Cardiovascular Medicine X-rays

Question 1

A patient is admitted with a history of SOB, fatigue + ankle swelling.

An X-ray shows the following.

Describe what you see and your differential diagnsosis.

What other investigation would you request to confirm your diagnosis?

Answer 1

Diagnosis based on combination of clinical suspicion + ECHO (gold standard)

1st line = NT-proBNP (N-terminal pro-B type natriuretic peptide) = blood test for BNP all with suspected HF
>2,000 ng/L be referred urgently to cardiology and transthoracic echo within 2 weeks
400 - 2,000 ng/L are referred and have transthoracic echo within 6 weeks.
<400 (i.e. normal) HF is unlikely and other diagnoses should be considered
Note that BNP levels can be elevated in other situations than heart failure – e.g. LVH, ischaemia, tachycardia, hypoxemia, renal dysfunction (* s

Question 2

A patient is seeminlgy healthy however has a Pansystolic murmur (described as ‘blowing’) – heard best at apex and radiates to axilla.

An ECG shows broad P wave -P mitrale – bifid.

Review the x-ray, what does it show and what is the diagnosis?

Answer 2

Mitral reugurg

CXR (cardiomegaly, with enlarged LA and LV)

Question 3

A patient is seeminlgy healthy however has a Early diastolic murmur.

An ECG shows signs of LVH = tall R waves, deeply inverted T waves in L-sided chest leads and deep S waves in R-leads

Review the x-ray, what does it show and what is the diagnosis?

Answer 3

AORTIC REGURGITATION

CXR – LV enlargement, enlarged cardiac silhouette and aortic root enlargement

Question 4

A patient presents with dyspnoea, fatigue, peripheral oedema, raised JVP (if RV involved), Loud S3 + S4).

An ECG shows,

• Sinus tachycardia
• T wave inversion + Q waves (even if no previous MI)
• ST-depression
• LBBB

Review this x-ray and give a diagnosis

Answer 4

DILATED CARDIOMYOPATHY (DCM)

CXR

Cardiomegaly, signs of HF, pleural effusion