Behçet's Disease

-It causes orogenital ulceration / Colchicine and steroids is used in the management / Arthritis is a feature, Superior vena cava obstruction may occur, Iritis,Thrombophlebitis,Neurological complications may occur,Genital ulceration,

Erythema nodosum / (HLA-B5,B1) An association with the GIMAP (GIMAP1, GIMAP2 and GIMAP4)‏ / Causes (auto-inflammation of the blood vessels)

+Vitiligo is associated with :

.Addison's disease

.Pernicious anemia

.Diabetes mellitus

.Thyrotoxicosis

Cadriology

**Coronary Artery Disease (atherosclerotic heart disease)

-Is a group of diseases that includes (Ischemic heart disease) :

.stable angina

.acute coronary syndromes (unstable angina,myocardial infarction,ST-segment elevation,non ST-segment elevation)

-Risk factors :

.smoking

.hypercolesterolemia (LDL)

.hypertension

.hyperglycemia

.lack of exercise

.stress

.alcohol

.obesity

.men over 60 ; women over 65 (M > F)

Angina

1.Stable Angina

-Classic type of angina related to myocardial ischemia.

-A typical presentation of stable angina is that of chest discomfort and associated symptoms precipitated by some activity (running, walking, etc.)

-With minimal or non-existent symptoms at rest or after administration of sublingual nitroglycerin

2.Unstable Angina

-It occurs at rest (or with minimal exertion), usually lasting 3–5 minutes

-It is severe and of new onset (i.e., within the prior 4–6 weeks)

-It occurs with a crescendo pattern (distinctly more severe, prolonged, or frequent than before)

.Is sometimes referref to as ‘preinfarction’ angina

-Diagnosis :

.ECG

.exercise stress test (best test)

-Treatment :

.Propranolol

.nitroglycerin (sublingual)

.beta-blockers and calcium channel blockers (act to decrease the heart`s workload)

.statins

.baby aspirin (100mg)

*NSTEMI (non ST-segment elevation MI) (heart attack)

-Is more severe than UA

-Is considerd to have occurred if ischemia produces damage detectable by biochemical markers of myocardial inhury (troponin or CK-MB) / If there are no detectable serum markers of myocardial injury 12-18hrs after symptoms onset,the Pt should be diagnosed with UA

-Patients with NSTEMI have a :

.normal physical examination

.abnormal ECG

.particulary dynamic ST-segment deviation

.T-wave inversion

-Symptoms & Signs :

.chest pain

.difficulty in breathing

.nausea,vomiting and sweating

.palpitation

.cardiogenic shock

-Risk factors :

.high serum cholesterol level

.elevated low density lipoprotein level (LDL)

.hypertension

.DM

.smoking

.male gender

.obesity

.increaseing age

.family history

.excess alcohol and carbohydrates intake

.stressful life-style

-Diagnosis :

1.ECG

.The usual ECG findings of NSTEMI are ST-segment depression or T-wave inversion

2.CARDIAC MARKERS

.Cardiospecific isoenzyme CK-MB (creatine kinase myocardial band) (starts to rise at 4-6 hours and falls to normal within 48-72 hours)

.Cardiospecific proteins troponin T and troponin I are rises in blood in NSTEMI (Troponin T and troponin I start to rise at 4-6 hours and remain high for up to two weeks)

3.FULL BLOOD COUNT

.WBC / ESR / CRP (c-reactive protein) are elevated

4.CHEST X-ray

.Signs of lung edema

5.ECHO

-Complications :

.Heart arrhythmia(commonest cause of death in the 1^st hr)

.Acute & Chronic heart failure

.Cardiogenic shock

.Mitral regurgitation

.Dressler’s syndrome

-Treatment :

.anteplatelet rherapy (baby aspirin)

.antithrombin therapy (heparin)

.glycoprotein (GP) Iib/IIIA inhibitors

.bet-blocker

.intravenous nitroglycerin (NTG) for refractory pain

*STEMI (ST-segment elevation MI)

-Symptoms & Signs :

.chest pain

.pain radiates most often to the left arm,but may also radiate to the lower jaw,neck

.nausea,vomiting and sweating

.shortness of breath

+Silent MI is more common in the elderly in patients with DM

-Diagnosis :

.ECG

.cardiac enzymes

-Treatment :

.oxygen

.baby aspirin

.nitroglycin

.heparin

.catheterization and tesnt

+Lipids (LDL,HDL,Triglyceride(TG),Cholestrol)

-Complications :

.Heart arrhythmia

.Acute & Chronic heart failure

.Cardiogenic shock

.pericarditis

.myocardial rupture

.papillary muscle rupture.

+Cardia Enzymes :

.troponin I (most specific -1^st)

.CK-MB (2^nd)

.AST

.LDH (lactate dehydrogenase)

+Causes false positive troponin :

.Septic shock

.Pulmonary embolism

.Pulmonary edema

.Renal failure

+Causes increased in troponin :

.Pulmonary edema

.MI

.Congestive heart failure

.Myocarditis

+Stable Angina +MI

-after excessive or stress -at rest

-cardiac enzyme (-) -cardiac enzyme (+)

-ECG (non-specific changes) -ST-elevation

-5-15minutes - >20minutes

-releived by nitroglycin -not releived by nitroglycin

-no nausea,no vomiting, -may be associated with nausea,vomiting,

No sweating sweating

+Regarding chest pain of myocardial infarction :

.Duration more than 30 minutes

.Associated with nausea

.Relieved with sublingual nitrate

.Left shoulder radiation

+Complications of myocardial infarction :

.Rupture chorda tendeni

.Mitral regurgitation

.DVT

.Pericarditis

.Atrial fibrillation

.Heart failure

.Systemic embolization

.Papillary muscle rupture

.Myocardial ruptured (at 1sr week)

Arrhythmias

-Is a group of conditions in which the heartbeat is irregular, too fast, or too slow

-A heartbeat that is too fast - above 100 beats per minute in adults - is called tachycardia

-A heartbeat that is too slow - below 60 beats per minute - is called bradycardi

-Symptoms :

.palpitations or feeling a pause between heartbeats

.lightheadedness

.shortness of breath

.chest pain

-Complications :

.stroke

.heart failure

.cardiac arrest

.sudden cardiac death

-Types :

.extra beats

.supraventricular tachycardias

.ventricular arrhythmias

.bradyarrhythmias

-Treatment :

.beta blockers or agents that attempt to restore a normal heart rhythm such as procainamide

.Amiodarone IV

.Diltiazem IV

+Antiarrhythmics drugs:

.Xylocaine

.Quinidine

.Amiodarone

.Procainamide

+Causes of MI without ACS :

.protein C deficiency

.polycythemia vera

.thrombocytosis

.coronary spasm

.coronary artery embolus

.SLE

.polyarteritis nodus

.kawasaki

+Causes of sinus tachycardia :

.Fever

.Pregnancy

.Anemia

.Cardiac failure

.Myxedema

.Atenolol

.Raised intracranial pressure

.Jaundice

+Causes of bradychardia :

.Digoxin

.Obstructive jaundice

.Hypothyroidism

.Heart block

Heart Failure

-Occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body's needs

-Symptoms :

.shortness of breath

.excessive tiredness

.leg swelling

.hear failure symptoms are divided into "left" and "right" sided :

1.Left sided herat failure

- M.C is pulmonary edema

.increased rate of breathing (respiratory distress)

.rales or crackles, heard initially in the lung bases

.pulmonary edema

.cyanos (hypoxemia)

.laterally displaced apex beat (which occurs if the heart is enlarged)

.gallop rhythm (additional heart sounds -third heart sound-triple rhythm)

.heart murmurs

.dyspnea

.orthopnea

.fatigability

.wheezing

.dizziness

.confusion

.cool extremities at rest

.pulsus alternans

.bilateral basal crepitations

.kerley B lines on chest X-ray

2.Right sided heart failure

.peripheral edema

.ascites

.hepatomegaly

.jugular venous pressure

.coagulopathy

-Causes :

.ischaemic heart disease (M.C.C)

.dilated cardiomyopathy

.calcular heart disease

.hypertension

.anemia

.Paget's disease

.arteriovenous malformations

.inflammation of the muscular layer of the heart

.SLE

.hyperthyroidism

.MI

.pneumonia

.NSAIDs and thiazolidinediones

-Diagnosis :

.Echo

-Treatment :

.angiotensin-converting enzyme (ACE)inhibition

+ACE (enalapril,captopril,lisinopril,ramipril)

.angiotensin reveptor blocker

.beta-blockers (metaprolo,bisoprol,carvidolol)

.digoxin (digitalis)

+Side effects of digoxin therapy :

.Nausea and vomiting

.Yellow vision

.AV block

.Ventricular extrasystole

+Side effects of ACE-inhibitors :

.Angioneurotic edema

.Hyperkalemia

.Dry cough

.Hypotension

+Indications for the use of Beta-blockers include :

.Angina

.Hypertension

.After myocardial infarction

.Congestive heart failure

.Ischemic heart disease

.Migraine

.Anxiety

+Crepitations which are late inspiratory and unchanged with cough are typical of Pulmonary edema

Hypertension

-Normal Bp at rest is within the range of 100-140mmHg systolic / 60-90mmHg diastolic

-Types :

.primary haypertension (90-95% of cases)

.secondary haypertension (5-10% of cases)

-HTN is rerely accompanied by any symptoms

-Secondary (renovascular hypertension,fibromuscular dysplasia,atheromatous stenosis)

-HTN secondary to renal disorders :

.CRF

.glomerulonephrites

-HTN secondary to endocrine disorders :

.pheochromocytoma

.hyperaldosteronism

.cushing`s syndrome

.hypertension

.hyperparathyroidism

.acromegaly

.hyperthyroidism

.hypothyroidism

.acromegaly

.conn`s syndrome

-HTN secondary to other :

.pregnancy

.drugs

.liquorice

.coarctation of aorta

-Complications :

.left ventricular hypertrophy

.hypertensive cardiomyopathy

.MI

.hypertensive encephalopathy

.stroke

.hypertensive retinopathy

.hypertensive nephropathy

-Treatment :

.diuretics

.beta-blockers (atenolo,metoprolol,propranolol) (post MI)

.mixed (alpha+beta-blocke ‘labetalol’) (pregnancy)

.alpha-blockers (tamsulosin,doxazosin,alfuzosin) (pregnancy)

.ACE inhibitors (for heart failure)

.losartan,valsartan

Date: 2016-04-22; view: 418