Lecture Notes Of Internal Medicine ppt

[...]... headaChe] Blurring of vision, non specific Easy fatigue Symptoms of complications Symptoms of the cause (2ry H.) (It is mostly asymptomatic) ~ii tfD $j ~ ~: ~:I = : Elevated blood pressure Signs of the cause (2ry H), see later Manifestations of the cause of hypertension: e.g.: *Radiofemoral delay (Coarctation of aorta) *Enlarged kidneys (polycystic kidney) *Moon face (Cushing's syndrome) * Acromegaly,... ng/rnl, it is > 2ng/rnl in case of digitalis toxicity ~ Treatment: ¢ ¢ ¢ ¢ Stop digitalis ¢ Stop diuretics Give K ¢ Treatment of arrhythmia (See later) Digitalis Ab: Fab fragments of digitalis Ab ~ Fab fragments digitalis complex ~ excreted through the kidney Haemopefusion adsorption of digitalis 1Ia~·lr»i.~~ti~liJ~ , Aim: II Sodium & water excretion Fluid loss with reduction of heart load Decrease Sodium... Cardiology Manifestations of the cause Marked dyspnea, orthopnea and haemoptysis (frothy pink sputum) Sense of impending death with marked irritability Bubbling crepitations and rhonchi allover the chest Iii i'r{tii ~Bli[.]it!! : Chest x ray: Showing butterfly opacity (Bat wing appearance) : Echo: Showing decline of ejection fraction of the left ventricle or any valve lesion Treatment of acute cardtogenlc... in cases of ischaemic heart disease, hyperthyroidism and myocarditis • The effect of digitalis in cases of cor pulmonale is poor !? 9 Cardi"'''lri , ~ Clinical picture: ~ Vomiting, diarrhea ~ Arrhythmia (e.g extrasystole) specially bigeminy, ventricular tachycardia and heart block (see ECG) ~ Blurring of vision, altered colour vision (xanthopsia) ~ ECG arrhythmia, digitalis effect (sagging of S-T segment)... pressure, this leads to relief of PVC & SVC Furosemide: Acts 'on loop of Henle: * It is a venodilator of pulmonary veins * J,J, PVC and SVC * Dose: (40-160 mg/d) oral or injection ~ Tablet 40 mg ~ Amp: 20 mg, 40 mg IV, I.M @ High ceiling loop diuretics: ~ Bumetanide (burinex) ~ Furosemide ~ Ethacrynic acid High ceiling diuretics i.e their action increases with increase of the dose Thiazides: Act mainly... Recent role of BB in treatment of heart failure • Activation of the sympathetic system may initially maintain cardiac output through an increase in myocardial contractility, heart rate and peripheral ve However prolonged sympathetic stimulation leads to cardiac myocyte apoptosis (cell death), hypertrophy and focal myocardial necrosis • BB may help to counteract the deleterious effects of enhanced sympathetic... sympathetic stimulation and may prevent arrythmia and sudden death We can start with small dose, bisoprolol (concor) 1.25 - 2.5 mg/d with gradual increase of the dose according to need with monitoring of patients • Abrupt administration of large doses of BB can intensify HF, specially acute HF 14 ( Different classifications i (A Systolic failure: ) (B Diastolic A t COP failure: dysfunction: ] This means... Coarctation of aorta Pregnancy: Preeclampsia Blood disease: Polycythemia Drugs: -7 hyperviscocity -7 tblood pressure Corticosteroids Oral contraceptives t - - Salt & H20 retention containing oestrogen NSAID Ephedrine, Erythropiotin, Cyclosporine, Carbenoxolone and Sympathomimetic agents ~ C/p of hypertension: Asymptomatic Occipital headaChe] Blurring of vision, non specific Easy fatigue Symptoms of complications... ACE inhibitors ACE inhibitors are the best vasodilators in cases of heart failure Captopril (12.5 mg/Shr up to50 mg /Shr.), ramipril (2.5 mg/12hr up to 5 mg/12hr)or enlapril (2.5-10 mg/12 hr) To get the benefit of these vasodilators, keep the systolic blood pressure above 100 nunHg ACE inhibitors also lead to reduction of the process of remodeling 6!ll1 Poteat iaot~ol?->ic~ in intractable (used or... dlastollc dl,sful1(:ti()11 give 1:313, verapamll ()I" deltlazem 27 • •• Definition: Sudden, marked elevation of blood pressure EB abnormal cerebral state i.e brain oedema, that is potentially reversible with control of blood pressure Sudden and marked increase of blood pressure ~ disturbance of the cerebrovascular autoregulatory mechanisms-obrain edema ~ ® ® ® Very high blood pressure, headache, visual . Detection of calcification of the valves . , Detection of pulmonary and aortic pressure . , Diagnosis of pericardial effusion . , Diagnosis of cardiomyopathy,. pressure .~ ~: ~:I = Signs of the cause (2ry H), see later. Manifestations of the cause of hypertension: e.g.: * Radiofemoral delay (Coarctation of aorta) * Enlarged