Breathlessness

Question 1

Which conditions cause increased in work of breathing through airflow obstruction?

Answer 1

Asthma
Chronic bronchitis
Tracheal obstruction

Question 2

Which conditions cause increased work of breathing by decreased pulmonary compliance “stiff lung”?

Answer 2

Fibrosis

Pulmonary oedema

Question 3

Which conditions caused increased work of breathing by restricted chest expansion?

Answer 3

Respiratory muscle paralysis

Question 4

Which conditions cause increased ventilatory rate by V/! mismatch (physiological dead space)?

Answer 4

Infection

Pulmonary embolism

Question 5

How does systemic hypertension lead to left ventricular failure?

Answer 5

Systemic Hypertension
Raised peripheral resistance
Increased ventricular afterload
Left ventricular hypertrophy 
Left ventricular failure

Question 6

How does left ventricular failure cause pulmonary oedema?

Answer 6

Increase pressure in left atrium and left ventricle (increase preload)
Back pressure on the lungs
Increase in pulmonary capillary hydrostatic pressure
Accumulation of fluid in interstitial/alveolar spaces (pulmonary oedema)

Question 7

What is orthopnoea?

Answer 7

Breathlessness on lying flat

Question 8

What is the sign that is described by patients as having to wake up suddenly during the night gasping for breath?

Answer 8

Paroxysmal nocturnal dyspnoea (PND)

Question 9

How do you investigate chest pain?

Answer 9

ECG
CXR
ETT (if on exertion)
(Thallium)

Question 10

How do you investigate dyspnoea?

Answer 10

ECG
CXR
ECHO

Question 11

How do you investigate palpitation?

Answer 11

ECG
24-hr ECG
ECHO

Question 12

How do you investigate a murmur?

Answer 12

ECG

ECHO

Question 13

How do you investigate infective endocarditis?

Answer 13

Blood cultures

ECHO

Question 14

What is thallium perfusion scintogoraphy?

Answer 14

Radiolabelled isotope taken up by normally perfused myocardial cells
Gamma camera counts radioactivity across the myocardium
Image taken at rest and after stress (exercise/pharma-induced)
Radioactivity should be equal over whole myocardium

Question 15

What does unequal distribution of radioactivity over the myocardium suggest?

Answer 15

Perfusion defect
(fixed = infarction: reversible = ischaemia)

Question 16

What is ECHO used for?

Answer 16

Non-invasive visualisation of the cardiac chambers and valves

Question 17

What is cardiac catheterisation?

Answer 17

Insertion of flexible gathers into heart and coronary arteries

Question 18

What is cardiac catheterisation used for?

Answer 18

Allows pressure to be measured via transducers or radio contrast to be injected to take x-ray pictures
Allows examination of valves, ventricular function, CO, systemic or pulmonary artery pressure, vascular resistance, shunt quantification, view of aorta + coronary arteries, abnormal communication

Question 19

What is CT coronary angiography?

Answer 19

X-ray exam with iodine containing contrast material to determine if fatty / calcium deposits have narrowed the patient’s coronary arteries

Question 20

CT coronary angiography is indicated as an investigation for?

Answer 20

Anatomical abnormalities
IHD
PE
MASK causes of chest pain
Congenital heart disease
Myocardial function