Cardiology : Chronic Fatigue
1. A=T, B=F, C=T, D=T, E=T. Myocarditis may cause a systolic murmur on auscultation because of cardiac dilatation. The blood pressure in myocarditis is often normal, but if myocardial damage is severe there may be severe hypotension. 2. A=F, B=T, C=F, D=F, E=T. Cardiomyopathy is recognised by left rather than right ventricular dilatation and systolic dysfunction in the absence of coronary artery, valvular, congenital or peripheral disease. Thus according to this definition, cardiomyopathy would not be associated with valve calcification. Cardiomyopathy is associated with thyrotoxicosis and acromegaly. Alcoholic cardiomyopathy has a poor prognosis 40-50% are dead within 3 to 6 years. 3. A=F, B=F, C=F, D=T, E=T. As many as 30-50% cases diagnosed as chronic heart failure (CHF) are incorrectly labelled as such. CHF rarely occurs if both ECG and chest X-rays are normal. The JVP is a particularly useful clinical sign. In the CONSENSUS study Angiotensin Converting Enzyme (ACE)inhibitors promoted a dramatic mortality reduction in patients with severe heart failure. Thyroid function tests are important, because thyrotoxicosis is a treatable cause of heart failure. ACE inhibitors may be problematic in the elderly with hypotension and effects on renal function as two severe side effects.Press here to go back to the questions
1. A=T, B=T, C=T, D=T, E=F.
Apart from weakness, muscular pain and other physical symptoms chronic fatigue sufferers may also complain of low-grade fever. Compared to controls and sufferers of irritable bowel syndrome chronic fatigue patients have the most pressurised lifestyles, usually self-imposed. They also have a problem-focused coping style. Although this can help them solve problems better than others, they tend to dwell on problems rather than directing their energies and emotions elsewhere. The concept of type A and type B personalities has now fallen out of vogue and the validity of the type A personality has even been questioned in relation to coronary heart disease.
2. A=T, B=T, C=F, D=F, E=F, F=F.
A 'lifestyle transformation' is often reported after an illness with a rejection of the ethos of over-work and achievement orientated success. Chronic fatigue patients are more likely to be fatigued by emotional distress than muscular dystrophy patients, but are as likely to report physical weakness as psychiatric patients. Although many do believe that they have a 'physical' illness there is a spectrum of beliefs amongst sufferers with some assuming a psychological cause. There is however a skew of beliefs towards a physical model. When stressed sufferers are just as likely to show emotional responses as physical ones.
3. All true.
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