GEM - cardiovascular symptomatology

Cardiovascular symptomatology GEM

Cardiovascular Problems are important because they are common, causing high levels of morbidity & mortality, resulting in considerable costs to society (1):

• coronary Heart Disease Greatest Burden in terms of Mortality Worldwide
• 50% of 45 year olds will die subsequently from coronary heart disease in UK
• stroke commonest form of acquired disability
• estimated direct health costs of cardiovascular problems are huge £1.75 billion on CHD and £1.65 stroke (1999 costs)
• primary and Secondary Prevention aimed at reducing risk factors (blood pressure, cholesterol, smoking, aspirin, better diabetic control) leads to clinically and statistically significant reductions in morbidity and mortality
• consulting rates for cardiovascular disease are increasing with an aging population and account for at least 931 per 10,000 person years at risk
• current evidence is that management of cardiovascular disease and its risk factors is often sub optimal

This GEM cannot cover the whole 'knowledge base' of the nMRCGP exam. However this GEM seeks to highlight important areas of knowledge for the primary care clinician (GP or GP registrar).

With respect to chest pain:

• Important causes of chest pain to consider include myocardial infarction; acute coronary syndrome; pulmonary embolism; oesophageal rupture
  • can you think of some other causes of chest pain
    • GPN reference
  • what symptoms are suggestive (but not definitive) of non-cardiac chest pain
    • GPN reference
  • in assessing a patient with chest pain a clinician should consider different aspects of the chest pain
    • nature of chest pain
      • GPN reference
    • radiation of pain
      • GPN reference
    • exacerbating factors
      • GPN reference
    • relieving factors
      • GPN reference
    • associated factors
      • GPN reference

With respect to breathlessness

• what is paroxysmal nocturnal dyspnoea?
  • GPN reference
• what are some suggested causes of patient presenting with a history of chest pain and breathlessness?
  • GPN reference

With respect to ankle swelling

• what are the causes of ankle swelling/lower limb swelling
  • GPN reference
• what features are important in the history of ankle swelling when assessing a patient?
  • GPN reference

With respect to clinical features of peripheral arterial disease

• calf claudication is a classic symptom of peripheral arterial disease. What other conditions should be considered in the differential diagnosis?
  • GPN reference

With respect to palpitations

• when assessing the a patient presenting with a history of palpiations it is important to assess:
  • associated symptoms e.g. chest pain, breathlessness, anxiety, syncope
  • the character of the palpitations
    • GPN reference
  • are there any trigger factors
    • GPN reference
  • mode of onset of the palpitatons
    • GPN reference
  • mode of termination of the palpitations
    • GPN reference

With respect to symptoms of cerbrovascular disease

• what is amaurosis fugax?
  • GPN reference
• clinical features of cerebrovascular disease vary with respect to arterial circulation involved, for example:
  • anterior cerebral artery stroke
    • GPN reference
  • middle cerebral artery stroke
    • GPN reference
  • posterior cerebral artery stroke
    • GPN reference

With respect to the patient with a history of syncope:

• important points to consider in the history include:
  • GPN reference
• important points to consider on examination
  • GPN reference

Reference:

1. Royal College of General Practitioners. Curriculum Statement 15.1 Cardiovascular Problems.