Heart Question

I'm just going to give my views on this (probably wrong):

It probably is angina from the sounds of it.

The oedema may be due to her having varicose veins, so incompetent valves impair skeletal muscle pumping... Or if she sits around a lot/lack of exercise could mean that there is no effective skeletal muscle pumping of the blood back to the heart.

Her lymph drainage could be blocked

It could also be that her sympatehtic nervous system is somewhat impaired hence, she is unable to vasoconstrict her artery bringing blood to the ankle/foot - increased filtration in the tissues (actually this is probably not so important in the ankle now that I think about it - more important in the foot).

I think the oedema could be unrelated (probably unlikely)...

Reply 2

OP

i don't think it's angina rahmed... angina is characterised by chest pains and there is no mention of chest pain...

Reply 3

pwofessow

1

Sounds like heart failure to be honest, though she is rather young. The cause could be pretty much any cardiac disease. Pitting oedema is a feature of heart failure due to back pressure.
Angina typically causes pain on exertion (althou occasionally the predominant feature can be breathlessness). It doesn't, however, cause pitting oedema.
Might have been useful if she was also complaining of orthopnoea or PND to help you with the diagnosis.
It could also be cor pulmonale related (I suppose you'd need to know her Oxygen sat., however since she isn't cyanosed, the diagnosis seems unlikely)

Reply 4

angina is characterised by chest pains and there is no mention of chest pain...

yeah I was thinking that too, pain is usually in the chest/neck/jaw etc... But the breathlessness and low BP seemed to fit the description.

Though I aprobably agree with you now. They would have definately mentioned chest pain if it were angina.

I'm pretty sure it's neither of the others (asthma or hypertension). What about increased filtration in the ankle = oedema -> Dec. CVP -> Less blood returning to the heart -> Lower BP/less oxygenated hence the fatigue...

edit: Postural hypotension??

But I'm not sure about the breathlessness...

Reply 5

</gibberish>

12

Is this med student stuff because i hope i dont need to know that for AS biology! :O :s-smilie:

Reply 6

This is mid-year AS stuff, on the heart topic you know...

Reply 7

OP

pwofessow

Sounds like heart failure to be honest, though she is rather young. The cause could be pretty much any cardiac disease. Pitting oedema is a feature of heart failure due to back pressure.
Angina typically causes pain on exertion (althou occasionally the predominant feature can be breathlessness). It doesn't, however, cause pitting oedema.
Might have been useful if she was also complaining of orthopnoea or PND to help you with the diagnosis.
It could also be cor pulmonale related (I suppose you'd need to know her Oxygen sat., however since she isn't cyanosed, the diagnosis seems unlikely)

Ok, I see... Congesive heart failure is were the heart doesn't work properly and so you are going to get blood collecting in the venous system, which causes the oedema of the legs...

And I think the body counteracts the heart failure by increasing sympathetic activity to the heart, which is actually makes the heart failure worse...

So as for the treatment according to wiki you have the following...

diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers, and aldosterone antagonists (e.g. spironolactone).

i can understand giving atenolol and digoxin... but i don't understand why would you give diuretics, vasodilators and aldosterone antagonists when the blood pressure is already low?... won't this just cause hypotention?

It's a 16 mark question and so I need 8 types of drug with their mechanisms...

btw... what do you mean by PND? Post-natal depression? :confused:

Reply 8

I was a bit off, lol.

Reasons for the drugs are given directly below in the wikipedia article.

Reply 9

OP

rahmed... i think i remember the difference now...

angina pectoris is where there is a mismatch between oxygen supply and demand on exertion... in questions it is nearly always "Mr X has chest pains when he runs for the bus"... you get it before you have a heart attack because you can't get enough blood to the heart...

i'm not so sure what CHF exactly is... but it's basically where the heart isn't working well... cardiac output is low... so you'd get low blood pressure and blood collecting in the veins causing swelling in the legs... i don't think this causes chest pain because the heart is pretty much fine... i think it's more of a problem of other organs not getting enough blood...

Reply 10

oh I see, it's hard to choose one cause when there are so many possibilties...

Dreading the clinical exams in a few years time

Reply 11

OP

rahmed

I was a bit off, lol.

Reasons for the drugs are given directly below in the wikipedia article.

no, but the thing is diuretics, ACE inhibitors, aldosterone antagonists are all used to reduce blood pressure... i don't know how they work to help anything but reduce blood pressure... all wiki says is that they reduce blood pressure but since blood pressure is already low in this case - i can't explain why they are given...

Reply 12

ACE inhibitor (ACEI) therapy is a recommended for all patients with systolic heart failure, irrespective of symptomatic severity or blood pressure. - That shows it's given despite a low BP, not sure about the others...

Not sure how bad the effect would be on the already low BP though

Reply 13

pwofessow

1

Revenged

Ok, I see... Congesive heart failure is were the heart doesn't work properly and so you are going to get blood collecting in the venous system, which causes the oedema of the legs...

And I think the body counteracts the heart failure by increasing sympathetic activity to the heart, which is actually makes the heart failure worse...

So as for the treatment according to wiki you have the following...

diuretic agents, vasodilator agents, positive inotropes, ACE inhibitors, beta blockers, and aldosterone antagonists (e.g. spironolactone).

i can understand giving atenolol and digoxin... but i don't understand... why would you give diuretics, vasodilators and aldosterone antagonists when the blood pressure is already low?... won't this cause hypotention?

It's a 16 mark question and so I need 8 types of drug with their mechanisms...

btw... what do you mean by PND? Post-natal depression? :confused:

PND= paroxysmal nocturnal dyspnoea (somewhat related to orthopnoea).

You're right with everything you said:
-diuretics are used to get rid of the excess extracellular fluid (especially important to avoid/minimise pulmonary oedema), it also reduces the preload, therefore preventing further strain on the already damaged myocardial cells.
-Vasodilators: again, they reduce preload..but also reduce afterload, which is useful considering your heart muscles are weak, therefore reducing the resistance of flow after contraction.
-spironalactone basically has a diuretic effect by preventing the actions of aldosterone, hence stoppin the reabsorption of sodium from the kidneys and therefore increasing urinary output.

Reply 14

j00ni

9

Diuretics: Reduce oedema, reduce Na and H2O retention (via RAAS), reduce preload and afterload

A2RAs & ACEis: Inhibit angiotensin II action/production, reduce myocardial o2 demand, promotes both arterial and venous dilation therefore decreases both preload and afterload

Vasodilators: reduce afterload and preload

Reply 15

Post-natal depression

LOL! Just saw that, this grandma just popped out a baby!

Reply 16

OP

j00ni

Diuretics: Reduce oedema, reduce Na and H2O retention (via RAAS), reduce preload and afterload

A2RAs & ACEis: Inhibit angiotensin II action/production, reduce myocardial o2 demand, promotes both arterial and venous dilation therefore decreases both preload and afterload

Vasodilators: reduce afterload and preload

ok, i get it... it is just basically reducing the physioloical responce to the heart failure, which is making the condition worse by increasing the preload and afterload...

Reply 17

OP

http://www.enterpriseportal2.co.uk/filestore/bts/asthmaupdahttp://www.thestudentroom.co.uk/editpost.php?do=editpost&p=8016872
Edit/Delete Messagetenov05.pdf

or pages 11/12 in http://www.enterpriseportal2.co.uk/filestore/bts/asthmatext.pdf

rahmed

oh I see, it's hard to choose one cause when there are so many possibilties...

Dreading the clinical exams in a few years time

pharm is actually quite good exam wise normally...

problems with my exams is that we get clinical like quesions when you haven't done any clinical...

i'll give you an example... bearing in mind i though you only had two drugs in asthma before i did this question (salbutamol and steroids)... and here is the question...

Q) X is 6 years old, has asthma, takes preventor drug A,

so i think it is a steroid (beclomethazone) and it turns out to instead be cromoglycate (have never heard of it - not even a steroid... no idea what it is or why it is given to children even after wikipaedia)...

Justin taken to hospital, drug B is administered IV, what the hell is that!, i thought it was adrenaline because he had bronchoconstriction and the answer turns out to be aminophylline - which i've never heard of before either...

I mean, if you've had like a 1 hour lecture on asthma... It is really hard to pick up all this technical clinical stuff that you never get taught but get tested on...

It is also very hard to understand why some drugs are given is some conditions and not in others... Like anti-histamines and adrenaline are given if you have anaphylatic shock but not if you have asthma - but both conditions are caused by brochoconstriction...

Reply 18

j00ni

9

See chapter 5 in the SIGN guidelines :wink:

Reply 19

OP