CVS cases

Question 1

40 years old man in rural hospital emergency with chest pain. All vitals are stable .ECG will be shown after 4 mins
Task-
*Take history for 4m in
*Explain ECG(NOT THROUGH JUST BASIC)
*Explain provisonal dx and DDX
*Explain management of the condition

Positive findings- Retrosternal central chest pain radiating to jaw 8/10,started 2h ago after playing tennis,associated with nausea ,sweating.Also he is diabetic for 5 years (metformin)and Hyepertensive taking perindopril for 3 years. Smoker for 40 years

Answer 1

in history
must exclude SOCRATES FOR CHEST PAIN
Also explore radiation of pain thorughly along with leaning makes it betterr or radiates to back
*Dont forget SADMA,SOCIAL AND OCCUPATIONAL HISTORY,FAMILY HISTORY of cv disease
cvs Risk factor-ABCDEFs (Alchohol.blood pressure,cholesterol,drugs,diet,exercise,family history,stress)

DDX-
pericarditis
aortic dissection
gerd
pneumonia
costochondritis(releived by leaning forward)
pulmonary embolism
shingles
arrythmia

Question 2

50 years old man in ED complaining of sharp chest pain progressing throughout the day
Task
*Take history for 4 min
*Explain the ECG to examiner
*Mention provisional dx and ddx
*Mention DDX with reasons

Sudden chest pain started 6h ago ,6/10,wosened by deep breathing and releived by leaning forward , had flu 1 week ago,drinks occasionaly.

Answer 2

donot forget to ask what trigers the pain such exercise ,heavy work or food..
also ask what were you doing when pain started

Question 3

Your next patient is 58 years old male ,known patient of HTN and COPD .Today he came here for leg swelling .He takes perindopril for HTN.
Task
*Take history for 4 mins
*PEFE AT 4 MIN
*EXPLAIN DDX with reasons AND PROVISONAL DX

all general and systemic examinations are normal except pitting oedema on both lower limb upto ankle .No verisoce vein and ulcers.
swelling worsens after prolong standing

Answer 3

Ask about medication and compliance
Heart failure-SOB,orthopnoea,how many pillows to sleep
Liver failure- any color changes,itchiness,alchohol intake
Renal failure- any dysuria,frothy urine,puffy face
Venous insufficiency-dialated veins,discoloration of legs,any history of clots
DVT-Calf pain, history of long travel

Question 4

Your next patient at your GP clinic is 52 years old lady with leg swelling for 4 months. She is a known case of HTN and COPD
Task\
*Take history for 5 mins
*ask pefe
*explain ddx and provisional dx
*explain management of the condition

everything normal with bilateral pitting edema and basal creps
swelling upto ankle worsens on climbing stairs,parents dies around 60 due to MI,,she smokes 1 pack daily for 30 years and drinks half a bottle wine daily as it is good for heart

dx is hf

Question 5

Your next patient is at your GP clinic who is 48 year old male and he is under treatment with MDT due to schitzophrenia which is under control now.Today he is here due to chest pain -
Task
*Take history fo r5 mins
*Explain provisional dx and management
*Explain DDX with reasons

crushing retrosternal pain lasting for 30 mins while mowing and releives by taking rest and worsens durung heavy work or climbing stairs.Father died at 60 suddenly.apparent delsuional paranoia (those people are making me sick and attacked my heart)

ap

Answer 5

Refer to hospital immediately for admission
discuss with supervisor and give some aspirin for now
in hospital they might do some ix to evaluate condition -FBC,,LFT.KFT.TFT.ELECTROLYTE,HBA1C,COAGULATION STUDIES,CK CK MB,TROPONIN I,CHEST XRAY,ECG,
ALSO CARDIOLOGIST WILL SEE YOU AND CHECK ECHO.ETT,ANGIOGRAM
ALSO ADVISETO STOP SMOKING
TREATMETN DEPENDS ON RESULTS BUT USUALLY IT IS STATIN
,BETA BLOCKER,ASPIRIN
I WILL SEE YOU ASAP YOU ARE DISCHARGED FROM HOSPITAL

Question 6

ANOTHER TASK
EXPLAIN CVS EXAMINATION TO MEDICAL STUDENT FOR AORTIC DISSECTION CASES