1 / 28

SYMPTOM - ANALYSIS

07/10/2K8. SYMPTOM - ANALYSIS. DR.V.DAYASAGAR RAO DM, FRCP (Ed), FRCP (CAN) KIMS HYDERABAD, A.P. Symptom Analysis. Presence : Severity : Type of Disease : Exertional Syncope  Obstructive Lesions Angina  CAD Valvular Heart Disease Edema  Heart Failure Cyanosis.

studs
Télécharger la présentation

SYMPTOM - ANALYSIS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 07/10/2K8 SYMPTOM - ANALYSIS DR.V.DAYASAGAR RAO DM, FRCP (Ed), FRCP (CAN) KIMS HYDERABAD, A.P

  2. Symptom Analysis • Presence : • Severity : • Type of Disease : • Exertional Syncope  • Obstructive Lesions • Angina  • CAD • Valvular Heart Disease • Edema  • Heart Failure • Cyanosis

  3. Symptom Analysis • Therapeutic Options: • ACC /AHA : Class III / IV Symptoms, Valvular Heart Diseases C A D (Class I Recommendations) • Effectiveness of Therapy: • Symptoms Relief • Prognosis: • AS : Angina / LVF / Syncope • Heart Failure • CAD : Rest Angina

  4. Symptom Analysis - Severity • NYHA Classification: I - IV • SUBJECTIVE • POOR REPRODUCIBILITY • SPECIFIC Activity Scale: • WORK LOAD : METS • OBJECTIVE : Tread Mill / Bicycle • Daily Activity : Work Load ( mets) • 6 Minute WALK Test: • C H F • P A H

  5. Symptom Analysis • DAILY ACTIVITYWORK LOAD # Dressing (without Stopping) : 2 Mets # Light Domestic Work : 2.5 (Broome, Bringing Grocery Bags) # Descending Steps ( non Stop) : 3 Mets # More Heavy Work : House : 3.25 (Making Bed, Washing, Veg Cutting) # Gardening : 4 - 5 # Fast Walking : 5 # Climbing Steps (With Luggage) : 6 - 7

  6. DYSPNEA • AWARENESS – BREATHING ABNORMAL UNCOMFORTABLE • “SHORTNESS OF BREATH” • SUBJECTIVE MANIFESTATION LEVEL OF ACTIVITY

  7. DYSPNEA GRADING OF SEVERITY : A T S Class I : UNUSUAL PHYSICAL EFFORT II : ORDINARY ACTIVITY III : LESS THAN ORDINARY IV : AT REST

  8. DYSPNEA • PULMONARY VENOUS HYPERTENSION Interstial Fluid  Lung Parenchyma LUNG : RIGID / LESS COMPLIANT INCREASES EFFORT  Respiratory Muscles • “REFLEXES” initiated vascular distension contributes – SENSATION of DYSPNEA SHALLOW & RAPID BREATHING

  9. DYSPNEA • BRONCHIAL VASCULAR SYSTEM:  Pulmonary Veins  Bronchial Veins (Dilate)  Production of Mucus  Rupture  Hemoptysis  Edema of Bronchial Mucosa Wheeze • ALVEOLAR EDEMA  Gas Exchange - Hypoxia P VH

  10. DYSPNEA ORTHOPNEA : Recumbant Posture Number of PILLOWS Increased VENOUS RETURN to HEART Worsening Pulmonary Venous Hypertension

  11. DYSPNEA PAROXYSMAL NOCTURNAL DYSPNEA • Variant Dyspnea / Orthopnea • 2 – 3 Hrs after SLEEP • Nocturnal Evolve  Acute Pulmonary Edema • Increased Venous Return  Heart • Absorption Edema Fluid  Vascular Space Decreased Adrenergic Drive  LV Depressed Respiratory Center (Nocturnal)

  12. DYSPNEA – Obstructive Sleep Apnea • EPISODES – HYPOPNEA / APNEA • OBSTRUCTION – SNORING • DAYTIME SLEEPINESS – SOMNOLENCE • RELATION – CARDIAC DYSRHYTHMIAS - PULMONARY ARTERIAL HYPERTENSION • SLEEP LAB DATA

  13. SYNCOPE • TRANSIENT LOSS : CONSCIOUSNESS POSTURAL TONE • PRESYNCOPE : LOSS OF POSTURAL TONE WITHOUT LOSS OF CONSCIOUSNESS Fainting / blackout : Near loss of Consciousness – “GREY” • REST  ERRECT POSTURE • EFFORT induced  RECUMBANCE STRUCTURAL HEART DISEASE CARDIAC DYSRHYTHMIAS

  14. SYNCOPE • CEREBRAL PERFUSION : • MARKEDLY REDUCED • SYSTEMIC ARTERIAL PRESSURE • CEREBRAL VASCULAR RESISTENCE • MARKED DECREASE in ARTERIAL PRESSURE – DECREASED C B F • PERFUSION PRESSURE : ARTERIAL - VENOUS

  15. SYNCOPE SYSTEMIC PRESSURE – C B F Decreased Cardiac Output : Preload Decreases Decreased S V R : Venous Pooling ARRHYHMIAS  LV Dysfunction Tachy & Brady  C O Inadequate Vasoconstriction Inappropriate Vasodilatation

  16. SYNCOPE • EFFORT Induced : • Inadequate Cardiac Output • Most C O  Exercising Muscles • Inappropriate Vasodilatation • Mechanoreceptors in ventricular wall  reflex vasodilatation • Exercise Induced Arrhythmias • OBSTRUCTIVE Lesions: • AS • HOCM • PS

  17. SYNCOPE • Multifactorial  Cardiac Output  Inappropriate Vascular Response  Arrhythmias • Drug Induced / Aggravated • Mechanoreceptors Reflex Effect • Chemoreceptors On Vascular Response

  18. SYNCOPE Confused : Neurological Problems / Disorders History • Patient : Rest / Effort • Bystander : Posture : Circumstances : Tonic – Clonic Movements : Sphincter Incontinence : Post-ictal Neuro status : Persistent Neuro Defecit

  19. EDEMA • Increased Interstitial Fluid • STARLING’S LAW – Fluid Dynamics • Hydrostatic Pressure • Oncotic Pressure • Vascular Permeability • Lymphatic Drainage • Pitting – Dependent areas of body Bilateral • Approximately 5 Lts Fluid (Adults) accumulate before clinically manifest.

  20. FLUID OVERLOAD • ASCITES: • Ascites Precox : Constrictive Pericarditis Tricuspid Valve Disease • HYDROTHORAX: • Pleural Veins  Pulmonary Veins & Systemic Veins • Common in COMBINED VENTRICULAR FAILURE • More on RIGHT side • PHANTON tumour

  21. CYANOSIS • Bluish Discoloration : Skin & Mucous Memb. • Excess : Reduced Hemoglobin : Capillaries (>5 G / dl ) • Central / Peripheral : Mechanism – Cyanosis • Normal Arterial Blood : >95% Saturation Reduced Hb% : 0.75 G / dl Venous Blood : 4.75 G / dl, 70% • Central Cyanosis – C H D ; R  L Shunt 30% of LV output (Bypassing Lungs)

  22. CYANOSIS • CENTRAL CYANOSIS: • Arterial Oxygen Desaturation • R  L Shunt • V / Q Abnormality • PERIPHERAL CYANOSIS: • Increased Extraction of O2 by Tissues (Low C O ) • Superficial areas : Fingers, Cheeks, Nose, Ext. Parts • Occasionally Localized • RAYNAUD’S Phenomenon

  23. CYANOSIS • CENTRAL : Desaturation : < 80% Level of Hb% Often Associated : Clubbing Secondary Erythrocytosis Not Associated with Dyspnea Except : Acute PTE Acute Pulm Edema ( Contrast – Pulmonary Cause) R  L Shunt : Pulmonary Stenosis P A H Common Mixing Chamber - Single Ventricle / T A P V C

  24. Onset Location Radiation Quality Severity Duration Precipitating Events Relieving Factors Associated Symptoms Stable / Progressive CHEST PAINIschemic Chest Pain

  25. CHEST PAIN • Classical Angina • Atypical Chest Pain • Non Ischemic Chest Pain Application Baye’s Theorem “ Positive Predictive Value of Test Proportional Prevelence of disease in Population” Pretest Probability  Final Diagnosis

  26. CHEST PAIN • Angina : Imbalance : Oxygen Supply / Demand • Coronary Circulation : • % Cardiac Out put • Maximal Oxygen Extraction • Increased Demand Met only with increased Flow • Normal Myocardial Oxygen Consumption • 6 -8 ml / min / 100Gms

  27. CHEST PAIN MYOCARDIAL OXYGEN DETERMINANTS • MAJOR DETERMINANTS : • Heart Rate • Blood Pressure • Contractility • Wall Stress

  28. Thank you

More Related