PACES Spiels Flashcards
CLD Investigations
Lab investigations include FBC, LFTs, Coag Panel (including INR) to assess liver function. I would use this to calculate the Child-Pugh Score.
An AST:ALT Ratio of >2 would be suggestive of alcoholic liver cirrhosis.
As for aetiology, I woud like to send off
- Viral Hepatitis Screen
- HIV Screen
For imaging, I would do an US Hepatobiliary System and possibly a Fibroscan to confirm the presence of cirrhosis.
If I am suspecting autoimmune hepatitis, I would send off Anti-Nuclear Antibody, Anti-Smooth Muscle Ab, Anti-LKM Ab.
Primary biliary cirrhosis is screened using Anti-Mitochondrial Ab, and primary sclerosing cholangitis by using p-ANCA.
Hepatomegaly
My key clinical finding is that of hepatomegaly. This is likely due to chronic liver disease, for which aetiologies include
- Viral hepatis
- Alcoholic liver disease
- Non-alcoholic fatty liver disease
Other possibilities include
- Autoimmune conditions (such as autoimmune hepatitis)
- Infiltrative conditions (such as haemochromatosis or sarcoidosis)
Aortic Stenosis
My main positive finding is that of an ESM, loudest in the aortic region, with radiation to the carotids.
The apex beat is heaving and undisplaced.
The pulse is regular.
There is no implantable cardiac defibrillator noted.
My diagnosis is aortic stenosis.
=== Complete with CVM Spiel ===
In terms of complications, I did not note any clinical signs of [PACE]
1. Pulmonary hypertension (eg parasternal heave, palpable P2)
2. Atrial fibrillation
3. Congestive heart failure
4. Infective endocarditis.
I would like to further evaluate by doing
1. ECG, to look for arrythmias
2. CXR, to look for fluid overload
3. TTE, to confirm my diagnosis and assess severity (eg valve area, valve gradient) and heart function (eg EF)
I would also do blood tests such as
1. FBC, to look anaemia which may present concomitantly and cause similar symptoms
2. RP, to obtain a baseline Cr prior to start medications (eg ACE-I)
As for management, since this patient is already symptomatic, I would consider referral to the cardiothorac surgeons for surgical management such as valve replacement.
Mitral Regurgitation
My main positive finding is that of a PSM, loudest at the apex, with radiation to the axilla.
The apex beat is displacced and has a thrusting quality.
There is also atrial fibrillation.
My diagnosis is mitral regurgitation.
=== Complete with CVM Spiel ===
In terms of complications, I did not note any clinical signs of [PACE]
1. Pulmonary hypertension (eg parasternal heave, palpable P2)
2. Atrial fibrillation
3. Congestive heart failure
4. Infective endocarditis.
I would like to further evaluate by doing
1. ECG, to look for arrythmias
2. CXR, to look for fluid overload
3. TTE, to confirm my diagnosis and assess severity (eg valve area, valve gradient) and heart function (eg EF)
I would also do blood tests such as
1. FBC, to look anaemia which may present concomitantly and cause similar symptoms
2. RP, to obtain a baseline Cr prior to start medications (eg ACE-I)
As for management, since this patient is already symptomatic, I would consider referral to the cardiothorac surgeons for surgical management such as valve replacement.
Tricuspid Regurgitation
My main positive finding is that of a PSM, loudest at the LLSE. Of note, it is softer on inspiration.
There are signs of pulmonary hypertension such as a raised jugular venous pressure with giant c-v waves, and a parasternal heave.
The pulse is regular.
My diagnosis is tricuspid regurgitation.
=== Complete with CVM Spiel ===
In terms of complications, I did not note any clinical signs of [PACE]
1. Pulmonary hypertension (eg parasternal heave, palpable P2)
2. Atrial fibrillation
3. Congestive heart failure
4. Infective endocarditis.
I would like to further evaluate by doing
1. ECG, to look for arrythmias
2. CXR, to look for fluid overload
3. TTE, to confirm my diagnosis and assess severity (eg valve area, valve gradient) and heart function (eg EF)
I would also do blood tests such as
1. FBC, to look anaemia which may present concomitantly and cause similar symptoms
2. RP, to obtain a baseline Cr prior to start medications (eg ACE-I)
As for management, since this patient is already symptomatic, I would consider referral to the cardiothorac surgeons for surgical management such as valve replacement.
