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
Posts
following up on this gentleman
ReplyDeletewe said at the time that his risk factors for PE were low, and that the search for a secondary cause, in particular cancer was critical
turns out the he is likely to have a lung primary with liver deposits
histology is awaited