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Dr Alicia Chan
Cardiologist, TQEH
Approach to cardiac patient
History
Exam
Investigations
Presenting complaints
Chest pain
Palpitations
Breathlessness
Dizziness and syncope
New murmurs
Chest pain - Causes
Cardiovascular Respiratory/chest GI Other
Other Anaemia
Metabolic acidosis
Hyperventilation syndrome
Breathlessness - Investigations
CBE
ECG rhythm, MI, LVH, right heart strain
CXR
Cardiomegaly/chamber enlargement
Pulmonary oedema
Pulmonary/mediastinal masses
Pleural pathology/ effusion
Focal lung disease
Pulmonary hypertension
Echo
Assess lV systolic and diastolic function
RV dialtation/impairment
Valve disease
Pericardial effusion
Optional investigations ABGs, lung function tests, EST
Rarely cardiac catheterization
Dizziness and Syncope - Causes
Cardiac causes
Bradycardia
Tachycardia
Myocardila ischemia
Vasovagal syndrome
Postural hypotension
LV outflow obstruction
Misc recurrent PE, atrial myxoma
Investigations
ECG
Exercise stress test
Ambulatory ECG
Echo
Tilt table testing
Electrophysiological study
Cardiac diagnosis?
YES NO
Consider: Consider:
EEG Tilt table testing
Carotid ultrasound ECG with carotid
CT/ MRI head sinus massage
New murmurs - Causes
Systole Midsystolic Mitral regurgitation
Physiologic
Flow
Pansystolic Mitral regurgitation
Tricuspid regurgitation
Ventricular septal defect
Ejection systolic Aortic stenosis
Outflow tract obstruction
Aortic sclerosis
Pulmonary stenosis