Y1 CVS and Respiratory PDF

Y1 CVS and Respiratory Dr Usman Adam Consultant Acute Internal Medicine, General Medicine Royal Blackburn Hospital ILOs CVS Myocardial infarction, Atherosclerosis (this is a direct LO in Y2 though), Aortic dissection (not the types) Pericardial Effusion C...

Y1 CVS and Respiratory Dr Usman Adam Consultant Acute Internal Medicine, General Medicine Royal Blackburn Hospital ILOs CVS Myocardial infarction, Atherosclerosis (this is a direct LO in Y2 though), Aortic dissection (not the types) Pericardial Effusion Cardiac tamponade Hypertension Pericarditis. Barry 55y male Plumber Ex semi-professional football player for Blackburn Rovers Smokes a pipe Drinks socially when out with ‘his mates’ Presenting complaint Chest pain  History Presenting What do you want to know? Complaint On Examination Chest clear Tender over his chest wall to palpation HS normal Abdomen SNT No pedal oedema Right leg looks more swollen than left – Barry says following football accident 30 years ago. Has a metal plate in his foot. What now? ECG Bloods 6 hours Bloods 6 hours later Troponin Protein found in cardiac and skeletal muscle Mostly entwined in muscle fibre Involved in muscle contraction in response to calcium concentrations Released following cardiac injury TSH Differential Diagnosis ACS Aortic Dissection PE Myocarditis ACS ACS treatment: DAPT, Fondaparinux ACE inhibitor Beta blocker Statin Any you wouldn’t give Patient bradycardic Right coronary artery occlusion Echocardiogram Normal heart vs LV failure https://www.youtube.com/watch?v=qko6FON_jO8 11mins Discharged Follow up with cardiology Represents 2 days later SOB Can’t lie flat Legs are swelling Bloods Diagnosis? New MI? HAP (hospital acquired pneumonia)? Aspiration pneumonia? Covid? Pulmonary oedema secondary to fast AF. Background heart failure Whats triggered the fast AF Management Furosemide acutely Uptitrate beta blocker (maybe digoxin) ACE inhibitor K sparing diuretic CRT Outcome Discharged Community heart failure team Fluid restriction Cardiac rehab  Readmitted 2 years later Haematemesis Black stool Is this a MI? And if so how will you manage it? Reverse the cause Stop the bleeding Respiratory Respiratory diagnoses so far? Asthma COPD pulmonary embolus lung cancer (not a lot) Pneumothorax pneumonia Lobes and Fissures Basic Anatomy of The Reparatory Tract Asthma: What is it? Chronic inflammatory airway disease characterised by reversible airway obstruction, airway hyper-responsiveness and bronchial inflammation. Three factors contribute to reversible airway narrowing: 1. Bronchial smooth muscle contraction triggered by a variety of stimuli 2. Mucosal swelling/inflammation caused by mast cell and basophil degranulation- release of inflammatory mediators 3. Increased mucus production  Factors increasing the probability of asthma Factors decreasing the probability of asthma Personal history of atopic disorder Symptoms occurring with colds only FH of asthma/ atopic disorder History of moist cough Widespread wheeze on auscultation Repeated normal physical examination of chest when symptomatic Improvement of symptoms or lung function in response to adequate therapy Normal PEFR when symptomatic No response to asthma therapy More than one of the following symptoms: Symptoms of: Chest tightness Light headedness/ Peripheral cough Difficulty dizziness tingling breathing wheeze Clinical features suggestive of alternative diagnosis Particularly if these are frequent and recurrent or can be exacerbated by: night and early pets morning emotions/laughter cold/damp air exercise  yes Continue Tx and find max effective High Trial of asthma Tx dose probability Response no Assess compliance, inhaler technique. Consider further tests/ referral Clincal assessment Intermediate FEV1/FVC 0.7 Further Investigation Consider referral Investigate/ Treat no Low probability Consider other condition Response referral yes Continue Tx Severe asthma Unable to complete sentences in 1 breath RR >25 HR >110 (cautious interpretation) Peak flow