photo.jpg
Transcript
## Cardiology ### Differential diagnosis: 1. Acute Coronary Syndrome 2. Acute Aortic Regurgitation/Mitral Regurgitation: * Acute Aortic Regurgitation (due to Aortic dissection, ruptured sinus of valsalva, infective endocarditis) * Acute Mitral Regurgitation 3. Myocarditis 4. Bilateral Re...
## Cardiology ### Differential diagnosis: 1. Acute Coronary Syndrome 2. Acute Aortic Regurgitation/Mitral Regurgitation: * Acute Aortic Regurgitation (due to Aortic dissection, ruptured sinus of valsalva, infective endocarditis) * Acute Mitral Regurgitation 3. Myocarditis 4. Bilateral Renal Artery Stenosis -> Splash pulmonary edema 5. Takotsubo Cardiomyopathy ### INVESTIGATIONS #### Chest xray: * Not done in an emergency * Bat wing appearance: * Indicates cardiopulmonary edema * Cephalisation of pulmonary vessels: * Earliest finding * Associated with Kerley A/B/C lines | | LAP | Description | | :--------------------------- | :------------------------------------ | :-------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Kerley A lines | 12-19 mm of Hg | Dilated anastomotic channels between peripheral and central lymphatics | | Kerley B lines | 20-24 mm of Hg | Fluid in the interlobular septa. Short sharp lines horizontal and perpendicular to pleura and parallel to lung base. | | Kerley C lines | 20-24 mm of Hg | Reticular opacities. En face Kerley B lines | | LAP > 25 mm of Hg: Acute Pulmonary Edema | | | ### Acute pulmonary edema | Stable | No | Yes | | :---------- | :------------------------------------------------------- | :--------------------------------------------------------------------- | | No | Warm & Dry. Pulmonary Capillary Wedge Pressure (PCWP) normal. Cardiac Index (CI) normal | Warm & Wet. PCWP elevated. CI normal | | Low Perfusion at Rest | (compensated) | CI normal | | Yes | Cold & Dry. PCWP low/normal. CI decreased | Cold & Wet. PCWP elevated. CI decreased | | Hypovolemia | | Natriuretic peptides. Nesiritide. Vasodilators. Nitroprusside. Nitroglycerin | ### Pulmonary edema + cardiogenic shock Inotropic Drugs: Dobutamine, Milrinone, Calcium Sensitizers **Congestion at rest** Medicine v1.0. Marrow 8.0. 2024
