File - COFFEE BREAK CORNER

 Lung congestive symptoms 1.
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Low cardiac output symptoms 1.
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Systemic congestive symptoms 1.
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Others 1.
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Dyspnea Paroxysmal nocturnal dyspnea Orthopnea Acute pulmonary edema Congestive cough Recurrent winter bronchitis Hemoptysis Cheyne Stokes respiration Exertional fatigue Dizziness and giddiness Fainting and syncope Anginal pain Oliguria if acute Pain right upper abdomen due to hepatic congestion GIT Congestion causing anorexia nausea, vomiting and dyspepsia CNS congestion causing confusion, headache, insomnia, lack of memory and encephalopathy Edema LL Ascites Chest pain Palpitation Pressure symptoms Cyanosis , jaundice Peripheral vascular disease Systemic embolization Toxic: fever, sweating, weight loss Definition Cardiac cause Sudden onset Rapidly progressive Paroxysmal course Regressive course Precipitation factor (exertion) Type Severity (NYHA) Associated symptoms Related to posture Dyspnea Abnormally uncomfortable awareness of breathing or subjective sensation of difficult breathing 1. All causes of pulmonary congestion 3. Cyanotic congenital heart disease o LVF o Teratology Fallot o MS 2. All causes of low cardiac output 4. Pulmonary embolism and pulmonary infarction o RVF 1. Acute pulmonary embolism 6. Acute pulmonary edema cardiogenic/or non 2. Pneumothorax cardiogenic 3. Acute bronchial asthma 7. Hemothorax 4. Foreign body inhalation 8. Psychogenic 5. Laryngeal edema Over months: CHF Over years: Chronic lung disease •
PND •
LA Myxoma •
Bronchial asthma •
Ball Valve thrombus •
IHD •
Some paroxysmal arrhythmia •
With diuretics à HF •
With surgical valve procedureà valve disease •
With blood transfusion à anemia •
With anti – ischemic drugs à angina equivalent (IHD) 1. CHD à LSHF 2. Hypoxic heart diseaseà cyanotic congenital heart disease 3. Angina equivalent (IHD) 4. Anemia 5. Thyrotoxicosis 6. Psychological à mental stress Inspiratory dyspnea à cardiac & upper airway obstruction Expiratory dyspnea à lower airway obstruction Grade 1 à SOB with > ordinary effort Grade 2 à SOB with ordinary effort Grade 3 à SOB with < ordinary effort Grade 4 à SOB at rest but increase by exertion Cardiac symptoms àchest pain palpitation, systemic congestion symptoms Chest symptoms à hemoptysis, wheezes, expectoration Orthopnea à indicates advanced LSHF Paroxysmal nocturnal dyspnea •
Pulmonary congestion {MS, LVF} •
Pulmonary congestion {MS, LVF} •
Massive pericardial effusion Cough & Hemoptysis CVS cause 1.
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Duration If more longer than dyspnea à chest disease If less duration than dyspnea àcardiac disease Dry à it can be from any causes Expectoration à if cardiac with whitish/frothy sputum and increased with pulmonary congestion Cough increase on lying flat à LSHF LSHF Types Relation to posture Precipitate by exertion Time Correlate with hemoptysis DDx Pulmonary edema Pulmonary congestion Pulmonary infarction CVS drugsà ACEI 5.
Compression and irritation of the bronchial tree by o Aortic aneurysm o Pericardial effusion o Dilated left atrium More coughing during night sleep àLSHF More coughing during morning à bronchitis, suppurative lung disease 1. LSHF à MS 2. Pulmonary edema 3. Pulmonary infarction 4. Rupture of aortic aneurysm in the bronchial tree 5. Severe pulmonary hypertension àeg Eisenmenger’s syndrome Cough due to heart disease Cough due to infection o Whitish mucoid/ frothy expectoration o Purulent sputum o Increase with pulmonary congestion Definition Etiology Cause of generalized edema by mechanism Onset Course Precipitating factor Relieving factor Associated with pain Associated with fever Related to drug intake Duration Lying down, therapy, salt restriction 1. DVT 2. Cellulitis 3. Traumatic More in inflammatory conditions Corticosteroids, NSAIDS, contraceptives o
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Edema Lower Limb Accumulation of fluids in interstitial tissues of lower limbs Localized (unilateral) Generalized (bilateral) o Venous obstruction o Cardiac 1. DVT o Hepatic 2. Varicose veins o Renal 3. Phlebitis o Nutritional o Idiopathic cyclic edema in females o Lymphatic obstruction 1. Filariasis 2. LN dissection or irradiation o Inflammatory edema as cellulitis o Allergic 1. Angioedema 2. Insect bite o Traumatic 1. HF Increase in capillary pressure 2. Constrictive pericarditis 3. Venous obstruction and varicose veins 1. Nutritional edema Decrease oncotic of plasma protein 2. Nephrotic syndrome in hypoproteinemia 3. Liver cirrhosis and failure 1. Angioneurotic edema Increase in capillary permeability 2. Edema of infections, trauma, stings, bites, burns 1. After repeated inflammation Diminished lymphatic drainage 2. Filariasis 1. Acute nephritis Salt and water retention and 2. HF increased in blood volume 3. Liver cirrhosis 4. Ingestion of liquorice Drugs 1. Nifedipine 2. Amlodipine o Commonly gradual o Acute onset in inflammatory condition (cellulitis) o Commonly progressive o Come and go à angioedema, bitting of insects Salt intake & long standing If edema comes first before ascites à in case of heart failure If edema comes late after ascites à liver failure, ascites precox {tricuspid valve disease, constrictive pericarditis} If edema comes after eyelid puffiness à in case of renal disease Systemic congestion symptoms Insomnia (due to brain congestion) Dyspepsia (due to stomach congestion) Constipation (due to intestinal congestion) Pain in the right hypochondrium (due to liver congestion à distended capsule) Ascites Edema lower limb Oliguria (due to renal congestion) Sweating on slight activity Definition Causes of cardiac syncope Related to drugs intake Position when syncope happen Premomentary symptoms Associated symptoms Injury during syncope Syncope Transient loss of consciousness due to temporary cerebral ischemia 1. Resistance to the blood flow à LVOT { AS or HCM} 2. Ball and valve embolus, left atrial myxoma 3. Adam – stokcs 4. Severe bradycardia/ tachycardia à Arrhythmia 5. Acute diminution of venous return o Hemorrhage o Extensive burns o Extensive peripheral vasodilatation Arrhythmias Obstruction Situational • Ventricular • Aortic / pulmonary • Neurocardiogenic tachycardia stenosis (vasovagal) • Rapid supraventricular • HCOM tachycardia • Fallot’s tetralogy • Sinus arrest • Pulmonary hypertension • AV block • Artificial pacemaker • Pulmonary embolism failure • Atrial myxoma • Atrial thrombus • Defective prosthetic valve Anti – hypertensive o Diuretics o Beta blocker Cardiac àsupine Neurological à standing Epilepsy o Flashes of light o Flushing of face 1. Pallor 3. Cold extremities 2. Sweating 4. Palpitation At head à mostly cardiac due to fall down Tongue bitting, rib fracture à due to epilepsy 1.
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Low cardiac output symptoms Syncope Dizziness, giddiness Exertional blurring of vision Angina Oliguria (only in acute low COP only) Intermittent claudication Exertional fatigue •
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Fatigue Fatigue is due to poor cerebral and peripheral perfusion and poor oxygenation When severe cardiac disorders are not present, an active infection such as Infective endocarditis may be responsible. Drugs prescribed for angina or hypertension, particularly B – blocker may cause fatigue Causes 1.
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Palpitation Increased force of cardiac contraction in 3.
case of hyperdynamic circulation and volume overload of the left ventricle •
Aortic regurgitation •
Patent ductus •
Thyrotoxicosis 4.
Increased rate of cardiac action (tachycardia) Change in heart rate Change in rhythm Change in force DDx palpitation Sinus tachycardia Paroxysmal tachycardia Rhythm Rate Regular Rapid Regular Very rapid Brady arrhythmia Atrial fibrillation Regular Slow but pounding Any Extra systole 5.
Markedly irregular Occasionally dropped beats Any Irregular cardiac action in all forms of •
Extrasystole •
Dropped beats •
Irregular tachycardia •
Irregular bradycardia Anxiety, emotions, exercise in unaccustomed person, and neurocirculatory asthenia Some drugs •
Ephedrine •
Salbutamol •
Nitrates •
Nifedipine Tachyarrhythmia •
Sinus tachycardia •
Paroxysmal tachycardia Bradyarrhythmia •
Sinus bradycardia •
Junctional rhythm •
Complete heart block 1. Atrial fibrillation 2. Extra systole 3. Sinus arrhythmia 4. Second degree heart block 1. Causes of ventricular hypertrophy 2. Causes of ventricular dilatation •
Causes of volume overload •
Causes of hyperdynamic circulation Onset & ↑ Factor ↓ Factors offset Gradual Exertion Emotional stress B blocker Anti Sudden Spontaneous arhythmic drugs Any Spontaneous Sleep Exertion Emotional stress B blocker CCB Digitalis Associated symptoms Course Polyuria Syncope Profuse sweating Dizziness Paroxysmal Paroxysmal Chest pain Occasional Pressure symptoms (Mediastinal syndrome) Fever Symptoms of systemic hypertension Symptoms of embolization Constitutional symptoms Symptoms of peripheral vascular disease •
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Other symptoms What press Left atrial enlargement Pericardial effusion Cardiomegaly Aortic aneurysm •
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What has been pressed? Esophagus à dysphagia Left recurrent laryngeal nerve à hoarseness of voice Trachea à cough and dyspnea Spines à backache Cardiac causes of fever 1. Rheumatic fever à ask about painful red joint swelling / recurrent tonsillitis/ long acting penicillin 2. Infective endocarditis à ask about minor operations 3. Myocardial infarction à ask about chest pain of pericarditis 4. DVT à ask about lower limb painful swelling 5. Streptococcal nephritis à ask about loin pain and dysuria •
Headache (occipital, in the morning) •
Flushing •
Tinnitus •
Palpitation •
Epistaxis •
History of treatment (anti – HTN/ SE of drugs causing HTN) •
Blurring of vision 1. Sudden hemiplegia à cerebral artery occluded 2. Sudden blindness à central retinal artery occluded 3. Sudden aphasia 4. Painless hematuria à renal artery occluded 5. Acute abdomen àsuperior mesenteric artery occluded 6. Sudden onset of coldness of one limb •
Fever •
Prostration •
Bony aches •
Chills •
Malaise •
Sweating •
Cold extremities •
Leg ulcer •
Cyanosed extremities •
Claudication •
DVT Chest pain Cardiac pain Causes /due to Site Onset Character Contionous, dull Radiation Associated symptoms Jaw, epigastrium, both shoulder and left arm 1. Dyspnea 2. Fatigue 3. Palpitation 4. Dizziness Timing / duration Exercabation factor Relieving factor 3 – 5 mins up to 20 mins 1.
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Ischemia of the heart muscle 1. Angina 2. Coronary insufficiency 3. MI Retrosternal Acute Exertion Emotional stress 3. Heavy meal 4. Cigarette smoking 5. Cold weather Rest Stop the precipitating factor Sublingual nitrates Pericarditis Pericardial effusion Myocardial infarction Angina Mitral valve prolapse Pericarditis Dissecting aortic aneurysm Retrosternal Retosternal Sudden (acute) Sharp Stabbing Throbbing Stabbing Left Back shoulder Fever Pulmonary embolism Cardiac neurosis Mitral valve prolapse Retrosternal Sudden (acute) Infra mammary Pricking Stabbing Aching Apex of left scapula Other signs of psychotic manifestations •
Throatling sensation •
Excessive sweating in palm with cold hand •
Irritability or depression •
Palpitation •
Throbbing headache Seconds or hours Prolonged Stitching Respiration Movement Lying flat Not precipitated by exertion Leaning forward Not relieved by rest Cardiac causes of chest pain 6. Pulmonary embolism 7. Aortic aneurysm 8. Huge heart 9. Cardiac neurosis