[cont. I] Day 5

There are so many things that I learnt today.

What I learnt:

1. Angina: the description by patient can be not exactly what was describe in the book. For example, patients may describe it as SOB.

So, assume the patient is correct at what he is describing, check for

- heart failure symptoms, COPD to rule out SOB

- then try to identify if it is of heart origin

- check with echocardiogram, ecg...

2. Diabetic patients treatment progress:

- Metformin: increase sensitivity of tissues to insulin

- Sulphonylurea: stimulate pancreatic function to increase insulin secretion (used in patient with failing pancreas)

- Insulin injection: when pancreas cannot produce enough insulin

3. Dialysis patient:

- Renal failure causes the body to retain fluid as it is not excreting. This can cause the blood pressure to increase due to fluid retention. During dialysis, the fluid is removed from the body and with this, the blood pressure will drop. If not monitored properly, patient's blood pressure will drop and cause the patient to faint.

- Antihypertensive drug is withheld before dialysis procedure.

4. Pregnant patient who are at a young age and have chest pain and SOB during labour, we should consider the following conditions that might happen but not CAD (age is incompatible with this cardiac event):

- Suspect Rheumatic Heart Disease (RHD), mitral valve abnormality (MR or MS)

- Suspect pulmonary embolism due to DVT: pregnant uterus can compress the inferior vena cava and impair the return of the blood causing stasis in the vessels of lower limbs.

Test that can be carried out:

~ D-dimer test: breakdown of clot. In pregnant woman, it can be slightly elevated esp in those who underwent C-section. This test can be slightly non-specific.

~ Doppler studies: on the vessels of lower limbs to indicate signs of thrombosis.

5. Read up on thyrotoxicosis and Graves disease.