Pericarditis,aortic Dissection,cardiac Ischemia

Question 1

What is pericarditis,what is the typical patient for it and history for it? What are the major symptoms and signs, diagnosis or investigations,

Answer 1

Pericarditis
Pericarditis causes pain with distribution similar to ischeamia but it is often made worse by breathing and it is markedly affected by posture. It is usually worst lying flat and it is relieved by sitting up and leaning forward.
Box 3.2 Pericarditis
Typical patient
 Middle-aged (male) or elderly (either sex), often with a family history of coronary heart disease and one or more of the major reversible risk factors (smoking, hypertension, hypercholesterolaemia)
 In many patients there is no preceding history of angina

Major symptoms
 Chest pain and shortness of breath. Pain usually prolonged and often described as ‘heaviness’ or ‘tightness’, with radiation into arms, neck or jaw. Alternative descriptions include ‘congestion’ or ‘burning’, which may be confused with indigestion
Major signs
 Ischaemic myocardial damage, fourth heart sound, dyskinetic precordial impulse
 Autonomic disturbance, tachycardia (anterior MI), bradycardia (inferior MI), sweating, vomiting, syncope
Diagnosis
 Markers of injury: raised CKMB and troponins
 ECG: may be normal or show ST depression or T-wave change (non-ST elevation
myocardial infarction). ST elevation myocardial infarction denotes higher risk
Additional investigations
 Biochemistry: blood sugar and lipids to rule out diabetes and dyslipidaemia
 Risk stratification: echocardiogram (LV function) and stress testing (reversible
ischemia)
Comments
 History and troponin testing most useful diagnostic tools

Question 2

What is aortic dissection

Describe the kind of chest pain using “Socrates “in aortic dissection

Answer 2

Aortic Dissection
Dissection of the aorta causes severe central chest pain that is often described by the patient as “tearing”. It typically radiates through to the back. It is of sudden onset and it is frequently accompanied by dizziness or transient loss of consciousness.

Question 3

What are the typical patients,major signs and symptoms and diagnosis for aortic dissection

Answer 3

Typical patient
 Middle-aged or elderly patient with a history of hypertension or arteriosclerotic disease
 Occasionally younger patient with aortic root disease (e.g. Marfan’s syndrome)
Major symptoms
 Chest pain
Major signs
 Often none
 Sometimes regional arterial insufficiency (e.g. occlusions of coronary artery
causing myocardial infarction, carotid or vertebral artery causing stroke, spinal artery causing hemi- or quadriplegia); subclavian artery occlusion may cause differential blood pressure in either arm; aortic regurgitation; cardiac tamponade; sudden death
Diagnosis
 CXR: widened mediastinum, occasionally with left pleural effusion
 Transoesophageal echocardiogram: confirms dissection
 CT scan: confirms dissection
 MRI scan: confirms dissection
Additional investigations
 None Comments
 Having established the diagnosis, emergency surgery is usually necessary, particularly if the dissection involves the ascending thoracic aorta

Question 4

What is myocardial ischemia ,difference between xanthomas and xanthelasma,typical patients for this disease,major signs and symptoms,diagnosis or investigations

Answer 4

ox 3.1 Myocardial Ischaemia
Typical patient
 Middle-aged or elderly man or woman often with a family history of coronary heart disease and one or more of the major reversible risk factors (smoking, hypertension, hypercholesterolemia)
Major symptoms
 Exertional chest pain and shortness of breath. Pain often described as ‘heaviness’ or ‘tightness’, and may radiate into arms, neck or jaw
Major signs
 None, although hypertension and signs of hyperlipidaemia` (. Hyperlipidemia refers to high levels of LDL or triglycerides. Dyslipidemia can refer to levels that are either higher or lower than the normal range for those blood fats.) (xanthelasmata(Xanthelasmata is the plural of xanthelasma, also called xanthelasma palpebrarum. They are sharply demarcated yellowish collections of cholesterol below the skin, typically on the eyelids or around them.),

xanthomas(Xanthoma is a skin condition in which certain fats build up under the surface of the skin. Xanthomas may appear anywhere on the body. The most common places are the elbows, joints, tendons, knees, hands, feet, and buttocks. If the fatty lumps are on the eyelids, it’s called xanthelasma.

) may be present

 Peripheral vascular disease, evidenced by absent pulses or arterial bruits(Bruit, also called vascular murmur, is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery, Bruits are blowing vascular sounds resembling heart murmurs that are perceived over partially occluded blood vessels. When detected over the carotid arteries, a bruit may indicate an increased risk of stroke; when produced by the abdomen, it may indicate partial obstruction of the aorta , ),is commonly associated with coronary heart disease

Diagnosis
 Typical history is most important diagnostic tool
 ECG: often normal; may show Q waves in patients with previous
myocardial infarction
 Stress test: exertion ST depression
 Isotope perfusion scan: exertion perfusion defects
 Coronary arteriogram: confirms coronary artery disease
Additional investigations
 Blood sugar and lipids to rule out diabetes and dyslipidaemia
Comments
 A careful history is the single most important means of diagnosing angina