Cardiology Flashcards
1
Q
equation for stroke volume (SV)
A
end diastolic vol (EDV) - end systolic vol (ESV) = SV
2
Q
equation for cardiac output (CO)
A
Heart Rate (HR) x Stroke Volume (SV)
3
Q
equation for BP
A
CO x Total Peripheral Resistance (TPR)
4
Q
equation for Pulse Presure (PP)
A
systolic - diastolic
5
Q
equation for Mean Arterial Pressure (MAP)
A
diastolic + 1/3 PP
6
Q
equation for ejection fraction
A
SV/EDV
7
Q
what’s Ohms law?
A
Flow = Pressure Grad/R
8
Q
whats Poiseuille’s law?
A
- flow is proportional to radius to power of 4*
- small change in R = BIG change in flow*
R = 8xLxViscosity /πr4
9
Q
define preload
A
vol of blood in ventricles immediately before contraction
10
Q
define afterload
A
force against which ventricles contract in order to expel blood
11
Q
define contractility
A
strength/vigour of contraction during systole
12
Q
define elasticity
A
ability of heart to return to normal shape after stretching (by recoiling)
13
Q
define compliance
A
how easily heart will stretch when filled with blood
14
Q
define resistance
A
force that must be overcome to push blood in circulatory system
15
Q
define ATHEROGENESIS
A
formation of fat deposits in arteries
16
Q
7 risk factors for ATHEROGENESIS
A
1) . age
2) . smoking
3) . increased LDLs
4) . Obesity
5) . diabetes
6) . fam history
7) . high BP
17
Q
4 components of ATHEROSCLEROSIS plaque
A
1) lipid
2) . necrotic core
3) . connective tissue
4) . fibrous cap
18
Q
list 7 inflammatory markers found in ATHEROSCLEROSIS plaque
A
IL-2 IL-6 IL-8 IFN-Gamma TGF-Beta MCP-1 C reactive protein
19
Q
what is C reactive protein
A
non specific inflammatory marker
20
Q
how does ATHEROSCLEROSIS start
A
1) . endothelial injury
2) . leads to endothelial dysfunction
3) . adhesion molecules sent to lymphocytes
4) . lymphocytes migrate to vessel wall
21
Q
what are the 4 stages of ATHEROSCLEROSIS
A
1) . fatty streak
2) . intermediate lesion
3) . fibrous plaque
4) . plaque rupture
22
Q
describe 1st stage of ATHEROSCLEROSIS (fatty streak)
A
- fatty streak occurs
- loaded with lipids / T-cells / Macrophages
- everyone has them
23
Q
3 features of 2nd stage of ATHEROSCLEROSIS (intermediate lesion)
A
1) . foam cells (lipid filled macrophages)
2) . smooth muscle proliferation
3) . platelet adhesion
24
Q
2 features of 3rd stage of ATHEROSCLEROSIS (fibrous plaque)
A
1) . fibrous layer of collagen + elastin
2) . are calcified
25
outline the 4th stage of ATHEROSCLEROSIS (plaque rupture) and how it leads to angina
1) . fibrous cap rupture due to increased inflammation
2) . plaque ruptures then heals repeatedly -> increasing occlusion
3) . full occlusion -> angina
26
what at most basic level causes myocardial ISCHAEMIA
imbalance between demand/supply of myocardial oxygen
27
what is the epidemiology of ISCHAEMIC HEART DISEASE
UK DEATHS
- 70k a year
- 1/7 men
- 1/11 women
28
what's the pathological basis for ISCHAEMIC HEART DISEASE
1) . imbalance in cardiac muscle oxygen supply/demand
| 2) . atherosclerosis causes narrowed arteries -> ischaemia and pain (angina)
29
list 7 causes of ISCHAEMIC HEART DISEASE
1) . coronary artery atheroma (most common)
2) . LV hypertrophy
3) . anaemia (less O2 carrying capacity)
4) . hypoxia (less O2 available)
5) . coronary artery thrombosis
6) . coronary artery spasm
7) . arteritis
30
list 6 modifiable risk factors for ISCHAEMIC HEART DISEASE
1) . smoking
2) . obesity
3) . exercise
4) . diet (high sat fat)
5) . alcohol intake
6) . sedentary lifestyle
31
list 4 clinical risk factors for ISCHAEMIC HEART DISEASE
1) . hypertension
2) . diabetes
3) . Hyperlipid/cholesterolemia
4) . depression
32
list 4 non-modifiable risk factors for ISCHAEMIC HEART DISEASE
1) . age
2) . fam history/genetics
3) . gender (M>F)
4) . ethnicity
33
list 3 psychosocial risk factors for ISCHAEMIC HEART DISEASE
1) . high stress job
2) . low social interaction
3) . lack of support network
34
what is the QRISK2 score
predicts risk of CVD in the next 10 years
35
list 9 things the QRISK2 score considers
1) . BP
2) . Age
3) . smoking status
4) . cholesterol
5) . rheumatoid arthritis
6) . diabetes mellitus
7) . anti-hypertensives
8) . BMI
9) . ethnicity
36
define ANGINA (angina pectoris)
- description of chest pain
| - result of myocardial ischaemia
37
list 5 types of angina
1) . stable
2) . unstable
3) . variant
4) . decubitus
5) . nocturnal
38
define stable ANGINA
- induced by effort
| - relieved by stress
39
define unstable ANGINA
- crescendo
- increases in severity
- occurs at rest
- is of recent onset ( <1 month)
40
define variant ANGINA
- Prinzmetal's
- caused by coronary artery spasm
- unprovoked angina (at rest)
41
define decubitus ANGINA
occurs lying down
42
define nocturnal ANGINA
- occurs at night
| - may wake you from sleep
43
list 4 symptoms of ANGINA
1) . central crushing chest pain radiating to arms/jaw/neck
2) . dyspnoea
3) . palpitations (laboured breathing)
4) . syncope (fainting)
44
list 3 signs of ANGINA
1) . chest pain with exertion
2) . pain fixed with rest/GTN spray
3) . exacerbated with cold weather/anger/excitement
45
3 scoring factors when determining type of Angina
1) . central tight chest pain radiating to arms/neck/jaw
2) . caused by exertion
3) . relieved by Rest/GTN
46
outline what score out of 3 is needed for determining anginal pain
```
3/3 = typical
2/3 = atypical
1/3 = non-anginal
```
47
list 5 differentials for ANGINA
1) pericarditis/myocarditis
2) . pulmonary embolism
3) . chest infection
4) . GORD
5) . aortic dissection
48
list 5 investigations for ANGINA
1) . 12 lead ECG
2) . CT angiogram
3) . stress ECG
4) . FBC
5) . Chest X-Ray
49
what would you see in ECG for ANGINA
- usually normal
- may show ST depression
- may show T wave inversion
50
what would you see in CT angiogram in ANGINA
- narrowing of a coronary artery
| - can then go in and open artery with stent/balloon
51
what would bloods show for ANGINA
- FBC shows anaemia
| - cardiac enzymes present
52
what do you look for in Chest-X ray for ANGINA
- check heart size
| - check pulmonary vessels
53
list 3 lifestyle treatments for ANGINA
1) . weight loss
2) . more exercise
3) . quit smoking
54
list 7 drugs used to treat ANGINA
1) . GTN spray (1st line)
2) . Beta blockers
3) . Calcium channel blocker
4) . anti-platelet
5) . statins
6) . ACE inhibitors
7) . Ivabradine
55
GTN SPRAY (glyceryl trinitrate) - method of action
- dilate coronary arteries
- preload reduced
* nitrate is vasodilator*
56
GTN SPRAY (glyceryl trinitrate) - - common side effect
headache
57
BETA BLOCKERS - 3 examples
1) . bisoprolol
2) . atenolol
3) . propranolol
58
BETA BLOCKERS - method of action
- reduce HR (neg chronotropic)
| - reduce contraction (neg inotropic)
59
BETA BLOCKERS - 2 times when are they contraindicated
1) . asthma
| 2) . people with heart block
60
BETA BLOCKERS - what's the alternative if contraindicated
Calcium channel blockers
61
CALCIUM CHANNEL BLOCKERS - example?
Amlodipine
62
CALCIUM CHANNEL BLOCKERS - method of action
- block calcium influx into cell
- utilise calcium within cell
- relax coronary arteries
- reduce force of LV contraction (neg inotropic)
63
ANTI-PLATELETS - give 2 examples
1) . aspirin 75mg
| 2) . clopidogrel (if aspirin contraindicated)
64
method of action of ASPIRIN?
- inhibits COX-1
- reduced production of thromboxane A2
- so platelet aggregation reduced
65
what do you give if aspirin is contraindicated
clopidogrel
66
STATINS - give 2 examples
1) . atorvastatin
| 2) . simvastatin
67
STATINS - method of action
- reduce cholesterol
| - HMG-CoA reductase inhibitor
68
ACE INHIBITORS - give 2 examples
1) . ramipril
| 2) . lisinopril
69
ACE INHIBITORS method of action
- reduce BP
| - stop Angiotensin 1 -> 2 conversion
70
list 2 ANGIOTENSIN RECEPTOR BLOCKERS
1) . candesartan
| 2) . losartan
71
method of action of IVABRADINE
- inhibits pacemaker current in SAN
| - HR reduced (neg chronotropic)
72
2 other managements if Angina not controlled with drugs
1) . Percutaneous Coronary Intervention (PCI) (stenting/balloon)
2) . Coronary Artery Bypass Graft (CABG)
73
2 principles of Angina management
1) . manage modifiable risk factors
| 2) . symptom control
74
define ACUTE CORONARY SYNDROMES (ACS)
- unstable coronary artery diseases
| - acute (3 types)
75
list the 3 types of ACS
1) . unstable angina
2) . STEMI
3) . NSTEMI
76
(ACS) define UNSTABLE ANGINA
1) . cardiac chest pain in crescendo pattern
2) . deterioration from stable angina
3) . symptoms at rest
77
(ACS) define STEMI
1) . develops after full occlusion of major coronary artery which was affected by atherosclerosis
2) . full thickness cardiac muscle damage
3) . be diagnosed with ECG
78
(ACS) define NSTEMI
1) . full occlusion of minor coronary artery OR partial occlusion of major coronary artery
2) . distal infarction / proximal ischaemia
3) . diagnosed after troponin / other tests
79
Pathology of all ACS
- rupture of athersclerotic plaque
| - leads to arterial thrombosis
80
list 4 investigations for ACS
1) ECG
2) . Bloods (FBC/U&E/Glucose/Lipids)
3) . Cardiac enzymes
4) . CT angiogram
81
list 3 ECG changes in Acute STEMI
1) . Tall T waves
2) . ST elevation
3) . new LBB
82
list 3 ECG changes in NSTEMI
1) . ST depression
2) . T wave inversion
3) . Q waves
83
what is troponin
- protein which regulates actin/myosin interaction
84
why is troponin used in MI investigation
-its a highly sensitive marker for cardiac muscle injury
85
3 cardiac enzymes you would see in ACS
1) . Troponin T/I
2) . Creatinine Kinase
3) . myoglobin
86
what is creatinine kinase
- catalyses conversion of creatinine
| - utilises ATP to make ADP and PCr (phosphocreatinine)
87
list 5 cardiac causes of raised troponin
1) . congestive heart failure
2) . coronary artery disease
3) . myo/endo/pericarditis
4) tachy/bradycardia
5) heart block
88
list 7 non-cardiac causes of raised troponin
1) . PE
2) . gram neg sepsis
3) pulmonary HTN
4) renal failure
5) . COPD
6) . diabetes
7) . drugs
89
6 diagnostic tools for UNSTABLE ANGINA
1) . take history
2) . FBC = anaemia
3) . cardiac enzymes (troponin normal so NOT MI)
4) . ECG = ST depression when pt in pain
5) . CT coronary angiogram
6) QRISK 2
90
4 risk factor modifications for UNSTABLE ANGINA
1) . stop smoking
2) . lose weight
3) . healthy diet
4) . exercise
91
next steps after QRISK2 for high or low risk?
low risk
- do elective stress test
high risk
- PCI
- CABG
92
7 drugs used to manage UNSTABLE ANGINA
1) . antiplatelet therapy
2) . anti-coagulants
3) Nitrates
4) . Beta Blockers
5) . Statins
6) . ACE Inhibitors
7) . Ca Channel blockers
93
list 3 drug types used in anti-platelet therapy of UNSTABLE ANGINA
1) . Aspirin
2) . P2Y12 inhibitor (dual therapy with aspirin)
3) . Glycoprotein IIb/IIIa inhibitor
94
P2Y12 INHIBITOR - give 3 examples
1) . Clopidogrel
2) . Ticagrelor
3) . Prasugrel
95
P2Y12 INHIBITOR - method of action
- inhibitor the P2Y12 receptors on platelets
| - decreases platelet activation and aggregation.
96
IIb/IIIa INHIBITOR - give example
abciximab
97
IIb/IIIa INHIBITOR - method of action
- Inhibits ADP-dependant activation of IIb/IIIa glycoproteins
- stops amplification of platelet aggregations
98
list 3 drugs used in anticoagulant therapy of UNSTABLE ANGINA
1) . Heparin
2) . Low Molecular Weight Heparin (LMWH)
3) . Fondaparinux
99
HEPARIN - method of action?
- inhibits factors II/VII/IX/X
| - stops thrombus formation
100
what is factor II
prothrombin
101
Give an example of a LMWH
enoxaparin
102
benefit of using LMWHs
-better efficacy than unfractionated heparin
103
method of action of FONDAPARINUX
- inhibits factor Xa
104
benefit of using FONDAPARINUX
- lower risk of bleeding than heparin
105
define MYOCARDIAL INFARCTION
- necrosis of cardiac tissue
- due to prolonged myocardial ischaemia
- due to COMPLETE artery occlusion
- by a thrombus
106
epidemiology of MYOCARDIAL INFARCTION
- most common cause of death in developed countries
| - 1/3 cases occur at night
107
pathology of MYOCARDIAL INFARCTION (4 steps)
1) . plaque rupture
2) . development of thrombosis
3) . total occlusion of coronary artery
4) . myocardial cell death
108
list 7 risk factors for MYOCARDIAL INFARCTION
1) . old age
2) . male
3) . Hx of premature coronary artery disease
4) . Diabetes Mellitus
5) . Hypertension
6) . Hyperlipidaemia
7) . Family History
109
list 6 symptoms of MYOCARDIAL INFARCTION
1) . central rushing chest pain
2) . sweating
3) . SOB/Dyspnoea
4) . fatigue
5) . nausea
6) . vomiting
110
list 7 signs of MYOCARDIAL INFARCTION
1) . occur at night
2) . lasts > 20 mins
3) . NOT relieved by GTN
4) . pain radiate to left arm/neck/jaw
5) . Pt is pale/sweaty/grey
6) . 4th heart sound
7) . pansystolic murmur
111
why might you hear a 4th heart sound in MYOCARDIAL INFARCTION
- ventricles are stiff/dysfunctional
| - atria must contract forcefull to overcome this
112
why might you heart a pansystolic murmur in MYOCARDIAL INFARCTION
- due to papillary muscle dysfunction / rupture
113
list 6 differentials for MYOCARDIAL INFARCTION
1) . stable/unstable angina
2) . pericarditis
3) . aortic aneurysm
4) . endocarditis
5) . pulmonary embolism
6) . pneumothorax
114
list 8 investigations you'd do with a suspected MYOCARDIAL INFARCTION
1) . clinical History
2) . ECG
3) . Cardiac enzymes
4) . CT angiography
5) . CXR
6) . FBC
7) . U&E
8) . Blood glucose / lipids
115
ECG results for STEMI
1) . ST elevation
2) . Tall T waves
3) . LBBB
4) . pathological Q waves
116
ECG results for NSTEMI
1) . ST depression (OR)
| 2) . T wave inversion
117
4 steps for acute (initial) management of MYOCARDIAL INFARCTION
1) . MONA
2) . 12 lead ECG / Cardiac Monitor
3) . Beta Blocker IV
4) . Refer for PCI/CABG/thrombolysis
118
what does MONA stand for
Morphine
Oxygen (if sats <94%)
Nitrates
Aspirin
119
give an example of a thrombolytic drug
Alteplase
120
7 treatments for subsequent MYOCARDIAL INFARCTION (secondary prevention)
1) . modify risk factors
2) . aspirin
3) . Dual antiplatelet therapy
4) . statins
5) . Beta blocker
6) . ACE inhibitor
7) . Advice
121
list 6 modifiable risk factors for secondary prevention of MYOCARDIAL INFARCTION
1) . Diabetes
2) . Smoking
3) . hypertension
4) . hypercholesterolemia
5) . Exercise
6) . Diet
122
list 2 antiplatelets used in dual therapy for MYOCARDIAL INFARCTION
1) . clopidogrel
| 2) . ticagrelor
123
what do you use if patient is intolerant to ACE inhibitors
angiotensin receptor blocker
124
give an example of an angiotensin receptor blocker
valsartan
125
list 3 pieces of advice for secondary prevention of MYOCARDIAL INFARCTION
1) . return to work after 2 months
2) . no air travel for 2 months
3) . no sex for 1 month
126
list 5 complications following a MYOCARDIAL INFARCTION
1) . Myocardial rupture
2) . arrhythmias
3) . pericarditis
4) . Dressler's sydrome
5) . Death
127
list 3 types of myocardial rupture and their result
1) . Ventricular septum
- right Heart Failure
2) . left ventricular wall
- cardiac tamponade
3) . papillary muscle
- mitral regurgitation/prolapse
128
list 2 arrhythmias that occur following MYOCARDIAL INFARCTION
1) Tachycardia
| 2) brachycardia
129
what is dressler's syndrome
pericarditis following cardiac intervention/surgery
130
list 4 CARDIAC differential diagnosis of chest pain
1) . ACS
2) . Aortic dissection
3) . pericarditis
4) . myocarditis
131
list 3 PULMONARY differential diagnosis of chest pain
1) . pulmonary embolism
2) . pneumonia
3) . lung cancer
132
list 3 MSK differential diagnosis of chest pain
1) . rib fracture
2) . chest trauma
3) . costochondritis
133
list 2 GI differential diagnosis of chest pain
1) . esophageal spasm
| 2) . GORD
134
list 2 PSYCH differential diagnosis of chest pain
1) . anxiety
| 2) . panic attacks
135
define costochondritis
inflammation of cartilage btwn ribs/sternum
136
define HEART FAILURE
- state where heart is unable to pump enough blood/O2
| - to satisfy needs of metabolising tissues
137
epidemiology of HEART FAILURE
- annual incidence of 10% in pts over 65
| - 50% of pts die within 5 yrs
138
list 7 causes of HEART FAILURE
1) . ischaemic heart disease!
2) . Hypertension
3) . cardiomyopathy
4) . valvular heart disease
5) . congenital heart disease
6) . alcohol/chemotherapy
7) . factors that increase myocardial work (anaemia/pregnancy/obesity etc)
139
list 4 risk factors for HEART FAILURE
1) . age >65 yrs
2) . obesity
3) . Male
4) . people who've had previous MI
140
what is SYSTOLIC HEART FAILURE
- failure to contract
| - ejection fraction <40% (SV/EDV)
141
list 4 causes of SYSTOLIC HEART FAILURE
1) . IHD
2) . MI
3) . Hypertension
4) . Cardiomyopathy
142
what is DIASTOLIC HEART FAILURE
- inability to fill/relax
- reduced preload
- ejection fraction >50%
143
list 3 causes of DIASTOLIC HEART FAILURE
1) . constrictive pericarditis
2) . cardiac tamponade
3) . hypertension
144
what is LOW OUTPUT HEART FAILURE
- the heart is not functioning efficiently
- Decreased CO
- CO doesn't increase with exertion
145
list 3 causes of LOW OUTPUT HEART FAILURE
1) . pump failure
- systolic HF
2) . Excessive Preload
- mitral regurg
- fluid overload
3) . increased afterload
- heart can't push against it
- hypertension
146
what is HIGH OUTPUT HEART FAILURE
- the requirements of the body are too high
147
list 3 causes of HIGH OUTPUT HEART FAILURE
1) . pregnancy
2) . anaemia
3) . hyperthyroidism
148
outline the 2 steps in pathology of HEART FAILURE
1) . heart fails -> compensation starts
| 2) . HF progresses -> compensatory changes overwhelmed -> changes become pathological
149
list 3 compensatory mechanisms for HEART FAILURE
1) . sympathetic stimulation
2) . RAAS
3) . cardiac changes
150
list 3 ways sympathetic changes compensate for HEART FAILURE
1) . activate SNS -> HR/contractility increased
2) . contract veins -> increased preload (frank starling)
3) . arterial constriction -> increased afterload
151
list 4 ways in which RAAS compensates for HEART FAILURE
1) . CO falls / increased sympathetic tone -> RAAS activated -> increased salt / water retention
2) . increases venous pressure / maintains stroke vol (frank starling)
3) . Angiotensin II causes arterial constriction -> increased afterload
4) . salt / water retention -> peripheral + pulmonary oedema -> dyspnoea
152
list 2 cardiac changes seen in compensation for HEART FAILURE
1) . ventricular dilation
| 2) . Myocyte hypertrophy (ventricular remodelling)
153
outline the cardiac compensatory method of ventricular dilation in HEART FAILURE
1) . Myocardial failure -> stroke vol decreased -> more blood in heart after systole
2) . increased vol stretches myocardium for stronger contraction (frank starling)
3) . stretching becomes detrimental -> bigger ventricles need more O2
154
Define Frank-Starling law
- stroke volume of left ventricle will increase as left ventricular volume increases
- due to the myocyte stretch, causing a more forceful systolic contraction.
155
list the 3 cardinal symptoms for diagnosing HEART FAILURE
1) . SOB
2) . Fatigue
3) . Ankle swelling
156
define LEFT SIDED HEART FAILURE
- heart failure with reduced ejection fraction
| - caused by systolic dysfunction
157
list 4 causes of LEFT SIDED HEART FAILURE
1) . IHD
2) . Hypertension
3) . Cardiomyopathy
4) . Aortic stenosis (narrow aortic valve)
158
outline the pathology of hypertension in LEFT SIDED HEART FAILURE
1) . arterial pressure increases -> harder for LV to pump blood out -> LV hypertrophy -> O2 demand increased
2) . coronary arteries squeezed by extra muscle -> less blood delivered to tissue
159
outline the pathology of 2 cardiomyopathies in LEFT SIDED HEART FAILURE
DILATED
- heart chamber grows in size to fill ventricle with more blood (increase preload) -> muscle wall gets thin/weak -> systolic HF
RESTRICTIVE
heart wall becomes stiff-> less compliant -> can't stretch
160
list 6 symptoms of LEFT SIDED HEART FAILURE
1) . SOB on exertion
2) . fatigue
3) . weight loss
4) . nocturnal SOB
5) . nocturnal cough w/ pink/frothy sputum
6) . orthopnoea (SOB when lying down)
161
list 6 signs of LEFT SIDED HEART FAILURE
1) . Cardiomegaly
2) . pulmonary oedema
3) 3rd/4th heart sounds
4) . pleural effusion
5) . crackle sound in lung bases
6) . tachycardia
162
what is cardiomegaly
displaced apex beat
163
list 5 causes of RIGHT SIDED HEART FAILURE
1) . left ventricular failure
2) . hypertension
3) . pulmonary stenosis
4) . lung disease
5) . atrial/ventricular shunt
164
outline the pathology of LV failure in RIGHT SIDED HEART FAILURE
fluid build up -> increased pressure in pulmonary artery -> harder for right side to pump blood
165
outline the pathology of lung disease in RIGHT SIDED HEART FAILURE
*COR PULMONALE*
pulmonary artery constricts -> increased pulmonary BP -> harder for RV to pump against -> hypertrophy / failure -> harder to exchange O2
166
outline the pathology of an AV shunt in RIGHT SIDED HEART FAILURE
- blood moves from L -> R
- increased vol on R-side -> RV hypertrophy
- more prone to ischaemia
- small filling volume
167
list 5 symptoms of RIGHT SIDED HEART FAILURE
1) . SOB
2) . Peripheral oedema
3) . ascites
4) . nausea
5) . anorexia
168
list 5 signs of RIGHT SIDED HEART FAILURE
1) . Raised JVP (distention)
2) . hepato/splenomegaly
3) . pitting oedema
4) . ascites
5) . weight gain (from fluid)
169
what are the 4 classes of HEART FAILURE
I = no dyspnoea at rest
II = comfortable at rest, dyspnoea with normal activities
III = minor activity produces dyspnoea
IV = dyspnoea at rest
170
list 9 investigations for suspected HEART FAILURE
1) . CXR
2) . ECG
3) . Bloods
4) . FBC (anaemia)
5) . LFTs
6) . TFTs
7) . U&Es
8) . Cardiac enzymes
9) . Echocardiogram
171
list 5 things CXR would show in HEART FAILURE (ABCDE)
- Alveolar oedema (bats wings)
- kerley B lines (intersitial oedema)
- Cardiomegaly
- Dilated upper lobe vessel
- Effusion (plural)
172
what are you looking for when you do LFTs in HEART FAILURE
hepatomegaly
