5-scheme by abdialasso

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									    In Capsule Series                                                            Cardiology

                        Cardiology scheme

Definition :       especially as regard to :
     Heart failure .
         Ischemic heart disease .
     Hypertension .
Etiology:         especially :
         Heart failure.
         Hypertension.
Clinical picture :       7 items
 i. Manifestations of LCOP :                 7 items
                  Caused by deficient blood supply to :
      1- CNS                       : dizziness , headache , syncope .
      2- CVS                       : ischemic heart disease .
      3- Kidney                    : oliguria .
      4- Skin                      : cold , peripheral cyanosis .
      5- Skeletal muscle           : fatigue ,intermittent claudication.
      6- Blood pressure            : low systolic blood pressure .
      7- Pulse                     : weak.

ii. Manifestations of Lung congestion :                ( in Left sided diseases ) 7 items
      1- Dyspnea .
      2- Exertional cough .
      3- Recurrent chest infections.
      4- Hemoptysis.
      5- Pleural effusion.
      6- Pulmonary edema .
      7- Bilateral basal crepitations.

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        In Capsule Series                                                   Cardiology


  iii. Manifestations of systemic congestion : (In right sided diseases) 7 items
            1- Insomnia.
            2- Sweating on slight activity.
            3- Congested neck vein.
            4- Edema lower limb , later on ascites.
            5- Liver : enlarged ,soft, tender.
            6- GIT : dyspepsia.
            7- Pleural effusion.

iv. chest pain :        Comment on the following points : 7 items
            1. Site ?
            2. Character ?
            3. Radiation ?
            4. Duration ?
            5. Precipitating factors ?
            6. Relieving factors ?
            7. Association ?

 v. Palpitation ( sensation of own heart beats )

vi. pressure manifestations :
    Resulting from compression e.g. : Left atrial enlargement, Pericardial effusion ,
   Aortic aneurysm.
    pressure symptoms are :
          Compression on trachea                                   cough & dyspnea.
          Compression on esophagus                                dysphagia.
          Compression on left recurrent laryngeal nerve  hoarseness of voice.

vii. Manifestations of embolization :         Sudden blindness, Hemiplegia …..


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       In Capsule Series                                                         Cardiology
 Investigations :            4 items
     1- X ray :
                     o Chamber enlargement .
                     o Pulmonary congestion in left sided diseases.
                     o Pleural effusion .
     2- ECG :
                     o Chamber enlargement .
                     o Detect the cause .
       you have to know ECG changes of the following diseases :          
               - angina                - MI               - dry pericarditis .
     3- Echo :
               o Chamber enlargement .
               o Detect the cause .
               o Paradoxical movement of the myocardium.
     4- Catheterization :
             o Chamber enlargement .
             o Detect the cause .
      But :
              In myocardial infarction          add : cardiac enzymes.
              In infective endocarditis  add : blood culture .
              In pulmonary embolism             add : pulmonary angiography
              In dissecting aorta               add : CT & MRI .

Treatment :
  1- Treatment of the cause.
  2- Treatment of precipitating factors :        e.g. hyperlipidemia :
       - statins : 20 - 80 mg/d         SE: myositis .
       - Fenofibrate : 300 mg/d                     - Omega 3 ( fish oil ) .
  3- Specific treatment : unfortunately it differs according to the disease !!!!
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