explain ANGINA

Explain HEART FAILURE

Explain MYOCARDIAL INFARCTION

A 68-year old woman presents to A&E with heavy central chest pain radiating to her left arm which began whilst walking to the shops an hour ago. GTN spray given by the paramedics relieved the pain in 5 minutes. She has had similar episodes of pain over the last 3 weeks always on exertion, but this is the most severe. Serum troponin levels taken in the A&E department, and again the following morning are normal.

A 35-year-old man is brought to the A&E department by ambulance having collapsed at work. His chest pain began forty minutes ago and has worsened gradually. It is now a tight band across his chest and radiates to his neck but not his arms. On examination he is grey, sweaty and short of breath with a pulse of 40bpm.

A 32-year-old man presents to his GP with a 2 day history of dyspnoea and retrosternal chest pain which came on gradually. The patient cannot recall any trauma or abnormal exertion and has never been ill before. The pain is stabbing in quality, radiates to the neck and left shoulder, is relieved by sitting upright, and is made worse by lying flat and coughing.

Symptoms: more likely to be sharp and pleuritic with coughing, inspiration, swallowing worse by lying supine, relieved by sitting and leaning forward

A 67-year-old hypertensive, obese man is brought to the A&E department by ambulance having collapsed whilst moving a chest of drawers 1 hour ago. His chest pain, which began suddenly as he started lifting, is central, severe and tearing in quality, and radiates through to his back and up to the neck. BP is 190/120mmHg in the right arm and 160/90mmHg in the left arm.

A 62-year-old man presents to his GP with shortness of breath on exertion (SOBOE) which has been getting worse for the last 6 months. He also complains of exertional chest pain and occasional light-headedness. He is asymptomatic at rest. On examination the carotid pulse is slow rising, apex beat is heaving but undisplaced and there is an ejection systolic murmur which is heard over the left sternal edge, the right second intercostal space and radiating to the carotids.

A 69-year-old man who has suffered 4 myocardial infarctions presents to his GP with SOB which has become gradually worse over the last 6 months, associated with increasing fatigue and cough. He has to sleep in a chair and becomes breathless on minimal exertion. On examination the apex beat is in the 6th intercostal space, mid axillary line. A gallop rhythm is evident on auscultation of the heart and in the chest there are bilateral basal crepitations. Echocardiography shows an ejection fraction of 20%.

You are called to the ward to see a 48-year-old woman who underwent CABG 2 days ago. She started to feel SOB 10 minutes ago but does not have any chest pain. On examination she is grey and clammy. Pulse is 120bpm, regular but impalpable during inspiration. BP 78/36mmHg. JVP grossly elevated. There is no time to listen to the heart before she arrests. The monitor shows PEA.

cause of ACUTE TAMPONADE

WHAT IS THE LIKELY CAUSE? A 58-yr-old policeman presents to the cardiology OP clinic with an 18 month history of increasing SOB and a dry cough. He has never smoked. On examination he is tachypnoeic at rest and has gross clubbing of the fingers. Auscultation reveals fine end inspiratory crackles.

What causes CRESCENDO-DECRECENDO murmur that RADIATES to the CAROTIDS

What causes PAN SYSTOLIC murmur RADIATING to the AXILLA