CVS History Z PDF

HISTORY AND TERMINOLOGY OF CARDIOVASCULAR SYSTEM Dr. Zaki Bettamer,MD [email protected]  Cardiovascular disease Disorders of heart rate, rhythm Diseases of the...

HISTORY AND TERMINOLOGY OF CARDIOVASCULAR SYSTEM Dr. Zaki Bettamer,MD [email protected]  Cardiovascular disease Disorders of heart rate, rhythm Diseases of the and conduction pericardium Coronary artery Diseases of the myocardium disease Diseases of the Vascular disease heart valves Congenital heart disease DISORDERS OF HEART RATE, RHYTHM AND CONDUCTION Atrial tachyarrhythmias ‘Supraventricular’ tachycardias Ventricular tachyarrhythmias Atrioventricular and bundle branch block CORONARY ARTERY DISEASE Stable angina Acute coronary syndrome STEMI NON STEMI UA VASCULAR DISEASE Peripheral arterial disease Diseases of the aorta Hypertension DISEASES OF THE HEART VALVES Rheumatic heart disease Mitral valve disease Aortic valve disease Tricuspid valve disease Pulmonary valve disease Infective endocarditis CONGENITAL HEART DISEASE Ventricular septal defect Atrial septal defect Patent ductus arteriosus Pulmonary stenosis Coarctation of aorta Aortic stenosis Tetralogy of Fallot Complete transposition of great arteries DISEASES OF THE MYOCARDIUM Myocarditis Cardiomyopathy Dilated cardiomyopathy Hypertrophic cardiomyopathy Restrictive cardiomyopathy Arrhythmogenic right ventricular Specific diseases of heart muscle Cardiac tumours DISEASES OF THE PERICARDIUM Acute pericarditis Pericardial effusion Tuberculous pericarditis Chronic constrictive pericarditis HISTORY OF CVS THE APPROACH TO CARDIAC DIAGNOSIS The cardiac history The cardiac physical exam Electrocardiogram Chest X-ray Echocardiography. Lab invx.  RULES 1. Patient should be allowed to tell his history in his own words. 2. Leading questions must be avoided unless the information can’t be obtained by other means  QUESTIONS 1. Complete inadequate description. 2. Fill in the gaps in the history not mentioned by patient. 3. Emphasize the important points.  PRESENT HISTORY This means detailed history of the patients present illness which must provide answer for the following questions: 1. Duration 2. Mode of onset (acute, sub acute, chronic). 3. Sequence of events: I. Course (progressive, regressive or recurrent). II. Appearance of new additional symptoms or disappearance of others. III. Treatment received during the course & response. 4. Analysis of each particular symptom.  PAST HISTORY Childhood diseases. Fever or joint pain ,Rheumatic fever Drug therapy. Operations. Prior illness (cardiac, noncardiac). Recent dental work ,IE Prior cardiac procedure  SOCIAL,FAMILY HISTORY Smoking. Physical efforts, Addiction. History of same illness History of sudden death Hereditary diseases  CORONARY ARTERY DISEASE RISK FACTORS Cigarette smoking. Age. Sex. Hypertension. Hyperlipidemia. Family history of CAD. Diabetes mellitus. SYMPTOMS OF CARDIAC DISORDERS A- Analysis of complaint B- Cardiovascular symptoms : 1-Symptoms of pulmonary venous Congestion. 2-Symptoms of systemic venous Congestion. 3- Symptoms of low Cardiac out put. 4-Chest pain. 5-Cyanosis & jaundice. 6-Palpitation. 7-Symptoms of Peripheral vascular disease. 8-Toxic symptoms 1. PULMONARY VENOUS CONGESTION Causes :- L V F. -M. S. Manifestations : - Dyspnoea - Orthopnoea - P.N. Dyspnoea - Cardiac asthma - Cough - Haemoptysis  SYMPTOMS DUE TO LUNG CONGESTION Dyspnea: sensation of breathlessness and pt reaction to it. pt using accessory muscle of respiration (SCM, Trapezius, scaleni, intercostal muscle) tachypnea: RR >20, normal respiratory rate 15-20 c/min at rest GRADES OF DYSPNOEA: Grade 1 : no breathlessness Grade 2 : Breathlessness on severe exertion. Grade 3 : Breathlessness on mild exertion. Grade 4 : Breathlessness at rest. (The New York Heart Association ) CARDIAC DYSPNEA Dyspnoea = Breathlessness =uncomfortable awareness of breathing. It is mainly due to reduced elastic properties of the lung (reduced pulmonary compliance). Dyspnea on effort is usually the 1 st symptom of pulmonary congestion. ORTHOPNEA Breathlessness that occurs when the patient lies flat. Dyspnea in a recumbent position. It is usually measured in number of pillows the patient must use to lie in bed (e.g., two-pillow orthopnea). Pathogenesis : 1-  Venous return,which in case of LVF, increase pulmonary congestion. 2- Recumbence cause abdominal contents to press up against diaphragm. PAROXYSMAL NOCTURNAL DYSPNEA ( PND ) Sudden onset of dyspnea occurring while reclining at night, usually related to the presence of congestive heart failure The patient wake up from sleep with severe breathlessness and cough with expectoration ,the attack usually lasts for 5 to 10 minutes by setting or getting up and inhalation of fresh air. Wheezing, due to bronchial endothelial edema is common (Cardiac asthma ) Pulmonary oedema: Dyspnoea become very marked,with prominent central cyanosis ,cough and expectoration of big amount of frothy sputum tinged with blood.  DYSPNEA ON EXERTION Dyspnea provoked by physical effort or exertion. It often is quantified in simple terms, such as the number of stairs or number of blocks that provoke the dyspnea, COUGH Dry ,or productive of frothy sputum ,occurs on exertion or lying flat , accompanied or preceded by dyspnoea. Haemptysis : -Blood tinged sputum : Pulmonary oedma. -Frank haemoptysis : M. S. Pulmonary embolism and infarction  2. SYMPTOMS DUE TO SYSTEMIC CONGESTION: Pain in the right hypochondrium.congested liver Dyspepsia. Swelling of lower limb,pedal edema or dependent edema,sacral edema Swelling of the abdomen, Ascites Oliguria.  SYMPTOMS DUE TO SYSTEMIC CONGESTION : Causes : R V F. Pericardial diseases. Manifestations : -Oedema of L.L (bilateral pitting ,start in dependent parts,always precedes ascites except in T.V or pericardial diseases (Ascites precox ) -Pain in Rt. Hypochondrium & epigastrium ( hepatic congestion.) -Anorexia & nausea ( G.I. T congestion. )  3. SYMPTOMS DUE TO LOW CARDIAC OUTPUT ( tissue hypoxia →brain, muscles, kidneys) Exertional fatigue. Dizziness / Syncope. Oliguria (