how would you investigate this patient?

Question 1

Heart Failure

Answer 1

ECG

oxygen sats to find out severity

Chest X-ray to check for heart size and pulmonary oedema

Echocardiogram to check for diastolic function

iron deficiency assessment (1/3 of HF have deficiency)

investigate for hyponatraemia in severe cases with serum electrolyte values

pulmonary function testing to exclude resp causes

urea is high in severe HF

LFT will be abnormal due to cardiac cirrhosis

Question 2

Myocardial Infarction

Answer 2

ECG to see if it is a STEMI

Cardiac Troponin (released only in myocardial necrosis)

Complete Blood Cell Count

Metabolic Panel (Mg, K , creatinine, blood glucose)

Question 3

Angina

Answer 3

Exercise Stress Testing (can be done alone or with ECG which can localize ischaemia)

Coronary Angiography evaluates the extent/ severity of CAD

ECG (50% have normal findings)

Chest X-ray usually normal but can show cardiomegaly

Question 4

Essential Hypertension

Answer 4

blood pressure test,
history and exam,
routine lab studies

to test for presence of end-stage organ disease/ possible causes/ risk factors

EGFR for chronic kidney disease

check for Cushing’s

Thyroid level

Question 5

DVT

Answer 5

D-Dimer assay (only really used to rule out DVT)

Wells Prediction Rule for diagnosing DVT

USS