Critical thinking and diagnostic reasoning of the heart and cardiovascular system

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.