This document provides information on cardiovascular symptoms, signs, and disease evaluation and management. It discusses:
1) Common cardiac symptoms like chest pain, palpitations, and dyspnea and what conditions they can indicate.
2) A comprehensive cardiac examination involves assessing the patient's general appearance, skin, head and neck, chest, abdomen, and extremities as well as measuring vital signs like jugular venous pressure and blood pressure.
3) Establishing a cardiac diagnosis involves considering etiology, anatomical abnormalities, physiological disturbances, and functional disability based on history, physical exam, ECG, imaging, and other tests. Management depends on whether heart disease is present and its severity.
Dilated cardiomyopathy is defined as dilatation and impaired contraction of the left ventricle not caused by ischemic or valvular heart disease. The document discusses the epidemiology, etiology, pathology, genetics, clinical features, diagnosis, and management of idiopathic dilated cardiomyopathy. Key points include:
- The annual incidence is 5-8 per 100,000 people with increased risk in males, blacks, and those with hypertension or chronic beta-agonist use.
- Causes include genetic mutations, viral infections, autoimmune diseases, and drugs. Pathology shows dilatation, myocyte hypertrophy and death, and extracellular matrix remodeling.
- Diagnosis involves ECG
This document discusses congestive heart failure in infants and children. It begins with background on the main causes of heart failure in children, which are often congenital heart disease and cardiomyopathy rather than issues like coronary artery disease that commonly cause heart failure in adults. The document then covers topics like the pathophysiology and classifications of heart failure in children, as well as diagnostic workup, management, and treatment approaches. Physical exam findings and classifications like Ross and NYHA scores are also outlined to help evaluate heart failure severity in pediatric patients.
1) Acute coronary syndromes (ACS) describe conditions caused by coronary plaque rupture and include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina.
2) Plaque rupture triggers blood clot formation, which can partially or completely block blood flow to the heart. STEMI involves complete blockage, while NSTEMI and unstable angina involve partial blockages.
3) Diagnosis involves ECG, cardiac enzyme tests, and angiography. Treatment depends on diagnosis but commonly includes aspirin, blood thinners, beta-blockers, and procedures like thrombolysis or angioplasty to restore blood flow.
This document provides an outline for a module on ventricular tachyarrhythmias. It begins with module objectives of differentiating types of ventricular tachycardias using ECGs. The outline then describes ventricular tachyarrhythmias, discusses characteristics like mechanisms and sustained vs nonsustained types. It classifies ventricular tachyarrhythmias as monomorphic or polymorphic, and provides subcategories within each with descriptions and ECG recognition details. Specific arrhythmias discussed include idiopathic VT, bundle branch reentry, ventricular flutter, fibrillation, and Torsades de Pointes.
definition of heart failure, classification of heart failure, risk factors for heart failure, clinical features, general physical examination findings in heart failure
No.1 history taking, physical examination CVSbharat kumar
This document provides guidance on evaluating symptoms related to cardiovascular conditions. It describes how to take a detailed history of common symptoms like chest pain, palpitations, breathlessness, and edema. For each symptom, it outlines important details to gather, such as onset, severity, exacerbating/relieving factors, and associated symptoms. Physical exam guidance includes general inspection, evaluating the hands, and positioning the patient for examination. Collecting a thorough history focusing on cardiovascular risk factors, medications, and functional status is emphasized.
Dilated cardiomyopathy is defined as dilatation and impaired contraction of the left ventricle not caused by ischemic or valvular heart disease. The document discusses the epidemiology, etiology, pathology, genetics, clinical features, diagnosis, and management of idiopathic dilated cardiomyopathy. Key points include:
- The annual incidence is 5-8 per 100,000 people with increased risk in males, blacks, and those with hypertension or chronic beta-agonist use.
- Causes include genetic mutations, viral infections, autoimmune diseases, and drugs. Pathology shows dilatation, myocyte hypertrophy and death, and extracellular matrix remodeling.
- Diagnosis involves ECG
This document discusses congestive heart failure in infants and children. It begins with background on the main causes of heart failure in children, which are often congenital heart disease and cardiomyopathy rather than issues like coronary artery disease that commonly cause heart failure in adults. The document then covers topics like the pathophysiology and classifications of heart failure in children, as well as diagnostic workup, management, and treatment approaches. Physical exam findings and classifications like Ross and NYHA scores are also outlined to help evaluate heart failure severity in pediatric patients.
1) Acute coronary syndromes (ACS) describe conditions caused by coronary plaque rupture and include ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), and unstable angina.
2) Plaque rupture triggers blood clot formation, which can partially or completely block blood flow to the heart. STEMI involves complete blockage, while NSTEMI and unstable angina involve partial blockages.
3) Diagnosis involves ECG, cardiac enzyme tests, and angiography. Treatment depends on diagnosis but commonly includes aspirin, blood thinners, beta-blockers, and procedures like thrombolysis or angioplasty to restore blood flow.
This document provides an outline for a module on ventricular tachyarrhythmias. It begins with module objectives of differentiating types of ventricular tachycardias using ECGs. The outline then describes ventricular tachyarrhythmias, discusses characteristics like mechanisms and sustained vs nonsustained types. It classifies ventricular tachyarrhythmias as monomorphic or polymorphic, and provides subcategories within each with descriptions and ECG recognition details. Specific arrhythmias discussed include idiopathic VT, bundle branch reentry, ventricular flutter, fibrillation, and Torsades de Pointes.
definition of heart failure, classification of heart failure, risk factors for heart failure, clinical features, general physical examination findings in heart failure
No.1 history taking, physical examination CVSbharat kumar
This document provides guidance on evaluating symptoms related to cardiovascular conditions. It describes how to take a detailed history of common symptoms like chest pain, palpitations, breathlessness, and edema. For each symptom, it outlines important details to gather, such as onset, severity, exacerbating/relieving factors, and associated symptoms. Physical exam guidance includes general inspection, evaluating the hands, and positioning the patient for examination. Collecting a thorough history focusing on cardiovascular risk factors, medications, and functional status is emphasized.
This document discusses ischemic heart disease and coronary artery disease. Coronary artery disease is caused by atherosclerosis which develops due to risk factors like smoking, high blood pressure, high cholesterol, and diabetes. Clinical presentations include stable angina, unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Treatment involves lifestyle modifications, medications like antiplatelets, anticoagulants, and statins, as well as procedures like percutaneous coronary intervention and coronary artery bypass grafting.
This document discusses acute coronary syndrome (ACS) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). It defines unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) and covers their clinical presentation, diagnostic criteria, laboratory investigation, and management. The key goals of diagnosis and treatment for NSTE-ACS patients are to recognize or exclude myocardial infarction, detect resting ischemia, and identify coronary artery obstruction. Treatment involves anti-ischemic, antithrombotic medications and consideration of coronary revascularization.
Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It has many potential causes, but is often due to problems with the heart muscle itself or valves. Treatment focuses on managing symptoms with diuretics, and slowing progression with ACE inhibitors, beta-blockers, and aldosterone antagonists. Other therapies aim to improve heart function or treat underlying causes. Prognosis depends on severity but ranges from 5-50% annual mortality.
Rheumatic fever is an autoimmune disease that can develop as a result of a streptococcal throat infection. It causes inflammation of the heart, joints, brain, and skin. The disease is most common in children ages 5-15 in developing countries. It is diagnosed using the Modified Jones Criteria which looks for major criteria like heart inflammation, arthritis, subcutaneous nodules, and minor criteria like fever and joint pain along with evidence of a prior streptococcal infection. Treatment involves antibiotics to treat the infection as well as medications for symptoms while long term prevention relies on regular antibiotics.
This document discusses brittle diabetes, which occurs when blood glucose swings become intolerable and disrupt daily life. Brittle diabetes can manifest as predominant hyperglycemia with ketoacidosis, predominant hypoglycemia, or mixed hyper-hypo glycemia. Evaluation involves monitoring glucose and insulin levels over 48 hours, psychosocial assessment, and screening for contributing medical, psychological, or drug-related factors. Management focuses on lifestyle changes, education, insulin therapy such as pumps, and treatment of underlying causes to stabilize glucose levels and reduce complications.
Mr. I, a 64-year-old male, presented to the hospital with chest pain. He reported feeling pressure and tightness in his chest for the past 5 months that had worsened. Examinations found elevated blood pressure, tachycardia, and signs of cardiomegaly on chest x-ray. ECG showed sinus rhythm with poor R wave progression. Echocardiogram indicated left ventricular dysfunction. The working diagnosis was unstable angina pectoris and hypertension. Management included medications to reduce blood pressure and prevent clots, with monitoring through daily ECGs.
Rheumatic heart disease is a condition that results from rheumatic fever, which causes inflammation and scarring of the heart valves, usually the mitral and aortic valves. It is most common in children ages 5-15 from low socioeconomic backgrounds living in crowded conditions. Long term antibiotic prophylaxis is needed to prevent recurrent streptococcal infections and further heart damage. For those with valve damage, treatment focuses on reducing cardiac workload through bed rest, medications, and possibly surgery such as valve repair or replacement.
History taking upper gastro intestinal bleedingAbino David
This document provides guidance on evaluating and managing a patient presenting with upper gastrointestinal bleeding. It outlines the differences between upper and lower GI bleeding and describes the relevant history, examination findings, and Rockall score for risk stratification. Key points include distinguishing symptoms of hematemesis versus hematochezia, assessing blood loss based on vital signs and volume, examining for stigmata of liver disease, and endoscopy to determine the source of bleeding and prognosis.
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
Acute Coronary Syndrome (ACS) refers to a range of conditions caused by reduced blood flow in the coronary arteries. It includes Unstable Angina (UA), Non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). ACS is diagnosed based on electrocardiogram (ECG) findings and cardiac enzyme levels. STEMI shows ST elevations and enzyme elevations, while NSTEMI shows ST depressions/inversions and enzyme elevations without ST elevations. UA shows non-specific ECG changes and normal enzymes. Risk stratification systems like the TIMI score are used for NSTEMI/UA patients to guide management, which may
The document provides a review of examining pulse and jugular venous pressure (JVP). It defines pulse as the expansion and elongation of the arterial wall due to blood pressure, and JVP as the oscillating top of blood in the right internal jugular vein reflecting right atrial pressure changes.
When examining pulse, the rate, rhythm, volume, character, arterial wall condition, and peripheral pulses are assessed. Abnormal rhythms and characteristics like pulsus paradoxus are also described. Examining JVP involves observing the pressure level and waveform pattern. An elevated or changed waveform can indicate cardiac or pulmonary issues. The document outlines how to properly examine both pulse and JVP and interpret the findings.
This document discusses ECG patterns in congenital heart disease. It begins by outlining the significance of ECG in diagnosing congenital heart defects. It then provides an overview of normal ECG changes in children and how they evolve over time as hemodynamics change. Next, it describes how ECG can help identify situs and ventricular position. It then discusses the characteristic ECG patterns seen in common acyanotic defects like atrial septal defects and ventricular septal defects. It also covers cyanotic defects like transposition of the great arteries. The document provides detailed information on ECG features, associated conditions, complications and evolution over time for many different congenital heart defects.
Approach to patient with Dilated CardiomyopathyNizam Uddin
This document provides an overview of dilated cardiomyopathy (DCM), including its definition, classification, etiologies, pathophysiology, clinical presentation, diagnosis and management. Key points include:
1) DCM is characterized by dilation and impaired contraction of the ventricles. Causes include genetic factors, viral myocarditis, toxins and idiopathic cases.
2) Diagnosis involves assessing history, symptoms of heart failure, echocardiogram showing reduced systolic function, and ruling out other potential causes.
3) Presentation varies from asymptomatic to heart failure symptoms. Management focuses on treating heart failure and its causes. Prognosis depends on the severity and reversibility of the underlying
Heart failure (what a family physician need to know)Ahmed Abouelela
Heart failure is a leading cause of hospitalization in those over 65. The family physician plays an important role in prevention through risk factor assessment, lifestyle counseling, and monitoring for signs and symptoms. When detected early, heart failure has a better prognosis than many cancers. Treatment involves medications like ACE inhibitors, ARBs, diuretics and beta-blockers to reduce symptoms and disease progression.
This document describes techniques for dynamic auscultation of the heart by altering circulatory dynamics through physiological and pharmacological maneuvers. Some key techniques discussed include respiration, postural changes, Valsalva maneuver, isometric exercise, and use of vasoactive agents. Various maneuvers cause changes in heart sounds and murmurs due to effects on hemodynamics, ventricular volumes, and pressures. For example, inspiration augments murmurs on the right side of the heart while expiration accentuates some left-sided murmurs. The Valsalva maneuver and post-premature ventricular contractions also cause characteristic changes heard on auscultation.
Rheumatic heart disease is caused by streptococcal infections which trigger an abnormal immune response damaging heart valves. It is characterized by joint pain, rashes, and neurological symptoms. Diagnosis involves checking for elevated inflammatory markers and antibodies from previous infections. Treatment focuses on eradicating infections, supporting cardiac function, and lifelong antibiotic prophylaxis to prevent recurrence which can be life-threatening if valves are affected. Nursing care centers around medication management, rest, hygiene, activity tolerance, and seeking prompt treatment of infections. Prognosis depends on age of first occurrence and severity of cardiac involvement.
Definition of heart failure - causes and types of heart failure - pathophysiology and risky factors for heart failure - Diagnosis clinical manifestations and investigations and classification of heart failure- treatment of chronic heart failure
Also Acute heart failure causes - clinical picture and treatment
Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.
Congestive Cardiac Failure presentation and diagnosisShah Abbas
This document provides an overview of congestive heart failure (CHF), including its definition, causes, pathophysiology, clinical manifestations, diagnostic evaluation, and management. CHF is defined as a clinical syndrome where the heart cannot pump enough blood to meet the body's needs. It is most commonly caused by conditions that overload or damage the heart such as hypertension, heart attacks, and cardiomyopathy. Clinically, it presents with symptoms of fluid backup like dyspnea, edema, and fatigue. Diagnostic tests include chest x-rays, EKGs, blood tests like BNP, and echocardiography. Treatment focuses on managing symptoms, addressing the underlying cause, and preventing complications through medications, lifestyle changes, and potentially devices
This document discusses the approach to evaluating and managing chest pain. It notes that chest pain accounts for millions of emergency department visits annually costing over $8 billion. The causes of chest pain are discussed, with musculoskeletal, gastrointestinal, and cardiac being most common. The initial approach to a patient with chest pain involves oxygen, IV access, monitoring, and an early ECG. A thorough history, physical exam including listening to heart and lungs, ECG, cardiac enzymes, CXR and other tests are used to evaluate the cause. Life-threatening conditions like myocardial infarction, pulmonary embolism, aortic dissection, and pericarditis require prompt diagnosis and treatment.
This document discusses ischemic heart disease and coronary artery disease. Coronary artery disease is caused by atherosclerosis which develops due to risk factors like smoking, high blood pressure, high cholesterol, and diabetes. Clinical presentations include stable angina, unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Treatment involves lifestyle modifications, medications like antiplatelets, anticoagulants, and statins, as well as procedures like percutaneous coronary intervention and coronary artery bypass grafting.
This document discusses acute coronary syndrome (ACS) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). It defines unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI) and covers their clinical presentation, diagnostic criteria, laboratory investigation, and management. The key goals of diagnosis and treatment for NSTE-ACS patients are to recognize or exclude myocardial infarction, detect resting ischemia, and identify coronary artery obstruction. Treatment involves anti-ischemic, antithrombotic medications and consideration of coronary revascularization.
Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. It has many potential causes, but is often due to problems with the heart muscle itself or valves. Treatment focuses on managing symptoms with diuretics, and slowing progression with ACE inhibitors, beta-blockers, and aldosterone antagonists. Other therapies aim to improve heart function or treat underlying causes. Prognosis depends on severity but ranges from 5-50% annual mortality.
Rheumatic fever is an autoimmune disease that can develop as a result of a streptococcal throat infection. It causes inflammation of the heart, joints, brain, and skin. The disease is most common in children ages 5-15 in developing countries. It is diagnosed using the Modified Jones Criteria which looks for major criteria like heart inflammation, arthritis, subcutaneous nodules, and minor criteria like fever and joint pain along with evidence of a prior streptococcal infection. Treatment involves antibiotics to treat the infection as well as medications for symptoms while long term prevention relies on regular antibiotics.
This document discusses brittle diabetes, which occurs when blood glucose swings become intolerable and disrupt daily life. Brittle diabetes can manifest as predominant hyperglycemia with ketoacidosis, predominant hypoglycemia, or mixed hyper-hypo glycemia. Evaluation involves monitoring glucose and insulin levels over 48 hours, psychosocial assessment, and screening for contributing medical, psychological, or drug-related factors. Management focuses on lifestyle changes, education, insulin therapy such as pumps, and treatment of underlying causes to stabilize glucose levels and reduce complications.
Mr. I, a 64-year-old male, presented to the hospital with chest pain. He reported feeling pressure and tightness in his chest for the past 5 months that had worsened. Examinations found elevated blood pressure, tachycardia, and signs of cardiomegaly on chest x-ray. ECG showed sinus rhythm with poor R wave progression. Echocardiogram indicated left ventricular dysfunction. The working diagnosis was unstable angina pectoris and hypertension. Management included medications to reduce blood pressure and prevent clots, with monitoring through daily ECGs.
Rheumatic heart disease is a condition that results from rheumatic fever, which causes inflammation and scarring of the heart valves, usually the mitral and aortic valves. It is most common in children ages 5-15 from low socioeconomic backgrounds living in crowded conditions. Long term antibiotic prophylaxis is needed to prevent recurrent streptococcal infections and further heart damage. For those with valve damage, treatment focuses on reducing cardiac workload through bed rest, medications, and possibly surgery such as valve repair or replacement.
History taking upper gastro intestinal bleedingAbino David
This document provides guidance on evaluating and managing a patient presenting with upper gastrointestinal bleeding. It outlines the differences between upper and lower GI bleeding and describes the relevant history, examination findings, and Rockall score for risk stratification. Key points include distinguishing symptoms of hematemesis versus hematochezia, assessing blood loss based on vital signs and volume, examining for stigmata of liver disease, and endoscopy to determine the source of bleeding and prognosis.
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
Acute Coronary Syndrome (ACS) refers to a range of conditions caused by reduced blood flow in the coronary arteries. It includes Unstable Angina (UA), Non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). ACS is diagnosed based on electrocardiogram (ECG) findings and cardiac enzyme levels. STEMI shows ST elevations and enzyme elevations, while NSTEMI shows ST depressions/inversions and enzyme elevations without ST elevations. UA shows non-specific ECG changes and normal enzymes. Risk stratification systems like the TIMI score are used for NSTEMI/UA patients to guide management, which may
The document provides a review of examining pulse and jugular venous pressure (JVP). It defines pulse as the expansion and elongation of the arterial wall due to blood pressure, and JVP as the oscillating top of blood in the right internal jugular vein reflecting right atrial pressure changes.
When examining pulse, the rate, rhythm, volume, character, arterial wall condition, and peripheral pulses are assessed. Abnormal rhythms and characteristics like pulsus paradoxus are also described. Examining JVP involves observing the pressure level and waveform pattern. An elevated or changed waveform can indicate cardiac or pulmonary issues. The document outlines how to properly examine both pulse and JVP and interpret the findings.
This document discusses ECG patterns in congenital heart disease. It begins by outlining the significance of ECG in diagnosing congenital heart defects. It then provides an overview of normal ECG changes in children and how they evolve over time as hemodynamics change. Next, it describes how ECG can help identify situs and ventricular position. It then discusses the characteristic ECG patterns seen in common acyanotic defects like atrial septal defects and ventricular septal defects. It also covers cyanotic defects like transposition of the great arteries. The document provides detailed information on ECG features, associated conditions, complications and evolution over time for many different congenital heart defects.
Approach to patient with Dilated CardiomyopathyNizam Uddin
This document provides an overview of dilated cardiomyopathy (DCM), including its definition, classification, etiologies, pathophysiology, clinical presentation, diagnosis and management. Key points include:
1) DCM is characterized by dilation and impaired contraction of the ventricles. Causes include genetic factors, viral myocarditis, toxins and idiopathic cases.
2) Diagnosis involves assessing history, symptoms of heart failure, echocardiogram showing reduced systolic function, and ruling out other potential causes.
3) Presentation varies from asymptomatic to heart failure symptoms. Management focuses on treating heart failure and its causes. Prognosis depends on the severity and reversibility of the underlying
Heart failure (what a family physician need to know)Ahmed Abouelela
Heart failure is a leading cause of hospitalization in those over 65. The family physician plays an important role in prevention through risk factor assessment, lifestyle counseling, and monitoring for signs and symptoms. When detected early, heart failure has a better prognosis than many cancers. Treatment involves medications like ACE inhibitors, ARBs, diuretics and beta-blockers to reduce symptoms and disease progression.
This document describes techniques for dynamic auscultation of the heart by altering circulatory dynamics through physiological and pharmacological maneuvers. Some key techniques discussed include respiration, postural changes, Valsalva maneuver, isometric exercise, and use of vasoactive agents. Various maneuvers cause changes in heart sounds and murmurs due to effects on hemodynamics, ventricular volumes, and pressures. For example, inspiration augments murmurs on the right side of the heart while expiration accentuates some left-sided murmurs. The Valsalva maneuver and post-premature ventricular contractions also cause characteristic changes heard on auscultation.
Rheumatic heart disease is caused by streptococcal infections which trigger an abnormal immune response damaging heart valves. It is characterized by joint pain, rashes, and neurological symptoms. Diagnosis involves checking for elevated inflammatory markers and antibodies from previous infections. Treatment focuses on eradicating infections, supporting cardiac function, and lifelong antibiotic prophylaxis to prevent recurrence which can be life-threatening if valves are affected. Nursing care centers around medication management, rest, hygiene, activity tolerance, and seeking prompt treatment of infections. Prognosis depends on age of first occurrence and severity of cardiac involvement.
Definition of heart failure - causes and types of heart failure - pathophysiology and risky factors for heart failure - Diagnosis clinical manifestations and investigations and classification of heart failure- treatment of chronic heart failure
Also Acute heart failure causes - clinical picture and treatment
Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.
Congestive Cardiac Failure presentation and diagnosisShah Abbas
This document provides an overview of congestive heart failure (CHF), including its definition, causes, pathophysiology, clinical manifestations, diagnostic evaluation, and management. CHF is defined as a clinical syndrome where the heart cannot pump enough blood to meet the body's needs. It is most commonly caused by conditions that overload or damage the heart such as hypertension, heart attacks, and cardiomyopathy. Clinically, it presents with symptoms of fluid backup like dyspnea, edema, and fatigue. Diagnostic tests include chest x-rays, EKGs, blood tests like BNP, and echocardiography. Treatment focuses on managing symptoms, addressing the underlying cause, and preventing complications through medications, lifestyle changes, and potentially devices
This document discusses the approach to evaluating and managing chest pain. It notes that chest pain accounts for millions of emergency department visits annually costing over $8 billion. The causes of chest pain are discussed, with musculoskeletal, gastrointestinal, and cardiac being most common. The initial approach to a patient with chest pain involves oxygen, IV access, monitoring, and an early ECG. A thorough history, physical exam including listening to heart and lungs, ECG, cardiac enzymes, CXR and other tests are used to evaluate the cause. Life-threatening conditions like myocardial infarction, pulmonary embolism, aortic dissection, and pericarditis require prompt diagnosis and treatment.
Heart failure (HF), often used to mean chronic heart failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the needs of the body.
Heart failure is a clinical syndrome where the heart is unable to pump enough blood to meet the body's needs. It can be caused by conditions that reduce the heart's ability to contract or fill properly and common symptoms include dyspnea, fatigue, and edema. Upon presentation, patients exhibiting signs of congestion such as elevated jugular pressure, rales, and edema are treated with diuretics, while those with low blood pressure or organ dysfunction may require inotropic support or mechanical circulatory support.
Cardiology 1.1. Chest pain - by Dr. Farjad IkramFarjad Ikram
Introduction to one of the most common symptoms that can represent a wide range of diseases, from benign to life-threatening, covering number of systems including gastrointestinal, cardiovascular, pulmonary, musculoskeletal and psychiatric. Includes a brief explanation of anti-anginal therapy.
Template design credits - http://www.slidescarnival.com
Unit III. Cardiovascular Disorders B.pptxSani191640
This document provides an outline of disorders of the cardiovascular system (CVS). It begins with an introduction and anatomy/physiology review. It then covers disorders in three sections: disorders of the heart like arrhythmias and coronary heart disease; vascular disorders like DVT and varicose veins; and hematological disorders like anemias and leukemias. Common diagnostic procedures and physical exam techniques are also discussed, including assessing heart sounds, murmurs, and jugular vein pressure. The document provides a comprehensive overview of cardiovascular conditions and their evaluation.
This document discusses ischemia and risk factors for atherosclerosis. It defines ischemia as an imbalance between myocardial oxygen supply and demand. Major risk factors include high blood pressure, high cholesterol, smoking, obesity, and diabetes. The stages of atherosclerosis and strategies for prevention and treatment are discussed, including lifestyle changes, medications like ACE inhibitors, and diagnostic tests. Angina symptoms and types are summarized.
This document provides an overview of congestive heart failure in adults. It begins with definitions and epidemiology, describing CHF as the heart's inability to pump enough blood due to structural or functional abnormalities. Main causes include reduced ejection fraction, volume overload, and pressure overload. Signs and symptoms include fatigue, shortness of breath, and leg swelling. The document then covers diagnosis, investigations such as BNP levels, classifications like NYHA staging, pathophysiology, types, manifestations, and management with medications like diuretics, ACE inhibitors, beta-blockers, and treatment of underlying conditions. It concludes with contraindicated medications in pregnancy or CHF.
This document provides an overview of cardiology and cardiovascular disease. It discusses the leading causes of death worldwide, including coronary heart disease and diseases of the heart muscles and valves. It then covers topics like case history taking in cardiology, common symptoms like chest pain and shortness of breath, methods for examining the cardiovascular system, and risk factors for conditions like coronary heart disease.
The document provides guidance on evaluating and diagnosing the causes of chest pain, including cardiac conditions like acute coronary syndrome (ACS) and pulmonary embolism. It describes approaches to obtaining a history, performing a physical exam, and ordering diagnostic tests like electrocardiograms (ECGs) and cardiac biomarkers. The goal is to identify high-risk conditions and accurately diagnose the underlying cause of the patient's chest discomfort.
Chest pain is a common complaint presenting to emergency departments. A thorough history and physical exam is important to identify life-threatening causes such as acute coronary syndrome, pulmonary embolism, aortic dissection, tension pneumothorax, and esophageal rupture. Initial evaluation should focus on ABCs and obtaining an EKG to identify ST segment changes concerning for acute myocardial infarction. Risk stratification using cardiac markers and diagnostic imaging can help determine need for further intervention or conservative management.
Approach to a Child with Congenital Heart DiseseCSN Vittal
This document discusses congenital heart diseases (CHD), specifically ventricular septal defects (VSD). It begins by outlining the approach to diagnosing and classifying CHD. It then describes the different types of VSDs based on their anatomical location, including perimembranous, muscular, inlet, and supracristal defects. The clinical manifestations, physical exam findings, ECG patterns, chest x-ray appearances, and echocardiogram features of VSDs are discussed in detail.
Chest pain is a common presenting complaint that can be caused by many cardiac and non-cardiac conditions. A thorough history, physical exam, EKG, biomarkers, imaging and stress testing are often needed to determine the underlying cause. The differential diagnosis includes acute coronary syndrome, pulmonary embolism, aortic dissection, pneumonia, gastroesophageal reflux disease, musculoskeletal disorders and anxiety. Location, radiation, relieving/worsening factors, associated symptoms and risk factors can help distinguish between potential life-threatening versus more benign causes of chest pain.
This document provides information on evaluating and diagnosing chest pain. It discusses:
- The importance of history taking in determining the cause of chest pain.
- Common life-threatening causes of chest pain like myocardial infarction, aortic dissection, pulmonary embolism, and tension pneumothorax.
- How to assess chest pain through physical examination, ECG, cardiac enzymes, imaging studies, and other investigations.
- Distinguishing cardiac from non-cardiac chest pain and differentiating conditions like angina, unstable angina, and STEMI based on features.
AHF is a leading cause of hospitalization in older adults and is associated with high mortality and readmission rates, with in-hospital mortality ranging from 4-10% and 1-year mortality after discharge reaching 25-30% or higher. AHF can be the first presentation of heart failure or a decompensation of known heart failure. It is classified by reduced or preserved ejection fraction and NYHA functional classification. Common causes include myocardial infarction, drugs, arrhythmias, valve dysfunction, and cardiomyopathy. Diagnosis involves clinical signs and symptoms overlapping with other conditions, along with diagnostic tests like ECG, imaging, and natriuretic peptide levels. Presentations include acute decompensated heart failure, acute pulmonary edema
This document provides an overview of topics to be covered in Part 1 of a PCCN review course. It lists cardiovascular and respiratory conditions that will be discussed, including acute coronary syndromes, heart failure, shock states, and respiratory alterations. The objectives of the review are outlined, focusing on understanding pathophysiology, signs and symptoms, classifications, and treatments. Breaks are included to allow time for questions.
This document provides an overview of cardiac failure/congestive heart failure. It begins with an introduction and objectives. It then reviews heart anatomy and physiology, including the structure of the heart, conducting system, heart sounds, and ECG. It defines cardiac failure and discusses epidemiology, causes, pathophysiology, clinical manifestations, classifications, diagnostic process, medical management, and complications. Nursing management is also addressed using the nursing process approach.
Rivaroxaban with or without aspirin in patients with stable peripheral or car...Bhargav Kiran
Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial
Vitamin D plays an important role in cardiovascular health beyond just calcium and bone metabolism. It has three main cardiovascular effects: 1) it maintains a balance between pro- and anti-inflammatory cytokines, 2) it decreases endothelial cell apoptosis and promotes proliferation, and 3) it is associated with the renin-angiotensin-aldosterone system. While observational studies show associations between low vitamin D levels and cardiovascular risk factors like dyslipidemia, randomized controlled trials findings have been contradictory. Both deficiency and excess of vitamin D can lead to vascular calcification and atherosclerosis. Low vitamin D has also been associated with higher rates of hypertension, heart failure, and diabetes; however, supplementation trials have not clearly shown cardiovascular benefits.
Nejm Effects of Aspirin for Primary Prevention in Persons with Diabetes MellitusBhargav Kiran
This document summarizes the results of the ASCEND trial, which investigated the effects of low-dose aspirin (100 mg daily) for primary prevention of cardiovascular events in 15,480 adults with diabetes but no history of cardiovascular disease. Over a mean follow-up of 7.4 years:
- Serious vascular events were lower in the aspirin group (8.5%) compared to placebo (9.6%), but major bleeding events were higher with aspirin (4.1% vs 3.2%).
- There was no significant difference in gastrointestinal cancer rates between groups.
- Aspirin prevented some vascular events but increased bleeding, largely offsetting the benefits. The absolute risks and benefits were closely balanced
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis could be safely treated with oral antibiotics rather than continued intravenous antibiotics. The trial involved 400 patients across multiple centers in Denmark who had infective endocarditis of the left heart caused by common bacterial species. Patients received either continued intravenous antibiotics according to guidelines or a partial oral antibiotic treatment regimen. The primary outcome was to show non-inferiority of oral treatment. Results showed that oral antibiotic treatment was found to be non-inferior to continued intravenous treatment for stable patients.
The document discusses various focal cerebral disorders related to language and memory. It describes the left perisylvian network that is critical for language abilities. Key areas include Broca's area in the inferior frontal gyrus and Wernicke's area in the posterior temporal lobe. Damage to this network can cause different types of aphasias, depending on the location of the lesion. It also discusses networks related to spatial orientation, object recognition, memory, and executive function. Assessment of language abilities including naming, speech, comprehension, repetition, reading, and writing is described. Various aphasia types such as Wernicke's, Broca's, conduction, and anomic aphasia are summarized. Other disorders
This document discusses various symptoms related to cardiovascular and respiratory systems. It defines palpitations as a sensation of irregular heartbeat and lists potential cardiac, psychiatric and miscellaneous causes. Dyspnea is defined as subjective breathing discomfort that can vary in intensity. Cough is described as an essential protective function, with excessive coughing having potential complications. The mechanism of cough and types based on duration are outlined. Hypoxia and its effects on cells, cardiovascular system and central nervous system are summarized. Various causes of hypoxia including respiratory, anemic, carbon monoxide poisoning and more are listed with brief descriptions.
Balanced crystalloids were compared to saline for intravenous fluid administration in critically ill adults. The study involved over 15,000 patients randomized to receive either balanced crystalloids or saline. The primary outcome was a composite of death, new renal replacement therapy, or persistent renal dysfunction within 30 days. Fewer patients who received balanced crystalloids developed hyperchloremia or acidosis. The use of balanced crystalloids resulted in a 1.1 percentage point lower rate of reaching the primary outcome compared to saline.
This document summarizes a randomized controlled trial that investigated whether stable patients with infective endocarditis on the left side of the heart could be safely treated with oral antibiotics instead of continued intravenous antibiotics. The trial involved 400 patients randomized to either continued intravenous or oral antibiotic treatment according to predefined regimens. The primary outcome was a composite of death, embolic events, or recurrence of infection. The results showed that oral antibiotic treatment was noninferior to continued intravenous treatment.
This document discusses acute encephalitis in India. It defines acute encephalitis and acute encephalitis syndrome. Japanese encephalitis virus is a major cause of AES in India, transmitted via Culex mosquitoes between pigs, birds and humans. The document outlines the epidemiology, clinical features, diagnosis and management of AES. It emphasizes the importance of vaccination and vector control in prevention and control of AES in India.
This document discusses the approach to fever of unknown origin (FUO). It defines FUO as a fever over 101°F for at least 3 weeks without a confirmed diagnosis after initial tests. The differential diagnosis is extensive and includes infections, cancers, and non-infectious inflammatory diseases. The diagnostic approach focuses on finding potentially diagnostic clues by thorough history, exam, initial tests, and more specialized tests like PET scans and biopsies if needed. Treatment depends on the suspected cause but generally avoids antibiotics until a source is found to avoid obscuring the diagnosis. Prognosis has improved over time but malignancies remain a significant cause of mortality in FUO cases.
1) ATT induced hepatitis refers to drug-induced liver injury caused by anti-tuberculosis treatment medications like isoniazid, rifampin, and pyrazinamide.
2) These drugs can cause a spectrum of liver damage from asymptomatic transaminase elevations to acute liver failure via both idiosyncratic and dose-dependent mechanisms including intracellular calcium disruption and apoptosis.
3) Risk factors for tuberculosis drug-induced liver injury include older age, female sex, extra-pulmonary or meningeal tuberculosis, malnutrition, alcohol use, viral hepatitis coinfection, and certain genetic factors. Careful monitoring of liver enzymes is recommended during treatment.
Recent changes in behavior of plasmodiumBhargav Kiran
Recent Changes in Behavior of Plasmodium
This document discusses recent changes observed in the behavior of the Plasmodium parasite, which causes malaria. It notes that Plasmodium vivax, previously considered a benign infection, has shown a new potential for severe and life-threatening disease. The document also reviews the epidemiology and pathophysiology of malaria, including clinical manifestations like anemia, renal failure, pulmonary edema, and complications in pregnancy. It discusses investigations, treatment approaches for uncomplicated and severe malaria, drug prophylaxis, emerging drug resistance, and strategies for controlling the mosquito vector.
This case presentation describes a 54-year-old female patient who presented with fever, easy fatigability, breathlessness, and abdominal pain for 7-10 days. Clinical examination revealed pallor, icterus, bilateral pedal edema, tachycardia, tachypnea, hepatomegaly, and splenomegaly. Investigations showed anemia, leukocytosis, reticulocytosis, spherocytes, decreased haptoglobin and complement levels, indirect hyperbilirubinemia, and a positive Coombs test. The patient was diagnosed with autoimmune mixed hemolytic anemia associated with systemic lupus erythematosus. She was treated with steroids and supportive
This document provides an overview of atrial myxoma, including its history, pathology, clinical presentation, diagnosis, and surgical management. Some key points:
- Atrial myxoma is the most common primary cardiac tumor, usually located in the left atrium and arising from the interatrial septum.
- Clinical presentation varies depending on location and size of the tumor but can include signs of heart failure, murmurs, arrhythmias, and embolic events.
- Echocardiography is the primary diagnostic tool to determine tumor location, size, and attachment site.
- Surgical resection is the only effective treatment due to risk of embolization and hemodynamic complications.
This document provides an overview of how to approach heart murmurs. It discusses the basics of heart sounds and cardiac cycle timing. It describes the locations used to auscultate heart sounds. Murmurs are defined as audible vibrations caused by increased turbulence in blood flow. Pathological murmurs have distinguishing characteristics like timing within the cardiac cycle. The document outlines how to describe murmurs and provides examples of different types of murmurs heard in various locations based on their timing within the cardiac cycle. It also discusses classifications of murmurs and potential causes.
Insulin analogues are genetically engineered versions of human insulin that are designed to more closely mimic the body's natural insulin secretion. Short-acting analogues like lispro and aspart have a faster onset of action than regular insulin, allowing for more flexibility in dosing around meals. Long-acting analogues like glargine and degludec aim to provide a steady basal insulin level throughout the day without peaks, reducing the risk of nocturnal hypoglycemia. While insulin analogues provide benefits over regular insulin in terms of better glycemic control and reduced side effects, their higher cost is still a limitation to their use.
This document discusses the normal metabolism of water and sodium in the body. It covers topics such as the distribution and composition of body fluids, osmotic pressure, and the regulation of water and sodium levels. Water intake and loss must be balanced to maintain homeostasis. The kidneys play an important role in regulating sodium balance by excreting more or less sodium depending on intake levels. Hormones like ADH and aldosterone also help regulate water and sodium metabolism in the body.
This document presents a case study of a 50-year-old female patient who presented with loose stools for 2 days. Her condition did not improve with initial treatment and her diarrhea increased to 20-30 episodes per day. Laboratory tests found Entamoeba histolytica cysts in her stool. Despite treatment with antibiotics, antiamoebic medications, and loperamide, her condition continued to worsen with increased diarrhea episodes. A CT scan showed a simple liver cyst but no other abnormalities. The case is presented for discussion as the patient's condition has not responded to treatment.
This document discusses bradyarrhythmias and approach to treatment. It defines various types of sinus node dysfunction and AV conduction blocks including sick sinus syndrome, sinus pause, sinus arrest, tachy-brady syndrome, and different degrees of AV block. It describes evaluation of sinus node function including intrinsic heart rate, sinus node recovery time and SA conduction time. It discusses reversible and irreversible causes of bradyarrhythmias and guidelines for pacemaker implantation for sinus node and AV node dysfunction. Treatment options including medications and permanent pacing are outlined.
The RNTCP has updated its guidelines for the programmatic management of drug resistant TB in 2017. The key updates include:
1. Expanding the criteria for screening presumptive drug resistant TB cases to include contacts of microbiologically confirmed TB patients, people living with HIV/AIDS, diabetes, malnutrition, cancer and those on immunosuppressants.
2. Introducing a new diagnostic algorithm for pulmonary, extra-pulmonary and pediatric TB that places more emphasis on rapid molecular testing.
3. Establishing district drug resistant TB centers to decentralize drug resistant TB treatment and bring care closer to patients.
4. Revising treatment regimens for drug sensitive TB, mono/poly drug resistant
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
Level 3 NCEA - NZ: A Nation In the Making 1872 - 1900 SML.pptHenry Hollis
The History of NZ 1870-1900.
Making of a Nation.
From the NZ Wars to Liberals,
Richard Seddon, George Grey,
Social Laboratory, New Zealand,
Confiscations, Kotahitanga, Kingitanga, Parliament, Suffrage, Repudiation, Economic Change, Agriculture, Gold Mining, Timber, Flax, Sheep, Dairying,
How to Download & Install Module From the Odoo App Store in Odoo 17Celine George
Custom modules offer the flexibility to extend Odoo's capabilities, address unique requirements, and optimize workflows to align seamlessly with your organization's processes. By leveraging custom modules, businesses can unlock greater efficiency, productivity, and innovation, empowering them to stay competitive in today's dynamic market landscape. In this tutorial, we'll guide you step by step on how to easily download and install modules from the Odoo App Store.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
THE SACRIFICE HOW PRO-PALESTINE PROTESTS STUDENTS ARE SACRIFICING TO CHANGE T...indexPub
The recent surge in pro-Palestine student activism has prompted significant responses from universities, ranging from negotiations and divestment commitments to increased transparency about investments in companies supporting the war on Gaza. This activism has led to the cessation of student encampments but also highlighted the substantial sacrifices made by students, including academic disruptions and personal risks. The primary drivers of these protests are poor university administration, lack of transparency, and inadequate communication between officials and students. This study examines the profound emotional, psychological, and professional impacts on students engaged in pro-Palestine protests, focusing on Generation Z's (Gen-Z) activism dynamics. This paper explores the significant sacrifices made by these students and even the professors supporting the pro-Palestine movement, with a focus on recent global movements. Through an in-depth analysis of printed and electronic media, the study examines the impacts of these sacrifices on the academic and personal lives of those involved. The paper highlights examples from various universities, demonstrating student activism's long-term and short-term effects, including disciplinary actions, social backlash, and career implications. The researchers also explore the broader implications of student sacrifices. The findings reveal that these sacrifices are driven by a profound commitment to justice and human rights, and are influenced by the increasing availability of information, peer interactions, and personal convictions. The study also discusses the broader implications of this activism, comparing it to historical precedents and assessing its potential to influence policy and public opinion. The emotional and psychological toll on student activists is significant, but their sense of purpose and community support mitigates some of these challenges. However, the researchers call for acknowledging the broader Impact of these sacrifices on the future global movement of FreePalestine.
How to Manage Reception Report in Odoo 17Celine George
A business may deal with both sales and purchases occasionally. They buy things from vendors and then sell them to their customers. Such dealings can be confusing at times. Because multiple clients may inquire about the same product at the same time, after purchasing those products, customers must be assigned to them. Odoo has a tool called Reception Report that can be used to complete this assignment. By enabling this, a reception report comes automatically after confirming a receipt, from which we can assign products to orders.
2. WHAT ARE THE CARDIAC SYMPTOMS ??
Chest pain
Palpitations
Dyspnea
Dizziness & Syncope
Easy fatigability
Oliguria
Swelling of feet
Loss of appetite & weight (due to congestive
hepatopathy & gastropathy)
Ascites
Jaundice (due to cardiac cirrhosis)
Recurrent respiratory tract infections (due to pulmonary
congestion)
3. WHAT DO THEY INDICATE ??
SYMPTOM CAUSE/ INDICATES
1) CHEST DISCOMFORT Myocardial ischemia caused by
an imbalance between the
heart’s oxygen supply and
demand
2) EASY FATIGABILITY
PERIPHERAL EDEMA
DYSPNEA (due to pulm. edema)
Reduction of the pumping
ability of heart
3) EDEMA (+ all other symptoms
resembling those of myocardial
failure)
Obstruction to blood flow (eg:
vascular stenosis)
4) PALPITATIONS
SYNCOPE
DYSPNEA
HYPOTENSION
Abnormal cardiac rate or
rhythm (Cardiac arrhythmias)
4. ARE THESE SYMPTOMS RESTRICTED TO ONLY
CVS ??
SYMPTOM OTHER POSSIBLE CAUSES
DYSPNEA • Pulmonary disease
• Marked obesity
• Anxiety, etc.
CHEST DISCOMFORT • Other cardiac causes (apart
from myocardial ischemia)
• Non-cardiac causes
EDEMA • Primary renal disease
• Hepatic cirrhosis
SYNCOPE • Neurological conditions
NOPE !!
5. HOW WILL YOU KNOW IF HEART DISEASE IS
RESPONSIBLE FOR THESE SYMPTOMS ??
By carrying out a careful clinical examination
Supplemented by non-invasive testing (eg:
electrocardiography at rest & during exercise,
echocardiography) & other forms of myocardial
imaging
Myocardial or coronary function
that may be adequate at rest
but insufficient during exertion
dyspnea, chest discomfort
(during activity) are
characteristic of patients with
heart disease
6. SO NOW ROUGHLY YOU HAVE COME TO KNOW THAT
IT IS CARDIAC PATHOLOGY..THEN WHAT NEXT ??
To come to a complete cardiac diagnosis, following
considerations to be made:
ELEMENTS QUESTIONS
1. UNDERLYING
ETIOLOGY
• Congenital ?
• Hypertensive ?
• Ischemic ?
• Inflammatory in origin ?
2. ANATOMIC
ABNORMALITIES
• Chambers involved?
• Are they hypertrophied?
dilated? both?
• Valves affected?
• Regurgitant? Stenotic?
• Pericardial involvement?
3. PHYSIOLOGIC
DISTURBANCES
• Arrhythmia present?
• Evidence of M.ischemia or
CHF
4. FUNCTIONAL
DISABILITY
• How strenuous is the
physical activity required to
elicit symptoms?
(NYHA classification)
8. 4B: (GRADING OF DYSPNEA)
Grade 1: Dyspnea occurring during unaccustomed
exertion (classical eg: running up 2 long flights of
stairs)
Grade 2: during accustomed exertion (classical eg:
climbing up 2 long flights of stairs)
Grade 3: during minimal exertion (classical eg:
walking from room to room)
Grade 4: at rest
9. FOR EXAMPLE,
In a patient who presents with exertional chest
discomfort, the identification of myocardial ischemia as
the etiology is of great clinical importance. However the
simple recognition of ischemia is insufficient to formulate
a therapeutic strategy or prognosis until the underlying
anatomic abnormalities responsible for the myocardial
ischemia [eg: coronary atherosclerosis or aortic
stenosis] are identified and a judgment is made about
whether other physiologic disturbances that cause an
imbalance between myocardial oxygen supply and
demand [eg: severe anemia, thyrotoxicosis] play
contributory roles. Finally the severity of the disability
should govern the extent and tempo of the workup and
strongly influence the therapeutic strategy that is
selected
10. The establishment of a
correct and complete cardiac
diagnosis usually
commences with
i. History
ii. Physical examination
iii. 5 types of lab tests
5 LABORATORY TESTS
• ECG
• Non-invasive imaging examinations (echocardiogram, CT
imaging, MRI, etc.)
• Blood tests to assess risk (eg: lipid determinations, CRP) or
cardiac function (eg: BNP)
• Occasionally specialized invasive examinations (cardiac
catheterization, coronary arteriography)
• Genetic tests to identify monogenic cardiac diseases (eg:
hypertrophic cardiomyopathy, Marfan’s syndrome, sudden
death assoc. with a prolonged QT interval syndrome)
In history taking of a patient
with known or suspected CV
disease, particular attention
should be directed to family
history
WHY ??
Coz familial clustering is
common in many forms of
heart disease:
• hypertrophic
cardiomyopathy
• Marfan’s syndrome
• sudden death assoc. with a
prolonged QT interval
syndrome
11. CAN YOU PREVENT CAD ?? HOW ??
Prevention begins with
Risk assessment
Lifestyle changes (eg: achieving optimal weight,
physical activity, smoking cessation, etc.)
Aggressive treatment of all abnormal risk factors
(HT, hyperlipidemia, DM)
YES !!
12. MANAGEMENT:
In absence of
evidence of
heart disease
In absence of
evidence of
heart disease
but the patient
has one or
more risk
factors
Asymptomatic /
mildly
symptomatic
patients with
valvular heart
disease (that is
anatomically
severe)
In patients
with CAD
Inform the pt.
clearly of this
assessment and
NOT BE asked
to return at
intervals
for repeated
examination
Develop a plan for
their reduction & pt.
should be retested
at intervals to
assess the efficacy
in risk
reduction
Evaluated
periodically every
6-12 months by
clinical & non-
invasive
examinations
Rx: medical,
percutaneous
coronary
intervention,
surgical
revascularization
13. Why scenario 3 type of patient needs to be evaluated
every 6-12 months ??
Coz in case of early signs of deterioration of ventricular
function signifies the need for surgical treatment before the
development of disabling symptoms, irreversible
myocardial damage, etc.
Can we do revascularization for all scenario 4 patients??
The mere presence of angina pectoris &/ demonstration of
critical coronary artery narrowing at angiography should
not reflexively evoke a decision to treat patient by
revascularization.
Instead it must be limited to patients with CAD whose
angina has not responded adequately to medical
treatment or in whom revascularization has been shown to
improve the natural history (eg: acute coronary syndrome
or multivessel CAD with left ventricular dysfunction)
14. SOMETHING ABOUT HEART MURMUR: (EXTRA)
Majority of heart murmurs are midsystolic and soft
(grades 1-2)
Do all murmurs require
echocardiography ??
NOPE !!
16. NOW LET US GO IN DETAIL WITH EXAMINATION
PART..
2 parts
GENERAL
PHYSICAL
EXAMINATION
CARDIOVASCULAR
EXAMINATION
17. GENERAL PHYSICAL EXAMINATION:
1. General appearance of patient
- built & nourishment
- posture
- dyspneic ?
- diaphoretic ?
- in pain / resting quietly ?
- does the patient choose to avoid certain body
positions to reduce/ eliminate pain ?
- mental status
- level of alertness
- mood
18. 2. SKIN
CONDITION INDICATES
1) CENTRAL CYANOSIS Significant right-to-left shunting at the
level of heart / lungs
2) PERIPHERAL CYANOSIS Reduced blood flow to extremity due
to small vessel constriction (as in
severe heart failure/ shock/ peripheral
vascular disease)
3) DIFFERENTIAL CYANOSIS • Large PDA
• Secondary pulmonary HT with right-
to-left shunting at great vessel level
4) TELANGIECTASIAS (on face) • Advance mitral stenosis
• Scleroderma
5) TAN/ BRONZE DISCOLORATION
OF SKIN
Hemochromatosis is the cause of
assoc. heart failure
6) JAUNDICE • Advanced right heart failure
• Congestive hepatomegaly (cardiac
cirrhosis)
19. 7) CUTANEOUS ECCHYMOSES Patient is taking Vit K antagonists or
antiplatelet agents (eg: aspirin)
8) XANTHOMAS Lipid disorders
20. 3. HEAD & NECK:
Dentition & oral hygiene
Ocular examination
Face
FEATURE CONDITION
1) High-arched palate Marfan’s syndrome & other
connective tissue disease
syndromes
2) Bifid uvula Loeys-Dietz syndrome
3) Orange tonsils Tangier disease
FEATURE CONDITION
1) Blue sclera Osteogenesis imperfecta
Many patients with
congenital heart disease
have associated
hypertelorism + low-set
ears + micrognathia
FEATURE CONDITION
1) INFLAMMED PINNA /
SADDLE NOSE
DEFORMITY
Relapsing polychondritis
21. 4. CHEST:
FEATURES INDICATES
1) Scars ?
2) Prominent venous
collateral pattern
Subclavian / vena caval
obstruction
3) Thoracic cage
abnormalities
• Pectus carinatum
(pigeon chest)
• Pectus excavatum
(funnel chest)
• Barrel chest
Connective tissue disease
syndromes
Obstructive Lung disease
4) Severe kyphosis Auscultate for murmur of
AR
5) Straight back syndrome Mitral valve prolapse
6) Asymmetric chest wall
with anterior displacement
of left hemithorax
Cyanotic congenital heart
disease
22. 5. ABDOMEN
FEATURE INDICATES
1) Point of maximum
cardiac impulse in
epigastrium
Advanced obstructive lung
disease
2) Enlarged & tender liver Chronic heart failure
3) Systolic pulsations over
liver
Tricuspid regurgitation
4) Splenomegaly Infective endocarditis
5) Ascites • Chronic right heart failure
• Constrictive pericarditis
• Hepatic cirrhosis
• Intraperitoneal
malignancy
6) Arterial bruit over
abdomen
High grade atherosclerotic
disease
23. 6. EXTREMITIES:
FEATURE INDICATES
1) Temperature ?
2) Color ?
3) Clubbing Central right-to-left shunting
4) Fingerized thumb Holt-Oram syndrome
5) - Arachnodactyly
- Positive “wrist” sign
(overlapping of thumb
& 5th finger around
the wrist) /
- Positive “thumb” sign
(protrusion of the
thumb beyond the ulnar
aspect of hand when the
fingers are clenched over
the thumb in a fist)
Marfan’s syndrome
24. 6) - Janeway lesions (non tender,
slightly raised hemorrhages on palms &
soles)
- Osler’s nodes (tender, raised
nodules on the pads of the fingers or
toes)
- Splinter hemorrhages
Endocarditis
7) Lower extremity or pre-sacral edema
(+increased JVP)
(-increased JVP)
(-increased JVP
+ varicosities/ venous ulcers –medial/
brownish cutaneous discoloration from
hemosiderin discoloration –
EBURNATION)
• Chronic heart failure
• Constrictive pericarditis
• Lymphatic/venous obstruction
• Venous insufficiency (MC)
8) Muscular atrophy / absence of hair
along an extremity
• Severe arterial insufficiency
• Primary neuromuscular
disorder
26. 1) JVP:
AIM: to estimate the volume status
Which vein is used to measure JVP?
Internal jugular vein is preferred. External Jugular
vein is less reliable coz of:
i. Does not directly drain into SVC & Rt. atrium
ii. Has valves
How do you measure JVP ?
Traditionally has been measured as vertical distance
between the top of the jugular venous pulsation &
Angle of Louis.
A distance > 4.5cm at 30 degree elevation is
considered abnormal
Finding of an
elevated JVP
implies a
cardiovascular
pathology
27. Why clavicle is preferred over Angle of Louis as a
reference point?
Coz the actual distance between the mid-right
atrium and the angle of Louis varies considerably
as a function of both body size & the patient angle
at which assessment is made (30/45/60 degree)
Venous pulsations above clavicle in the sitting
position (with the legs dangling below the bedside)
are clearly abnormal as the distance between the
clavicle & the right atrium is at least 10 cm
28. Differentiation btw venous & arterial pulsation ?
VENOUS PULSATION ARTERIAL PULSATION
1) Lateral to SCM Medial to SCM
2) Waves disappear when
pressure given at root of neck
Not easily obliterated with
palpation
3) Usually biphasic Monophasic
4) Easily seen than felt Easily felt than seen
5) Change with changes in
posture or inspiration
29. Waves ??
‘ WAVES MECHANISM
‘a' wave [MOST
DOMINANT WAVE] +
Right atrial contraction
‘c’ wave + Closure & bulging of
tricuspid valve
‘x’ descent - Atrial relaxation with
downward descent of
tricuspid valve
‘v’ wave + Passive right atrial filling
during ventricular systole
‘y’ descent - Right ventricular filling with
atrial emptying
30. Prominent ‘a’ wave??
Tricuspid stenosis/atresia
Mitral stenosis
Pulmonary stenosis
Pulmonary HT
‘a’ wave absent in??
Atrial fibrillation
Cannon ‘a’ wave??
Very large ‘a’ wave is known as cannon wave. Seen
in
AV dissociation
Right atrial contraction against a closed tricuspid
valve
31. Kussmaul’s sign/ Venous pulsus paradoxus ?
In normally healthy persons, the venous pressure
should fall by at least 3 mmHg with inspiration (due
to sucking of blood into right atrium)
Kussmaul’s sign – Either a rise or a lack of fall of
JVP with inspiration
Classically associated with constrictive pericarditis
Also seen in patients with
- restrictive cardiomyopathy
- massive pulmonary embolism
- right ventricular infarction
- advanced left ventricular systolic heart failure
32. Other methods of eliciting venous HT?
Abdomino-jugular reflex
Passive leg elevation
Abdomino-jugular reflex?
Elicited with firm & consistent pressure over the
upper portion of the abdomen, preferably over the
right upper quadrant, for at least 10 sec.
+ : Sustained rise of > 3 cm in JVP for at least 15
sec after release of the hand (as hepatic venous
reservoir gets compressed)
Useful in predicting pulmonary artery wedge
pressure in excess of 15 mmHg in patients with
heart failure
33. 2) BP:
How to measure BP?
Best measured in seated position with the arm at
the level of the heart, using an appropriately sized
cuff, after 5-10 mins of relaxation
When measured in supine position, arm must be
raised to bring it to the level of mid-right atrium
Cuff should be inflated to 30 mmHg above the
expected systolic pressure and the pressure
released at a rate of 2-3 mmHg /sec
Systolic & diastolic pressures are defined by?
1st & 5th Korotkoff sounds respectively
34. BP measured at?
Best assessed at brachial artery level (though it can
be measured at radial, popliteal or pedal pulse level)
BP should be measured in both arms and the
difference should be less than 10 mmHg.
>10 mmHg indicates ?
Atherosclerotic/
Inflammatory subclavian artery disease
Supravalvular aortic stenosis (right sided higher
BP)
Pre-ductal coarctation of aorta (right sided higher
BP)
Unilateral occlusive disease of arteries
35. Systolic leg pressures are usually as much as 20
mmHg higher than systolic arm pressures. Greater
leg-arm pressure differences are seen in?
Chronic severe AR
Extensive & calcified lower extremity peripheral
arterial disease
White coat HT?
Defined by
at least 3 separate clinic-based measurements >140/90
mmHg &
at least 2 non-clinic based measurements <140/90
mmHg
in the absence of any evidence of target organ damage
May not benefit from drug therapy
36. Masked HT?
Suspected when normal or even low BPs are
recorded in patients with advanced atherosclerotic
disease, especially when evidence of target organ
damage is present or bruits are audible.
Orthostatic hypotension?
Fall in systolic pressure > 20 mmHg or in diastolic
pressure > 10 mmHg in response to assumption of
the upright posture from a supine posture within 3
mins
Common cause of postural lightheadedness/
syncope
CAUSES: advanced age, DM, hypovolaemia (blood
or fluid loss), certain medications (centrally acting
anti HT)
37. 3) ARTERIAL PULSE:
Can aortic pulse be felt?
Yes. Best appreciated in the epigastrium just above the
level of umbilicus
Peripheral arterial pulses to be assessed?
Subclavian
Brachial
Radial
Ulnar
Femoral
Popliteal
Dorsalis pedis
Posterior tibial
38. Pulses to be examined for?
Symmetry
Volume
Timing
Contour
Amplitude
Duration
Radio-femoral delay?
HT
Suspected aortic coarctation
Character of pulse is best appreciated at?
Carotid level
39. PULSE SEEN IN
1) PULSUS PARVUS ET TARDUS (Parvus – low
in volume & amplitude; Tardus – slow rising pulse
with a late systolic peak)
AS
2) CORRIGAN’S / WATER-HAMMER Pul.
High volume pulse, sharp rise, ill sustained &
sharp fall
AR
3) ANACROTIC PULSE
Slow rising pulse (notched, or interrupted
upstroke ) with 2 systolic peaks
AS (some)
4) PULSUS BISFERIENS
Rapid rising pulse with 2 systolic peaks
• AS + AR
• Hypertrophic obstructive
cardiomyopathy (HOCM)
5) PULSUS ALTERNANS
Alternating small & large volume pulse in regular
rhythm
Severe LV systolic dysfunction
6) Fall in systolic pressure > 10 mmHg with
inspiration (PULSUS PARADOXUS)
• CARDIAC: Pericardial effusion,
Constrictive pericarditis,
Restrictive cardiomyopathies
• RS: Acute severe asthma, COPD
• SVC obstruction
Why normally fall
occurs ? – PJM 41
40. Causes of arterial bruit?
Vascular obstruction
AV fistula with enhanced flow
Auscultation of
carotid, subclavian,
abdominal aortic and
femoral artery bruits
should be routine
41. 4) INSPECTION OF HEART:
Apex beat?
Visible in left 5th ICS, ½ inch medial to mid clavicular line in
thin-chested adults
Abnormal visible pulsations?
Anywhere other than this expected location
Visible right upper parasternal pulsation is suggestive of?
Ascending aortic aneurysm disease
In thin, tall patients and patients with advanced obstructive
lung disease and flattened diaphragms; the cardiac
impulse may be visible in the epigastrium and should be
distinguished from a pulsatile liver edge
42. PALPATION OF HEART:
Begins with the patient in the supine position at 30
degree and can be enhanced by placing the patient
in the left lateral decubitus position
Normal LV impulse?
< 2cm in diameter
Moves quickly away from the fingers
Better appreciated at end expiration
With the heart closer to ant. chest wall
Characteristics such as size, amplitude & rate of force
development should be noted
43. Right ventricular pressure or volume overload
sternal lift
APEX BEAT INDICATES
1) Leftward & downward
displacement of an
enlarged apex beat
Enlargement of LV cavity
2) Sustained apex beat Pressure overload
• AS
• Chronic HT
44. 5) CARDIAC AUSCULTATION:
S1 indicates?
Mitral & tricuspid valve closure
S2 indicates?
Aortic & pulmonary valve closure
Ventricular systole?
Interval between S1 & S2
S2 consists of?
A2 + P2
A loud single or palpable P2 is suggestive of?
Pulmonary arterial HT
45. When is P2 considered to be loud?
When its intensity exceeds that of A2 at the base/
When it can be palpated in the area of proximal
main pulmonary artery (2nd left ICS)/
When both components of S2 can be appreciated
at lower left sternal border or apex
Intensity of A2 decreases with?
Aortic stenosis
Intensity of P2 decreases with?
Pulmonary stenosis
46. CARDIAC MURMURS:
Result from audible vibrations that are caused by
increased turbulence
Intensity of a heart murmur is graded on a scale of
1-6
Thrill is present with murmurs of >/= grade 4
Types of systolic murmurs based on timing?
Early
Mid – begins after S1 & ends before S2
Late
Holosystolic
47. MURMUR CONDITION
1) Early systolic murmur MR
2) Early systolic murmur
(increases in intensity with
inspiration) heard at left lower
sternal border
TR
3) Midsystolic murmur • AS (most common)
• Pulmonary valve stenosis
• HOCM
• Left-to-right shunting
• Several states associated with
accelerated blood flow in the
absence of structural heart
disease
- fever
- thyrotoxicosis
- pregnancy
- anemia
4) Late systolic murmur (heard
best at apex)
MVP
5) Holosystolic VSD
48. MURMUR OF BEST HEARD
1) AS 2nd right ICS with radiation into
carotids
2) HOCM Between lower left sternal border
& apex
3) PS 2nd left ICS
4) MR Over cardiac apex
5) VSD Mid-left sternal border (+thrill)
6) TR Lower left sternal border
(increases in intensity with
inspiration – Carvallo’s sign)
49. Diastolic heart murmurs always signify?
Structural heart disease
Classic cause of mid- to late diastolic murmurs?
MS
Classic example of continuous murmur?
That assoc. with PDA
2 types of benign continuous murmurs?
Cervical venous hum – heard in children or
adolescents in supraclavicular fossa
Mammary souffle of pregnancy – due to enhanced
arterial blood flow through engorged breasts
50. How can diagnostic accuracy be enhanced?
Right sided events increase (except for pulmonic
ejection sound) in intensity with inspiration &
decrease with expiration
Left sided events behave oppositely