CAT clinical medicine

1. CAT
CLINICAL MEDICINE 1

2. WHAT ARE THE CLINICAL FEATURES OF CONGENITAL
SYPHILIS?
1. Early
 rhinitis (“snuffles”), hepatosplenomegaly, skin rash with desquamation, chorioretinitis
and pigmentary chorioretinopathy (salt and pepper type), glaucoma, cataracts,
interstitial keratitis, optic neuritis, periostitis and cortical demineralization of
metaphysis and diaphysis areas of long bones, anaemia and thrombocytopenia.
2. Late
 saddle nose due to destruction of cartilage, frontal bossing due to periostitis, tibial
thickening (saber shins), joint swelling (clutton joints), perforation of hard palate,
abnormal tooth development (Hutchinson’s teeth, mulberry molars), interstitial
keratitis, neurologic deafness and optic atrophy.

3. WHAT IS THE DIFFERENCE BETWEEN CAROTID ARTERY
AND JUGULAR VEIN PULSATION?

4. DISCUSS CLINICAL FEATURES, TYPES, INVESTIGATIONS
AND TREATMENT OF CARDIOMYOPATHY
• Definition (1.5Mks) :
Cardiomyopathy is a disease of the heart muscle which affects its size, shape or
thickness causing the heart to lose its ability to pump blood well.

5. FEATURES (2.5MKS)
• Shortness of breath or trouble breathing, especially with physical exertion
• Fatigue
• Swelling in the ankles, feet, legs, abdomen and veins in the neck
• Dizziness
• Lightheadedness
• Fainting during physical activity
• Arrhythmias (abnormal heartbeats)
• Chest pain, especially after physical exertion or heavy meals
• Heart murmurs (unusual sounds associated with heartbeats)

6. INVESTIGATIONS (3.5MKS)
•Blood tests: FHG, LFTS, UECS
•Chest X-ray
•Electrocardiogram (EKG or ECG):
•Echocardiogram (Echo):
•Stress test
•MRI
•Chest CT scan
•Cardiac Markers
•Cardiac catheterization
•Myocardial biopsy
•Genetic testing
•coronary angiogram

7. TYPES (10 MKS)
• Dilated
• Hypertrophic
• Restrictive
• Arrhythmogenic right ventricular cardiomyopathy

8. • Dilated cardiomyopathy is the most frequent form of cardiomyopathy. The cavity of the heart is
enlarged and stretched, compromising the heart's ability to pump normally and relax appropriately:
• This occurs most often in adults ages 20 to 60. It is more common in men than women, but has been
diagnosed in people of all ages, including children.
• Most people eventually develop heart failure.
• Dilated cardiomyopathy can be caused by chronic, heavy alcohol use and nutritional deficiencies tied
to alcoholism.
• It sometimes occurs as a complication of pregnancy and childbirth.
• Other possible causes include: alcohol abuse, infections, and illicit drugs. Rarely, it is inherited.
Sometimes medicines used to treat a different medical condition can damage the heart and cause
dilated cardiomyopathy. However, in most cases, a specific cause is never found.

9. • Restrictive cardiomyopathy occurs when the heart muscle becomes stiff and not able
to fill with blood properly. It's the least common type of cardiomyopathy in Kenya.
• It often occurs due to an underlying problem, such as amyloidosis, hemochromatosis,
scleroderma, or sarcoidosis.
• Restrictive cardiomyopathy does not appear to be inherited, but some of the diseases
that lead to the condition are inherited.
• Symptoms may include fatigue, swelling of the arms and legs, and trouble breathing
on exertion.

10. • ARVD is a rare type of cardiomyopathy that occurs if the muscle tissue in the right
ventricle dies and is replaced by fat or scar tissue:
• This process disrupts the heart's electrical system, causing arrhythmias.
• It usually affects teens and young adults.
• Symptoms include heart palpitations and fainting after physical activity.
• It can cause sudden cardiac arrest in young athletes.
• It may require implantation of a device to prevent death from an arrhythmia

11. • Hypertrophic cardiomyopathy is most often caused by abnormal genes in the heart
muscle. These genes cause the walls of the heart chamber (left ventricle) to become
thicker than normal.
• The thickened walls may become stiff and this can reduce the amount of blood taken
in and pumped out to the body with each heartbeat.
• In obstructive HCM, the thickened part of the heart muscle, usually the wall (septum)
between the two bottom chambers (ventricles), blocks or reduces the blood flow from
the left ventricle to the aorta. Most people with HCM have this type.
• In nonobstructive HCM, the heart muscle is thickened but doesn’t block blood flow
out of the heart.

12. TREATMENT (3.5MKS)
• Lifestyle changes : Diet and physical activity
• Medications: diuretics, antibiotics, anticoagulants, steroids , CCBs
• Surgery : Pace markers, heart transplant