A 71-year-old woman is admitted with acute dyspnoea to the Emergency Department. Oxygen saturations are 94% on 28% supplementary oxygen and her respiratory rate is 30/min. A rapid B type natriuretic peptide (BNP) assay is reported as follows:
What is the best interpretation of this result?
Correct Answer D:
B-type natriuretic peptide:
B-type natriuretic peptide (BNP) is a hormone produced mainly by the left ventricular myocardium in response to strain.
Whilst heart failure is the most obvious cause of raised BNP levels any cause of left ventricular dysfunction such as myocardial ischaemia or valvular disease may raise levels. Raised levels may also be seen due to reduced excretion in patients with chronic kidney disease. Factors which reduce BNP levels include treatment with ACE inhibitors, angiotensin-2 receptor blockers and diuretics.
Effects of BNP:
Clinical uses of BNP:
Diagnosing patients with acute dyspnoea:
Prognosis in patients with chronic heart failure:
Guiding treatment in patients with chronic heart failure:
Screening for cardiac dysfunction:
A 44-year-old man is seen in the cardiology clinic. For the past 6 months he has been experiencing episodes of palpitations associated with pre-syncopal symptoms. An ECG taken in clinic shows T wave inversion in leads V1- 3 associated with a notch at the end of the QRS complex. He is known to have a family history of sudden cardiac death.
What is the most likely diagnosis?
Correct Answer A:
The notch at the end of the QRS complex is referred to as an epsilon wave.
Which one of the following types of hyperlipidaemia are palmar crease xanthoma most commonly associated with?
Palmar crease xanthoma are most strongly associated with remnant hyperlipidaemia.
Hyperlipidaemia: xanthomata:
Characteristic xanthomata seen in hyperlipidaemia:
Palmar xanthoma:
Eruptive xanthoma are due to high triglyceride levels and present as multiple red/yellow vesicles on the extensor surfaces (e.g. elbows, knees).
Causes of eruptive xanthoma:
Tendon xanthoma, tuberous xanthoma, xanthelasma:
Xanthelasma are also seen without lipid abnormalities.
Management of xanthelasma, options include:
Which one of the following is least associated with ST depression on ECG?
Correct Answer C:
ECG: ST depression:
Causes of ST depression:
Which one of the following is the strongest risk factor for developing infective endocarditis?
Infective endocarditis - strongest risk factor is previous episode of infective endocarditis.
Infective endocarditis:
The strongest risk factor for developing infective endocarditis is a previous episode of endocarditis.
The following types of patients are affected:
Causes:
Culture negative causes:
Following prosthetic valve surgery Staphylococcus epidermidis is the most common organism in the first 2 months and is usually the result of perioperative contamination. After 2 months the spectrum of organisms which cause endocarditis return to normal, except with a slight increase in Staph. aureus infections.
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