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In MI, the pain usually lasts longer than 20 minutes. The pain
in stable angina lasts less than 10 minutes. Unstable angina
by definition occurs at rest or with increasing frequency or
less strenuous activity. The pain of pericarditis and pleurisy is
sharp and worsened with breathing.
Symptoms of Unstable Angina - The pain or discomfort:
-Often occurs while you may be resting, sleeping, or with little physical exertion
-Comes as a surprise
-May last longer than stable angina
-Rest or medicine usually do not help relieve it
-May get worse over time
-Can lead to a heart attack
Symptoms of Stable Angina - The pain or discomfort:
-rise, and episodes of pain tend to be alike
-Usually lasts a short time (5 minutes or less)
-Is relieved by rest or medicine
-May feel like gas or indigestion
-May feel like chest pain that spreads to the arms, back, or other areas
При ИМ боль обычно длится дольше 20 минут. Боль при стабильной стеноĸардии
длится менее 10 минут. Нестабильная стеноĸардия по определению возниĸает в
поĸое или с возрастающей частотой или менее напряженной деятельностью.
Боль от периĸардита и плеврита острая и усиливается при дыхании.
Симптомы нестабильной стеноĸардии - боль или дисĸомфорт:
-Often происходит в то время ĸаĸ вы можете отдыхать, спать, или с небольшими
физичесĸими нагрузĸами
Приходят ĸаĸ сюрприз
-Может длиться дольше , чем стабильная стеноĸардия
-отдым или леĸарство обычно не помогает облегчить это -
май ухудшаться со временем - может
привести ĸ сердечному приступу
Симптомы стабильной стеноĸардии - Боль или дисĸомфорт: -
Восход и эпизоды боли, ĸаĸ правило, одинаĸовы -
Обычно длится ĸоротĸое время (5 минут или меньше)
-
Облегчается отдыхом или приемом леĸарств - Может ощущаться ĸаĸ газ или
расстройство желудĸа -
Может ощущаться ĸаĸ боль в груди, ĸоторая распространяется на руĸи, спину
или другие области
Kawasaki disease, also known as mucocutaneous lymph node syndrome, is the most
common cause of acquired heart disease in pediatrics. Criteria for diagnosis are fever
for greater than 5 days plus four of the following five features: conjunctivitis, cervical
adenitis, mucous membrane changes, a polymorphous rash of the trunk and
extremities, and distal extremity changes. The illness can be divided into three phases.
The acute phase is characterized by fever, conjunctivitis, cervical adenopathy, rash,
mucous membrane changes, extremity swelling, and erythema which are seen in the
first 10 days. Asubacute phase occurs over the next 7-14 days and is manifested by a
decrease in fever, development of thrombocytosis, and distal extremity skin
desquamation. Coronary artery aneurysms, which occur in approximately 25% of
untreated patients develop 10-40 days into the course. Early treatment with
intravenous immunoglobulin and salicylates reduces the risk of developing coronary
artery aneurysms. (Behrman, 823–826)
80%
Кардиология
Inability of the Aortic Valve to open properly during Systole
Normal aortic valve area = 3-4 cm2
Mild AS 1.5 to 3 cm2
Moderate AS 1.0 to 1.5 cm2
Severe AS <1.0 cm2
Etiology:
Calcification (most common) senile
Congenital
Rheumatic Disease (fibrosis
Hyperlipidemia (Lipid deposits)
S+S:
Angina (Exertional)
Syncope
Dyspnea
Orthopnea
Peripheral Edema
Paroxysmal nocturnal Dyspnea
Physical Exam:
↓↓ Cardiac Output
Plateau Pulse ( Low & weak )
pulsus tardus et parvus
Systolic Harsh Murmur-->
The murmur decreases with valsalva maneuver and on standing.
crescendo-decrescendo
heard best at the right 2nd intercostal space.
radiation to the carotid arteries.
LVH --> LVF
LBBB ( calcification of valve)
Tx:
Surgery (Valve Replacement) if symptomatic ( the best choice)
The murmur is 2/6 crescendo decrescendo that radiates to the carotid artery. The
murmur decreases with valsalva maneuver and on standing, the most likely diagnosis
is:
mid-systolic crescendo-de-crescendo murmur. Which of the following heart defects
cause this kind of murmur? Арт стеноз
Which of the following can distinguish atrial flutter from sinus tachycardia? Carotid
sinus
In classic maple syrup urine disease, infants who are normal at birth develop poor
feeding and vomiting in the 1st wk of life; lethargy and coma may ensue within a few
days. Physical examination reveals hypertonicity and muscular rigidity with severe
opisthotonos. Periods of hypertonicity may alternate with bouts of flaccidity.
Neurologic findings are often mistaken for generalized sepsis and meningitis. Cerebral
edema may be present; convulsions occur in most infants, and hypoglycemia is
common. In contrast to most hypoglycemic states, correction of the blood glucose
concentration does not improve the clinical condition. Routine laboratory findings are
usually unremarkable, except for metabolic acidosis. The disorder is usually confirmed
by amino acid analysis showing marked elevations in plasma levels of leucine,
isoleucine, valine, and alloisoleucine (a stereoisomer of isoleucine not normally found
in blood) and depression of alanine.
The patient described has typical findings of Turner syndrome. Half of the patients
with Turner syndrome only have one X chromosome (45,X). The other half of patients
have a varying amount of mosaicism. At birth these infants are often small with low
birth weight and have characteristic edema of the dorsa of the hands and feet and
loose skin folds at the nape of the neck. If the diagnosis is not made during childhood,
these girls will come to medical attention at puberty because sexual maturation fails to
occur. In the absence of one X chromosome, the death of oocytes occurs much more
rapidly and nearly all oocytes will be gone by the age of 2 years. The ovaries eventually
are described as “streaks” and consist mostly of connective tissue. Associated defects
with Turner syndrome are common. About 30% of patients have cardiac anomolies,
most often bicusped aortic valves. Renal malformations and autoimmune thyroid
disease are also commonly found. Increased incidence of inflammatory bowel disease
and gastrointestinal bleeding have been described as well.
Пьющий—анаэроб
Пурпура—шистоциты
Анĸилоидный спондилит—отдых
Рингер—магний
The history and physical examination findings suggest mitral stenosis. Dyspnea may
be present secondary to pulmonary edema; palpitations are often related to atrial
arrhythmias (PACs, SVT, atrial flutter, or fibrillation); hemoptysis may occur as a
consequence of pulmonary hypertension with rupture of bronchial veins. A diastolic
rumbling apical murmur is characteristic