SOB

Question 1

What is an ETT

Answer 1

exercise tolerance test

Question 2

what does thalium show

Answer 2

metabolically active areas taking up more of it, perfusion defects, infarction (fixed defect), ischaemia (reversible defect)

Question 3

what is the first treatement for a NSTEMI

Answer 3

thrombolysis

Question 4

why is PO2 normal in anaemia

Answer 4

oxygen still in blood just not enough haemoglobin to carry it

Question 5

what is haemodynamic instability

Answer 5

perfusion failure represented by clinical features of circulatory shock and advanced heart failure

Question 6

what does a narrow QRS mean

Answer 6

SVT

Question 7

what does a wide QRS mean

Answer 7

ventricular tachycardia

Question 8

what are the factors contributing to production of shortness of breath

Answer 8

increased;

• work of breathing
• ventilatory drive

impaired resp muscle function

Question 9

what can cause increased work on breathing

Answer 9

airflow obstruction (asthma, chronic bronchitis, tracheal obstruction)

decrease pulmonary compliance (pulmonary oedema, fibrosis)

restricted chest expansion (resp muscle paralysis)

Question 10

what can cause increased resp drive

Answer 10

physiological dead space (ventilation-perfusion miss match e.g. infection, PE)

stimulation of resp centre

Question 11

what are the chemical and neural stimulation of respiration

Answer 11

increased:

• aterial hydrogen ion conc (metabolic acidosis)
• arterial PacO2 (resp acidosis)
• central arousal (anxiety, thyrotoxicosis)

decreased:
-aterial PaO2 via aortic, carotid and brain stem chemoreceptors (pneumonia, anaemia)

pulmonary j receptor (in lungs) discharge (pulmonary oedema)

Question 12

what is after load

Answer 12

force against which left ventricle contracts to eject blood into systemic circulation

Question 13

what can increase afterload

Answer 13

increased peripheral resistance- which can be raised by high blood pressure

Question 14

what happens when the left side of the heart fails

Answer 14

the left atrial and left ventricular pressures rise. The increased left-sided
pressures (called preload) produce back pressure on the lungs and cause a rise
in pulmonary capillary hydrostatic pressure resulting in accumulation of fluid
in the interstitial and intraalveolar lung spaces: - a condition known as
pulmonary oedema

Question 15

how is pulmonary oedema manifested clinically

Answer 15

varying degrees of shortness of breath

Question 16

what causes orthopnoea

Answer 16

increased venous return caused by lying down

Question 17

what are the cardiac causes of SOB

Answer 17

• MI (most common)
• hypertension (leads to heart failure)
• arrhythmia
• valvular disease
• cardiomyopathies: dilated, hypertrophic, restrictive
• diabetes

Question 18

what are the main diagnostic investigations in heart failure

Answer 18

ECG (hypertrophy, MI), CXR, echo

Question 19

what investigations should be carried out for chest pain and in what order

Answer 19

ECG, bloods, CXR, ETT, (Thallium)

Question 20

list non cardiac causes of SOB

Answer 20

• COPD
• Pneumothorax
• asthma
• musculoskeletal

Question 21

what investigations should be carried out for breathlessness and in what order

Answer 21

ECG, CXR, bloods, Echo

Question 22

what investigations should be carried out for palpitations and in what order

Answer 22

ECG, 24 hour ECG, Echo

Question 23

what investigations should be carried out for murmurs and in what order

Answer 23

ECG, Echo

Question 24

what investigations should be carried out for IE and in what order

Answer 24

blood cultures, (serology if negative) echo

Question 25

what is the method of thallium perfusion scintigraphy

Answer 25

• Radiolabelled isotope taken up by normally perfused
  myocardial cells.
• Gamma camera counts radioactivity over the myocardium
• Images taken at rest and after stress
• Stress can be exercise or pharmacological

Question 26

what is a cardiac CT angiogram

Answer 26

special type of x-ray examination of the
heart that helps determine if fatty or Calcium deposits
have narrowed the patient’ coronary arteries.

Question 27

what are the pros and cons of CT angiography

Answer 27

p- 
• Excellent cardiac anatomy depiction
• Non-invasive coronary arteries assessment
• Functional assessment
• Chamber assessment
• Looks at vessels and lungs

c-
• Significant radiation
• Resolution less than angiograms
• Contrast allergy/nephropathy
• Need special equipment/expertise

Question 28

what can be seen with echocardiography

Answer 28

• chambers
• valves
• muscle walls
• great vessels
• blood flow
• function of heart

Question 29

What X-Ray technique is used to visualise the coronary arteries and how is it carried out?

Answer 29

Coronary angiography

Catheter in radial/femoral arteries, inject dye and then x ray