- Antihyperlipidemic medication therapy
- Muscle pains
Statins (need to be stopped)
- Hypotension
- Venous hypertension (jugular venous distention)
- Muffled or distant heart sounds
Cardiac tamponade (Beck’s triad)
Change in heart rate/ECG with respiration
- increased with inhalation
- decreased with exhalation
Sinus arrhythmia
- Claudication
- weak lower extremity pulses with high blood pressure in the upper extremities
- rib notching
- “3” sign
Coarctation of the aorta
- Headache with scalp tenderness
- Jaw claudication with mastication, talking
- Visual changes (monocular vision loss)
- Elevated erythrocyte sedimentation rate (ESR)
- Associated with polymyalgia rheumatic
Giant cell/temporal arteritis
- Hypertension that is refractory to several medications (patient is on several antihypertensives)
- bruit in abdomen
Renovascular disease (secondary hypertension)
- Increased jugular venous pressure
- Clear lung sounds
- Positive Kussmaul sign
Right ventricular myocardial infarction
- Intermittent claudication
- Decreased or absent pulses in feet
- Atrophic skin changes (loss of hair, shiny skin, thick nails)
- Ankle-brachial index < 0.90
Peripheral arterial disease
Irregularly irregular cardiac arrhythmia
Atrial fibrillation
Machinery-like continuous murmur
Patent ductus arteriosus
- Mid-systolic click
- young female with chest pain and palpitations
Mitral valve prolapse
Most common acyanotic heart lesion
(Perimembranous) ventricular septal defect
- Most common cyanotic heart lesion
- Four components: pulmonic stenosis, right ventricular hypertrophy, overriding aorta, ventricular septal defect
- “Boot-shaped” heart
- Tet spells
Tetralogy of Fallot
- Opening snap
- history of acute rheumatic fever or untreated streptococcal pharyngitis
Mitral stenosis
- Paresthesias (often early)
- Pain
- Pallor
- Pulselessness
- Poikilothermia (cold extremities)
- Paralysis (late finding with poor prognosis)
Acute arterial occlusion
- Pericardial knock
- Square root sign
- Kussmaul’s sign
- Increased jugular venous pressure
- Pericardial thickening or calcification on CT/MRI
Constrictive pericarditis
- Post-myocardial infarction
- Fever
- Pulmonary infiltrates on CXR
Dressler syndrome
- Post-myocardial infarction with hypotension
- Severe systolic heart failure
- Wet lung sounds
Cardiogenic shock
- Post-viral illness
- Chest pain
- Worse with deep breathing, thorax movement
- Better with leaning forward
- Pericardial friction rub (pathognomonic)
- Global ST segment elevation
- PR interval depression in inferior leads
Acute pericarditis
- Severe emotional stress manifestations of heart failure
- absence of obstructive coronary artery disease
- apical ballooning
Takotsubo (stress) cardiomyopathy
- Smoking history
- Abdominal or flank pain
- Pulsatile abdominal mass (the “pulsating lemon”)
Abdominal aortic aneurysm
- Spinal cord injury with hypotension
- Bradycardia
- Absence of sweating below the site of injury
Neurogenic shock
- Sudden cardiac death in young male athlete
- family history of young sudden cardiac death
- murmur at RUSB
Hypertrophic obstructive cardiomyopathy
- Tearing or ripping chest pain
- Radiation to intrascapular region
- History of hypertension
- Widened mediastinum on CXR
Aortic dissection
