Causes of Fever in Cardiac Patient

 Rheumatic fever 

Subacute Bacterial Endocarditis 

Pericarditis 

Pulmonary Embolism

Myocardial Infarction 

Deep Vein Thrombosis

Associated Fever from RTI

Examples of Pseudoallergic reactions

 Pseudoallergic reactions which occur with first contact with drugs  like 

Bronchospasm induced by Morphine 

Itching induced-by Morphine 

Urticaria induced by Aspirin 

Bronchospasm induced by N-Acetyl Cystiene 

Aspirin induced Urticaria 

Treatment of Anaphylaxis Shock

 Adrenaline Amp

Intravenous Hydrocortisone 

Oxygen if needed

Intravenous Fluids

Intravenous Chlorpheniramins 

Clinical features of Anaphylaxis

 Bronchospasm

Laryngospasm

Hypotension

Diarrhea 

Cyanosis 

Common Side Effects of widely used drugs dose dependant

 Aminglycosides causes Eighth Nerve Damage 

Duretics especially Thiazides causes Gout 

Methotrexate causes Bone Marrow Depression

Doxorubicin therapy causes Myocardial Damage 

Chloramphenicol causes Aplastic Anaemia 

Anaphylaxis due to Penicillins 

Haemolytic Anaemia due to Methyl Dopa 

Serum Sickness due to Carbimazole 

Thrombocytopenic Purpra  due to Quinine 

Contact Dermatitis due to topical Antibiotics 

Anticonvulsants cause Megaloblastic Anaemia 

Methyseregide for Rx of Migraine causes retropritoneal Fibrosis

Amiodorane for Arrythmia causes  Pulmonary Fibrosis 

Methysergide causes retropritoneal Fibrosis 

Features of right sided cardiac edema

Bilateral 

Pitting

Subside at morning

Starts before ascites because it is gravitional

Systemic congestive symptoms of right sided heart failure

 Oedema both lower limbs

Dyspepsia to all types of food 

Sweating to mild activities 

Nocturia

pain in right hypochondrium

Low Cardiac Output Symptoms

 Headache 

Dizziness 

Syncope Attacks 

Anginal pain 

Fatigue 

Intermittent Claudication 

Oliguria

Causes of Heamoptysis in Cardiac Patient

 Mitral Stenosis 

Secondary to Chest Infections

Pulmonary Embolism or Deep Vein Thrombosis 

Acute Pulmonary Oedema

Causes of Cough in Cardiac patient

 Lung Congestion 

Dry irritating spasmodic nocturnal cough 

Recurrent Chest infections

Compression on recurrent   laryngeal nerve by dilated left atrium characterized by hoarseness of Voice 

Compression on trachea by dilated aortic Aneurysm

 

Differences between Cardiac Asthma and Bronchial asthma

 Cardiac Asthma

History for Cardiac disease 

Occurs after 2 hours after sleep 

Dyspnea before cough 

Frothy Pinkish Sputum 

Auscultation Crackles bilateral basal with inspiration

Bronchial Asthma 

History of Respiratory disease 

Occurs late at night 

Cough before Dyspnea

Little viscid mucoid sputum 

Auscultation wheezes with expiration

Major cause for Tall T.Wave in ECG

 Hyperkalemia is the main cause of tall T.Wave in Human Cardiac ECG 

Causes of inverted T. Wave in Cardiac ECG

 Ventricular Ischaemia

Ventricular Strain in cases of Pulmonary Hypertension and Systemic Hypertension

Digitalis Effect

Pericarditis 

Cerebrovascular Accidents associated with Bundle Branch Block 

Signs and Symptoms of Cushing Syndrome

 Obesity 

Altered Fat Distribution

Muscle wasting 

Thin easily Bruised Skin 

High Blood Pressure 

Diabetes 

High Vulnerability for infections

Clinical Presentation of Acute Cholecystitis

 Fever         

      Guarding 

Positive Murphy Sign 

Leucocytosis

Clinical presentation Gall Bladder Stones

 Jaundice 

Colicky pain Right Upper Quadrant of Abdomen.           No Fever.                                   No Leucocytosis            Tenderness                            Pain radiating to lower part of right Scapula 

Diagnosis confirmed by Ultrasonography gall bladder and Biliary Duct

Pathophysiology of Acute Myocardial Infarction

 Progressive Coronary Artery narrowing to a  current model of plague rupture and thrombus formation

Fixed narrowing is typical for Stable Angina due to increased Cardiac Deman But UA , NSTEMI, and STEMI involves continous process of Inflammation and intravascular Thrombosid

Immediate Therapy in Case of Acute Myocardial Infarction

 Aspirin

Clopidogrel

Oxygen

Sublingual Nitroglycerin 

Thrombolysis Tenectaplase or Streptokinase

Clexane

If the case is severe

IV nitroglycerin, IV Beta blockers 

As an emergency physician what you have to do if you suspect Acute Myocardial Infarction

 Establish IV Access

Chest X ray

ECG

Serum Level of Cardiac Enzymes especially Troponin , CPK

Cardiac Monitor

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