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DIFFERENTIAL DIAGNOSIS

VIEWS: 8 PAGES: 19

									     &
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
 CHRONIC PULMONARY DISEASE ASSOCIATED
  PULMONARY HYPERTENTION
 PULMONARY EMBOLISM
 ACUTE RESPIRATORY DISTRESS SYNDROME
 EDEMA SECONDARY TO RENAL DISEASE
 HEPATIC CIRRHOSIS
 NON CARDIAC EDEMA
CHRONIC PULMONARY DISEASE
ASSOCIATED WITH PULMONARY HTN
 DYSPNOEA IS MOST COMMON SYMPTOM.
 ORTHOPNEA,PND RARE FEATURES
 ASCITIS,TENDER HEPATOMEGALY ,LOWER
  EXTREMITY EDEMA PRESENT
 DIFFERENTIATED FROM CARDIAC FAILURE BY
  ECHO-CARDIOGRAPHY
           *NORMAL LEFT VENTRICULAR FUNCTION
           *PULMONARY HYPERTENSION
 PULMONARY FUNCTION TEST
           *RESTRICTIVE PULMONARY DISEASE—TLC
           DECREASED
           *OBSTRUCTIVE PULMONARY DISEASE—FEV1/FEV
           DECREASED
PULMONARY EMBOLISM
 SMALL &MEDIUM SIZED PULMONARY
  THROMBOEMBOLISM
 PRESENT WITH DYSPNOEA & OTHER
  MANIFESTATIONS OF HEART FAILURE
 DIFFERENTIATED BY PRESENCE OF
  HEMOPTYSIS,PLEURITIC CHEST PAIN,RT
  VENTRICULAR LIFT &VENTILATION/PERFUSION
  MISMATCH
ACUTE RESPIRATORY DISTRESS
SYNDROME
 RAPID ONSET OF DYSPNOEA OCCUR
  FOLLOWING INITIATING EVENT
 LABOURED
  BREATHING,TACHYPNEA,INTERCOSTAL
  RETRACTIONS
 CXR:
     1.BILATERALLY DIFFUSE /PATCHY INFILTRATES
     SPARING COSTOPHRENIC ANGLES
     2.UPPER ZONE VENOUS ENGORGEMENT IS
     DISTINCTLY UNCOMMON
     3.HEART SIZE NORMAL
EDEMA SECONDARY TO RENAL
DISEASE
 EDEMA MOST COMMON IN PERIORBITAL AND
  SCROTAL REGIONS
 DIFFERENTIATED BY

   1.RENAL FUNCTION TESTS
          ELEVATED BLOOD UREA,SERUMCREATININE
HEPATIC CIRRHOSIS
  ENLARGEMENT OF LIVER & ASCITIS SIMILAR TO
   HEART FAILURE
  BUT DIFFERENTIATED
              1.BY NORMAL J.V.P
              2.ABSENCE OF POSITIVE
              HEPATOJUGULAR REFIEX
              3.ABSENCE OF TENDER HEPATOMEGALY
NON CARDIAC EDEMA
 VARICOSE VEINS
 GRAVITATIONAL EDEMA
               1.ABSENCE OF HEPATO JUGULAR REFLEX
               2.NORMAL J.V.P
INVESTIGATIONS
 AIM:TO KNOW

  1.UNDER LYING CAUSE
  2.FUNCTIONAL STATUS OF HEART (EJECTION
  FRACTION)
  3.DETECT ANY OTHER ABNORMALITY
                            Contd…
 1.ROUTINE LAB TESTING
 2.ELECTROCARDIOGRAM
 3.CXR
 4.ECHO-CARDIOGRAM
 5.BIOMARKERS
 6.EXCERSISE TESTING
 7.CARDIAC CATHERIZATION
ROUTINE LAB TESTING
 1.COMPLETE BLOOD COUNT
 2.PANEL OF ELECTROLYTES
 3.BLOOD UREA
 4.SERUM CREATININE
 5.HEPATIC ENZYMES
 IN SELECTED PATIENTS
                 1.FASTING BLOOD GLUCOSE
                 2.FASTING LIPID PANEL
                 3.TSH LEVEL
ELECTROCARDIOGRAM
 TO ASESS
             1.CARDIAC RHYTHM ABNORMALITYS
             2.LEFT VENTRICULAR HYPERTROPHY
             3.PRIOR MI
CHEST X-RAY
ECHO CARDIOGRAM
 TO ASSES SIZE & FUNCTION OF BOTH
  VENTRICLES(EJECTION FRACTION) AND ATRIA
 ALSO DETECTS
              1.VALVULAR ABNORMALITIES
              2.SEGMENTAL WALL MOTION
              ABNORMALITIES(MI)
              3.GENERALISED WALL MOTION
              ABNORMALITIES(CARDIOMYOPATHY)
              4.INTRA CARDIAC SHUNTS
BIOMARKERS
 ASSAY OF BNP,AMINO TERMINAL PROBNP
 ELEVATED IN PATIENTS WITH HEART FAILURE &
  CAN BE USED AS SCREENING TEST IN PATIENTS
  WITH BREATHLESNESS,AND EDEMA
 HELPFUL IN DIFFERETIATING FROM CARDIAC
  AND NON CARDIAC DYSPNOEA
STRESS TESTING
 IMPORTANT IN SUSPECTED CASES OF
  MYOCARDIAL ISCHEMIA
 ST -DEPRESSION IS NOTED IN THIS CASE
CARDIAC CATHETERIZATION
 LEFT HEART CATHERIZATION MAY HELPFUL TO
  DEFINE THE PRESENCE AND EXTENT OF
  CORONARY ARTERY DISEASE
 RADIONUCLEOTIDE ANGIOGRAPHY
     HELPFUL WHEN ECHO CARDIOGRAPHY IS
     TECHNICALLY SUB-OPTIMAL AS IN PTS WITH
     SEVERE PULMONARY DISEASE
     --MEASURES LEFT VENTRICULAR EJECTION
     FRACTION
     --ANALYSIS OF REGIONAL WALL MOTION
     ABNORMALITIES
THANK YOU

								
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