Case Presentaion R3

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Case Presentaion R3

  1. 1. Case presentation KHALID ALRASHDI R3
  2. 2. <ul><li>-case study </li></ul><ul><li>-diagnosis </li></ul><ul><li>-home massage </li></ul>
  3. 3. <ul><li>Seen at 8:20 am </li></ul><ul><li>Middle age male presents with h/o chest pain since 3 days. </li></ul>
  4. 4. <ul><li>Primary survey: </li></ul><ul><li>Oriented , alert with some chest pain </li></ul><ul><li>A- patent </li></ul><ul><li>B- good b/l air entry, rr:20/min </li></ul><ul><li>C- bp:137/76 pr:114/min spo2:96% </li></ul><ul><li>D- GCS:15/15 RBS:6.2 </li></ul>
  5. 5. <ul><li>Middle age laborer not known to have any medical problems not a smoker or ethanol consumer . no family history of heart disease . Referred from Rusayl health center with ========================== Gave a 3 day h / o of on and off pricking chest pain that is alternates between the rt and lt side of the chest . Is not associatd with sweating, nausea or dizziness . no particular radiation or relation to exertion or rest. </li></ul>
  6. 6. <ul><li>The pain was particularly severe starting 11 pm last night . He went to LHC in the early hours of the morning . He received aspirin 81 mg and and s / l GTN after which the pain somewhat subsided and he was reffered to SQUH. </li></ul><ul><li>Denies h / o fever, dizziness, SOB, orthopnea, PND or cough no urinary or gastroinestinal complaints. </li></ul>
  7. 7. <ul><li>Secondary survey: </li></ul><ul><li>Head and neck:nad </li></ul><ul><li>CVS:S1S2 </li></ul><ul><li>P/A:soft </li></ul><ul><li>CNS:NAD </li></ul><ul><li>ECG </li></ul>
  8. 9. <ul><li>Lab investigations: </li></ul><ul><li>-CBC; hb 14, plt 355, WBC 12.2, ANC:9.7 </li></ul><ul><li>-U&E,LFT,BONE PROFILE:NAD </li></ul><ul><li>-TROPONIN:NEGATIVE </li></ul>
  9. 11. <ul><li>The ECG was shown to and d / w Dr . Mehar . since the patient is pain free and currently stable, he opted for thrombolysing the patient. - </li></ul><ul><li>-thrmbolyse with reteplase 10 units ad repeat another 10 units after 10 min - -enoxaprin and continue aspirin 81 mg and clopidogrel 75 mg od - Admit to CCU - </li></ul>
  10. 12. <ul><li>repated ecg still showed st elevation in anterior leads. </li></ul><ul><li>Plan: </li></ul><ul><li>For angio+/-ptca </li></ul>
  11. 13. <ul><li>Angio NORMAL CORONARIES GOOD LV FUNCTION. </li></ul><ul><li>Impression : Chets pain with Normal Coronaries with good LV function and normal serial troponins </li></ul><ul><li>? Pericarditis - -Possible pneumonia left upper zone </li></ul>
  12. 14. <ul><li>Plan </li></ul><ul><li>-stop all antiplatelets and heparin -Continue augmentin and azithromycin -Check repeat CBC ESR Blood cultures and CRP and ESR -respiratory review ECHO routine - </li></ul>
  13. 15. Pericarditis <ul><li>Pericarditis can be classified according to the composition of the inflammatory exudate . </li></ul><ul><li>Types include: </li></ul><ul><li>serous </li></ul><ul><li>purulent </li></ul><ul><li>fibrinous </li></ul><ul><li>caseous </li></ul><ul><li>hemorrhagic </li></ul><ul><li>Post infarction </li></ul>
  14. 16. <ul><li>Clinically : </li></ul><ul><li>Acute (<6 weeks), </li></ul><ul><li>Subacute (6 weeks to 6 months) </li></ul><ul><li>Chronic (>6 months). </li></ul>
  15. 17. <ul><li>Causes: </li></ul><ul><li>-infections </li></ul><ul><li>Viral 1-children coxsackievirus </li></ul><ul><li>2-adults cytomegalovirus , herpesvirus , and HIV . </li></ul><ul><li>Bacteria Pneumococcus or tuberculous </li></ul><ul><li>Fungal histoplasmosis </li></ul><ul><li>in immunocompromised Aspergillus , Candida , and Coccidioides . </li></ul>
  16. 18. <ul><li>Idiopathic : No identifiable etiology found after routine testing. </li></ul><ul><li>Immunologic conditions including lupus erythematosus (more common among women) or rheumatic fever </li></ul><ul><li>Myocardial Infarction ( Dressler's syndrome ) </li></ul><ul><li>Trauma to the heart, e.g. puncture, resulting in infection or inflammation </li></ul><ul><li>Uremia ( uremic pericarditis ) </li></ul><ul><li>Malignancy (as a paraneoplastic phenomenon ) </li></ul><ul><li>Side effect of some medications , e.g. isoniazid , cyclosporine , hydralazine </li></ul><ul><li>Radiation induced </li></ul><ul><li>Aortic dissection </li></ul><ul><li>Tetracyclines </li></ul><ul><li>Postpericardiotomy syndrome </li></ul>
  17. 19. <ul><li>Complications: </li></ul><ul><li>- Pericardial effusion </li></ul><ul><li>- Constrictive pericarditis </li></ul><ul><li>- Cardiac tamponade </li></ul>
  18. 20. <ul><li>Treatment: </li></ul><ul><li>- NSAID </li></ul><ul><li>- pericardiocentesis </li></ul><ul><li>- antibiotics </li></ul><ul><li>- steroids </li></ul><ul><li>- colchicine </li></ul><ul><li>in rare cases, surgery </li></ul>
  19. 21. HOME MASSAGE: <ul><li>- there are more than ten causes for ST elevation </li></ul><ul><li>-MI -pericarditis </li></ul><ul><li>-LVH -hyperkalemia </li></ul><ul><li>-myocardium disorder -acute cor pulmonale </li></ul><ul><li>-post cardiac injury syndrome </li></ul><ul><li>-cadiac truma -myocardial contusion </li></ul><ul><li>-dresslers syndrome –aortic disection </li></ul><ul><li>-early repolarization ECG syndrome </li></ul>

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