Cardio + Vascular

Question 1

How to calculate ABPI

Answer 1

1. Take brachial systolic BP with cuff or doppler probe + Sphygmomanometer in both left and right arms.
2. Take ankle systolic BP at posterior tibial artery (behind the medial malleolus of the foot) and dorsalis pedis artery of the left foot (lateral to the extensor hallucis longus tendon), use the highest of the readings for that foot.
3. Repeat on the other foot.
4. To calculate Right ABPI: DIVIDIE THE HIGHEST OF RIGHT SBP READINGS WITH ANY OF THE ARM SBP READINGS.

Question 2

Right brachial artery: 120 mmHg
Left brachial artery: 125 mmHg
Right DP: 80 mmHg
Right TP: 75 mmHg
Calculate the right ABPI and comment on the significance of the results.

Answer 2

• Highest right leg reading / highest arm reading:
  80/125 = 0.64.
• As is <0.9, the patient is likely to have peripheral arterial disease but as it is not <0.5 it is not critical limb ischaemia.

Question 3

1. ECG of tricyclic overdose

2. Common pathologies which arise.

Answer 3

1. Wide QT and Terminal R wave in aVR.

2. Arrhythmias and seizures (sodium channel blocking).

Question 4

Causes of pulmonary oedema with normal sized heart

Answer 4

acute renal failure
adult respiratory distress syndrome
aggressive fluid resuscitation
massive MI