). Ask about dependence on help.
• Always link chest pain + risk factors: e.g., same pain in a 25yo woman 🚺 vs a 60yo smoker with HTN + diabetes 🚹 gives very different likelihood of CAD.
• Key cardiac symptoms: 💔 chest pain, 😮‍💨 breathlessness, 🔄 palpitations, 😵 syncope/presyncope, 😫 fatigue.

💔 Chest Pain

• Differentials:
  • 🫀 Acute Coronary Syndrome (ACS) → ECG, troponin, echo.
  • 🫁 Pulmonary Embolism (PE) → D-dimer, CTPA.
  • 🩻 Aortic Dissection → CXR, CT/TOE.
  • 🩸 Oesophageal Rupture → CXR, history.
  • 🌬️ Pneumothorax → expiratory CXR.
  • 🤧 Pneumonia/Pleurisy → fever + CXR.
  • 🔥 Shingles → dermatomal rash + pain.
  • 🤕 Rib/sternal fracture → trauma history.
• Cardiac pain: heavy, central, crushing → “Levine’s sign” ✊.
• 💊 Relieved by rest or GTN → angina. Persistent → MI.
• MI pain: severe, with pallor, sweat, nausea 🤢.
• Atypical: elderly & diabetics may only present with 💨 dyspnoea or fatigue.
• Pericarditis: 🔥 sharp, pleuritic, relieved leaning forward. May hear a rub.
• Aortic dissection: ⛓️ tearing pain → back radiation.

😮‍💨 Breathlessness

• Suggests heart failure (fluid overload + pulmonary oedema).
• 🏔️ Orthopnoea: breathless lying flat → “How many pillows at night?”
• 🌙 Paroxysmal Nocturnal Dyspnoea (PND): wakes suddenly, gasping, needing to sit up.
• 🦶 Oedema: ankles → legs → ascites + scrotal swelling. May also get hepatomegaly, pleural effusion.

😫 Fatigue

• Common in 💔 heart failure, but also in anaemia, hypothyroidism, malignancy, viral illness.
• Ask: “How has this changed your daily stamina vs before?”

🔄 Palpitations

• Patient awareness of heartbeat. Ask them to tap rhythm to assess rate/regularity.
• ⚡ Sudden fast → stops abruptly → + polyuria → suggests SVT.
• “Thump” → post-ectopic beat (benign, but record).

😵 Syncope / Presyncope

• Always serious. Investigate murmurs + arrhythmias.
• History: what happened before, during, after? 🧑‍🤝‍🧑 Witness reports are vital.
• Tests: ECG, echo, 24h Holter if cardiac cause suspected.
• Cardiac causes:
  • Severe aortic stenosis 🚫
  • Severe bradycardia (complete heart block, sinus pause)
  • 💉 Vasovagal (often medication-linked)
  • ⚡ Ventricular Tachycardia (VT)
  • 🧠 Stokes-Adams attacks

⚡ Cardiac Arrest

• No cardiac output → no pulse, no breathing.
• Causes:
  • 🚨 Pulseless VT
  • 🌩️ VF
  • 📉 Asystole
  • 📺 Pulseless Electrical Activity (PEA/EMD)