we discussed the most likely causes, namely LVF [secondary to something], COPD and pneumonia
as there was little evidence for these conditions, we pursued other diagnoses, eg PE, anaemia [secondary to something] and cancer
we discussed the distinction between massive and peripheral PE, including examination & ECG features of right heart strain
here is the classical SI QIII TIII, taken from ABC of clinical electrocardiography, which is a useful resource [we should have mentioned AF as a common ECG presentation of PE]
he also briefly mentioned hypercoaguability, something worth knowing about
homework generated included:
- causes of breathlessness [kumar & clark, harrisons, cecils, cheese & onion, medicine at a glance and beck et al were mentioned as things to read - paul dilworth's lecture is also a possibility - eric beck is a PDS tutor at the whitt & basically invented the MRCP - very good clinician, co-author diana holdright is one of your cardiology consultants]
- causes of metabolic acidosis
- wells score (or geneva score) for DVT/PE
most important, it is vital to follow this chap up to see what happens to him - this is the only way to get a full picture of what is going on
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