cvs disease
TRANSCRIPT
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In The Name Of ALLAH,The Most Beneficent,
The Most Gracious,The Most Merciful !
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CARDIOVASCULAR SYSTEM
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PRESENTED BY:
Prof. Muhammad ZafarM.B;B.S., M.PHIL., PH.D
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SYMPTOMS OF CVS DISEASES
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Following are the main symptoms of CVS disea
1.Chest pain (discomfort)
2.Breathlessness (Difficulty in Breathing)3.Palpitation
4.Syncopial attacks (Syncope)
5.Peripheral oedema
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1. Chest pain / discomfort this
occurs due to angina, myocardial
infarction, pericarditis and rarely
aortic dissecting aneurysm. Cardiacpain is retrosternal, pressure like
i.e. squeezing and radiates to left
shoulder and arm (may be in jaws
or upper abdomen).
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Continue..
It is of shorter duration in case ofangina and prolonged (more than
half hour) in cases of myocardial
infarction. Pain is relieved by rest
(occurs with exertion) and taking
sublingual nitroglycerine tablet
shows anginal pain. Pericarditis
pain is central. It is increased withinspiration and changes with
posture and disappears with
NSAID.
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PAIN
1.Site2.localized or diffuse?
3.Radiate
4.Character (Burning, stabbing, crushing,
gripping, pricking, dull, colicky)5.Intensity (mild, moderate, severe)
6.Factors which aggravate?
7.Factors which relieve?8.Is pain associated with some other
symptoms?
9.Relationship of posture with pain
10.Pain continuous or intermittent?
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2. BREATHLESSNESS (Dyspnoea)
Following should be asked:
1.What are the circumstances under which
attack of dyspnoea occurs i.e. after
exercise and exertion or in lying on bed(orthopnoea)? If dyspnoea occurs after
exertion, what is the grade of exertion i.e.
severe, moderate or mild.2.Does dyspnoea appear suddenly
(pulmonary oedema, asthma) or gradually
(advance chest or heart disease)?
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BREATHLESSNESS continue
3.What is the character of breathing? Is it
rapid, wheezing or labored?
4.What is the degree of distress? Does the
patient collapse while having the attack of
dyspnoea (dyspnoea syncope).
5.Is the patient free from symptoms inbetween the attacks (Asthma)?
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In paroxsmal nocturnal dyspnoea, patient is
comfortable lying down to sleep but is
woken later with acute, severe,breathlessness which is relieved by sitting
up.
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3. Palpitation awareness of heartbeat islabeled as palpitation. During emotional
upset or after exercise it is a common
physiological phenomenon. Palpitation may
occur due to abnormal cardiac rhythm i.e.
extra systole or tachycardias. Atrial
fibrillation,supraventricular tachycaedia
(SVT) are common causes. Few patientsmay complain of dropped or missed beats.
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Palpitation: (continued)
Ask about:
1. The mode of onset and termination
2. Specific triggers of exercise, alcohol,caffeine
3. Frequency
4. Duration of attacks5. Rhythm
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4. Syncope (dizziness or loss ofconsciousness) this occurs due to abrupt
cerebral hypo function as a result of
transient hypotension (postural
hypotension). Cardiac causes are
arrhythmia, bradycardia, and aortic stenosis.
Other non-cardiac causes include stroke,
epilepsy and vosovagal syncope.
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5. Peripheral oedema pitting oedema of
lower limbs is cardinal feature of CCF. This
can occur in cases of Hypoproteinemia,and kidney disease.
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SIGNIFICANCE OF HISTORY TAKING
FROM A CVS PATIENT
THE HISTORY:
The history is as important as clinical
examination in the evaluation of the patientwith cardiac disease. Indeed the most
common cause of cardiac symptoms,
coronary heart disease, commonly occurswithout abnormal physical findings.
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PRESENTING COMPLAINT
Establish the frequency, duration and
severity of symptoms and causative and
relieving factors.
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FUNCTIONAL IMPAIRMENT
Assess the impact of symptoms of exertional
chest pain or breathlessness on the patients
functional capacity.
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PAST HISTORY
Rheumatic feverHeart murmurs during childhood
Specifically enquire about conditions associated
with cardiac disease, including:Diabetes mellitus
Glomerulonephritis and hypertensive heart
disease
Thyrotoxicosis and atrial fibrillationAmyloidosis and cardiomyopathy
In cases of suspected infective endocarditis
ask about recent dental work
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DRUG HISTORY
Thyroxine may precipitate or aggravate angina.
Non-steroidal anti-inflammatory drugs
Herbal remedies
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Genetically determined cardiovascular disorders
Single-gene defects Polygenic inheritance
Hypertrophic
cardiomyopathy
Ischaemic heart disease
Marfans syndrome Hypertension
Familial
hypercholesterolaemia
Type 2 diabetes mellitus
Muscular dystrophies Hyperlipidaemia
Long Q-T syndrome
FAMILY HISTORY
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SOCIAL HISTORY
Smoking
Consumption of alcohol
Caffeine consumption
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OCCUPATIONAL HISTORY
3.15 Occupational aspects of cardiovascular disease
Occupational exposure associated with cardiovascular disease
Organic solvents Arrhythmias
cardiomyopathy
Vibrating machine tools Raynauds phenomenon
Publicans Alcoholic cardiomyopathyOccupational exposure exacerbating pre-existing cardiac conditions
Cold exposure Angina
Raynauds diesase
Deep-sea diving Embolism through foramen ovale
Occupational requirements for high standards of cardiovascular fitness
Pilots
Public transport / heavy goods vehicle drivers
Armed forces
police
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THANK YOU