Category 3

Sinister / Systemic / Co-morbidities

Activity 1
1. Do you think that there is a non-musculoskeletal or neurological cause of his
a. foot pain? Metroprolol, can cause swelling in the limbs, PVD, Heart
failure
b. feet and ankle swelling? Heart failure
2. What are the possible causes of his dyspnoea on exertion and orthopnoea?
• Heart failure
• AAA
• PVD

Activity 2
What type of drug is
a. Metoprolol (Beta blocker)High blood pressure, heart failure
b. Frusemide (diuretic)High blood pressure, heart failure and oedema
While considering his symptoms, why might they have been prescribed?
For treatment of his high blood pressure and his swelling in ankles and feet due to his heart
failure.

Activity 3
• For each of your DDx named in Activity 1, compile a table stating:
• elements from the history/examination which support your DDx
• elements from the history/examination which do not support your DDx
• the investigations which would help to confirm or deny the diagnosis.

Heart Failure Venous congestion PVD

SUPPORTIVE • Dyspnoea • Swelling • Pain in feet
• Orthopnoea • Skin temp
• Lower limb • Pulses
oedema
NON-SUPPORTIVE • Described as • Pain is
pain rather constant, not
than by exercise
discomfort • Sweeling
• Weak pulse
• Swelling not
found in
calves
• Skin temp
INVESTIGATIONS • Chest X-ray • Doppler • Doppler
• Brain ultrasound ultrasound
natriuretic
peptide