Pathology

Question 1

Differentials for dyspnoea on exertion

Answer 1

CHF
Angina 
COPD
Pleural effusion
Anaemia 
Hypothyroidism
Metabolic acidosis 
anxiety and hyperventilation

Question 2

Investigations for dyspnoea on exertion

Answer 2

CXR
Echo
ECG
FbC, U&E, BNP

Question 3

Salient features on CXR of heart failure

Answer 3

Alveolar oedema 
kerley B lines
Cardiomegaly
Dilated prominent Dpper lobe vessels 
Pleural effusion

(ABCDP)

Question 4

How does LVF cause breathlessness

Answer 4

Raised end diastolic pressire
Causes raised left atrial pressure
Causes raised pulmonary capillary pressure
This leads to increased diffusion barrier for gas exchange and increased interstitial fluid formation (pulmonary oedema)
Breathlessness

Question 5

How does HF causes pitting oedema

Answer 5

RVF
Raised end diastolic pressure
Raised right atrial and jugular venous pressures
Raised central venous pressure
Liver distension (abdo discomfort)
Increased interstitial fluid formation (peripheral oedema)

Question 6

Causes of LVF

Answer 6

Acute ventricular dysrhthmias (VF)
Myocardial infarction and ischaemic heart disease
Longstanding hypertension
Valve disease (aortic and mitral)
Cardiomyopathies and drugs
Congenital heart disease

Question 7

Cause of RVF

Answer 7

The commonest cause of right ventricular failure is failure of the left ventricle
Acute right ventricular failure - massive pulmonary thromboembolism
Chronic right ventricular failure due to chronic lung disease and pulmonary hypertension (Cor pulmonale)
Valve disease (pulmonary/tricuspid) is rare