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09/10/15
Difficulty of Breathing
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SALIENT FEATURES
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PHYSICAL EXAMINATION
General Survey: conscious, coherent, ambulatory, very anxious
Vital Signs:
BP=90/60, HR=102/min (irregularly irregular)
RR= 24/min,
24/min Temp: 36.8oC
Weight: 46 kg, Height: 155cm, BMI= 19.0
HEENT: pink palpebral conjunctivae, no cervical lymphadenopathy
icteric sclerae
Skin:good skin turgor, no lesions
Neck: no carotid bruits, brisk upstroke of carotid pulse,
JVP=5 cm at 30o
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PHYSICAL EXAMINATION
Lungs: equal chest expansion, no retractions, equal tactile fremitus
both lung fields, resonant to percussion on both lung fields
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DIFFERENTIAL DIAGNOSIS
Mitral Valve Disease
Mitral Stenosis
Mitral Regurgitation
Atrial Myxoma
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
PRIMARY WORKING IMPRESSION:
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DIAGNOSTICS
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LABS
CBC
Hgb 12
Hct 0.48
WBC 10
seg 55%
lympho 45%
plt 230,000
FBS: 80
Creatinine: 1.0
Na 142, K 3.5, SGPT 40
Urinalysis:
Spec grav 1.030
(-)sugar, WBC, RBC
Additional Diagnostics
2D Echocardiography
Holter Monitoring
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DIAGNOSIS
1) Underlying Etiology: Rheumatic Fever
2) Anatomical Abnormalities:
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Pathophysiology
Pathophysiology
Pathogenesis
Mitral Stenosis
Pathophysiology
Pathogenesis
LA failure causes pulmonary hypertension
and edema
Pathophysiology
Pathogenesis
MITRAL STENOSIS:
Management
Goals of Medical Treatment:
1.Prevention / Treatment of Complications
2.Monitor
3.Prevention of recurrent infection
Pharmacologic approach:
Symptom Control:
Beta blockers, nondihydropyridine calcium
channel blockers, or digoxin for rate control of AF
Cardioversion for new-onset AF and HF
Diuretics for HF.
Natural History
Warfarin for AF or thromboembolism
PCN for RF prophylaxis