CARDIOVASCULAR SYSTEMppt.pptx

359 clinical presentation patients with variant

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359
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CLINICAL PRESENTATION:- PATIENTS WITH VARIANT ANGINA TYPICALLY PRESENT WITH A CHRONIC PATTERN OF RECURRENT EPISODES OF CHEST PAIN. THE QUALITY OF THE CHEST PAIN IS INDISTINGUISHABLE FROM CLASSICAL ANGINA PECTORIS ASSOCIATED WITH OBSTRUCTIVE CORONARY ARTERY DISEASE; HOWEVER, THE CONTEXT IN WHICH IT OCCURS DIFFERS. IN PARTICULAR, PATIENTS WITH VARIANT ANGINA REPORT THAT THEIR EPISODES ARE PREDOMINANTLY AT REST AND THAT MANY OCCUR FROM MIDNIGHT TO EARLY MORNING. EACH EPISODE OF CHESTPAIN GENERALLY LASTS 5 TO 15 MINUTES. 360
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DIAGNOSIS:- TRANSIENT ST-SEGMENT ELEVATION ON AN ELECTROCARDIOGRAM AT THE TIME OF AN EPISODE. 361
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MANAGEMENT:- SMOKING CESSATION NITRATES AND CALCIUM CHANNEL BLOCKERS RHO KINASE INHIBITORS - FASUDIL IS A RHO KINASE INHIBITOR THAT HAS BEEN SHOWN TO INHIBIT ACETYLCHOLINE-INDUCED SPASM. STATINS:- STATINS HAVE BEEN SHOWN TO BE EFFECTIVE IN PREVENTING CORONARY SPASM. 362
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363 C
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364
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WELLEN'S SYNDROME SUGGESTS UNSTABLE ANGINA:- IT IS AN E.C.G MANIFESTATION OF CRITICAL PROXIMAL LEFT ANTERIOR DESCENDING CORONARY ARTERY (LAD STENOSIS) IN PATIENTS WITH UNSTABLE ANGINA. . IT IS CHARACTERIZED BY :- - DEEP > 2 MM T WAVE INVERSIONS IN THE ANTERIOR PRECORDIAL LEADS. . WELLENS SYNDROME REPRESENT A PRE-INFARCTION STAGE CORONARY ARTERY DISEASE (CAD) THAT OFTEN PROGRESSES TO DEVASTATING ANTERIOR WALL MI. 365
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COMPLICATIONS - MI 366
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367
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368 B
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369
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370
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THE POST CARDIAC INJURY SYNDROME HAS ALSO BEEN CALLED DRESSLER SYNDROME, POST PERICARDIOTOMY SYNDROME AND WHEN OCCURRING AFTER MYOCARDIAL INFARCTION (MI) POST MYOCARDIAL INFARCTION SYNDROME. IT OCCUR IN SETTINGS OTHER THAN ML PARTICULARLY AFTER CARDIAC SURGERY OR PULMONARY EMBOLISM. IT IS USUALLY A LATE COMPLICATION DEVELOPING WEEKS TO MONTHS AFTER ACUTE M.I. BUT RARELY MAY BE EVIDENT WITHIN THE FIRST WEEK PAST MI. DRESSLER SYNDROME DEVELOPS AFTER AN INTERVAL OF 1-4 WEEKS OR EVEN MONTHS FOLLOWING CARDIAC INJURY (MI) AND NOT WITHIN HOURS. 371
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THE CLINICAL MANIFESTATIONS INCLUDE: - PLEURITIC CHEST PAIN - PERICARDIAL FRICTION RUB - FEVER - LEUCOCYTOSIS - PLEURAL EFFUSION AND PULMONARY INFILTRATES. 372
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DIAGNOSIS:- DIAGNOSIS IS MADE BY CHARATERISTIC SYMPTOMS AND INCREASED ESR. TREATMENT:- THE PERICARDITIS USUALLY RESOLVES IN 1-2 WEEKS WITH ASPIRIN. NSAIDS OR ANALGESIC (OFTEN NO TREATMENT IS NECESSARY). THERAPY WITH CORTICOSTEROIDS IS SOMETIMES REQUIRED IN RESISTANT CASES. 373
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374 A
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Q- TREATMENT 375
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376
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377
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INFARCT SIZE CAN BE ASSESSED BY :- ECHOCARDIOGRAPHY COMPUTERIZED TOMOGRAPHY MAGNETIC RESONANCE IMAGING POSITION EMMISION TOMOGRAPHY RADIONUCLIDE SCINTIGRAPHY (THALLIUM, TECHNETIUM) 378
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  • Winter '16
  • jean grey
  • Cardiology, Ans., Constrictive pericarditis

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