Critical thinking and diagnostic reasoning of the heart and cardiovascular system
This is the second of two articles exploring assessment and clinical reasoning of conditions relating to the heart and cardiovascular system in the context of emergency care. In the last article, the structure and function of the heart was reviewed, and reference made to many of the conditions that may affect the heart. In addition, the common presenting complaints of cardiac conditions were highlighted, together with important aspects of the history for each symptom. The full cardiac examination was outlined. In this article, some of the common cardiac conditions will be discussed. These will be linked to common findings in the history, examination, and investigations.
The previous article (Byrne, 2021) discussed cardiac anatomy and many of the conditions that can affect the heart and aorta. The major presentations of cardiac conditions were introduced, and the clinical examination was outlined. In this article, the aim is to examine each of these presenting complaints in more detail and highlight common findings in the history, examination and investigations that may aid diagnosis in the emergency department. The common presentations are chest pain, dyspnoea, syncope, and palpitations (Bickley, 2017).
Chest pain is a common complaint, comprising up to 25% of emergency department attendances (Byrne, 2014). Not all of these will have a cardiac complaint; however, it is crucial to recognise important cardiac presentations such as acute coronary syndromes (ACS), an umbrella term for unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). In addition, aortic dissection, pericarditis, myocarditis and myopericarditis often present with chest pain.
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