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In Capsule series Cardiology ______________________________________________________________________________

Cardiology scheme
Definition :
especially: Heart failure . Ischemic heart disease . Hypertension .

Etiology:

especially:

Heart failure. Hypertension. Valvular heart diseases .

Clinical picture :
i) Manifestations of LCOP :
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7 items

Caused by deficient blood supply to :


CNS : dizziness , headache , syncope . CVS : ischemic heart disease . Kidney : oliguria . Skin : cold , peripheral cyanosis . Skeletal muscle :fatigue ,intermittent claudication. Blood pressure : low systolic blood pressure . Pulse : weak. ( in Left sided diseases )

ii) Manifestations of Lung congestion : 7 items


1- Dyspnea .
2345Exertional cough . Recurrent chest infections. Hemoptysis. Pleural effusion.
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In Capsule series Cardiology ______________________________________________________________________________

6- Pulmonary edema . 7- Bilateral basal cripitation .

iii) Manifestations of systemic congestion : 7 items


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

chest pain :
7 items

The following questions are asked for any pain: 1- Site? 2- Character? 3- Radiation? 4- Duration? 5- ppt factors? 6- Relieving factors? 7-Association?

v) Palpitation ( sensation of own heart beats ) vi) pressure manifestations :


resulting from compression by : - Pericardial effusion - Aortic aneurysm. - Left atrial enlargement.

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In Capsule series Cardiology ______________________________________________________________________________

pressure symptoms are :


Compression on trachea cough Compression on esophagus dysphagia Compression on left recurrent laryngeal nerve hoarseness of voice.

vii) clinical picture of the cause .

Investigations :
1- X ray :

4 items

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 In Infective endocarditis In Pulmonary embolism In Dissecting aorta : : : : add :cardiac enzymes. add : blood culture . add : pulmonary angiography add : CT & MRI .

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In Capsule series Cardiology ______________________________________________________________________________

Treatment :
1- treatment of the cause 2- treatment of precipitating factors : eg. 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 differs disease !!!!

We think so because all other people think so,or because we were told to think so,and think we must think so

Rudyard Kipling

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