By Paul R Roberts; Stephen J Fowler; Royal College of Physicians of London. Education Department

ISBN-10: 1860162606

ISBN-13: 9781860162602

ISBN-10: 1860162703

ISBN-13: 9781860162701

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Station 3: Cardiovascular Examination 29 CAR_C01_CAR 12/15/10 10:43 Page 30 CARDIOLOGY: PACES STATIONS AND ACUTE SCENARIOS TABLE 11 TYPES OF PROSTHETIC HEART VALVE Mechanical Biological Ball and cage (Starr–Edwards) Porcine (Carpentier–Edwards) Single disc (Björk–Shiley or Medtronic Hall) Pericardial Bileaflet (St Jude or Carbomedics) Homograft Autologous (pulmonary autograft) • BP: a wide pulse pressure suggests aortic regurgitation and a narrow pulse pressure outflow tract obstruction (offer to check this at the end of your examination).

Has she been eating lots of liquorice? Cardiovascular system Hypertension initially results in left ventricular hypertrophy (LVH), followed by diastolic and finally systolic left ventricular dysfunction. Pursue a history of shortness of breath on exertion or at rest, as well as one of pulmonary oedema. Enquire about swelling of ankles. Other non-specific symptoms can include palpitations and potentially chest pain (if associated with ischaemic heart disease, although this is unlikely in this patient).

The severity of left ventricular dysfunction on echocardiography correlates poorly with the severity of the clinical syndrome of heart failure, but normal systolic left ventricular function on echocardiography should prompt a review of a diagnosis of heart failure. When the cause of breathlessness is not obvious, consider chronic repeated pulmonary thromboembolism, which is a commonly missed diagnosis. Multiple small pulmonary emboli lead to progressive occlusion of the pulmonary arteriolar bed, classically presenting with breathlessness that becomes more severe in a stepwise manner.

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Cardiology and respiratory medicine by Paul R Roberts; Stephen J Fowler; Royal College of Physicians of London. Education Department

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