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Pericardial Disease
Pericarditis Etiology Infectious Viral → Coxackie B Staph Strep Fungi Autoimmune SLE Wegener Goodpasture RA PAN Uremia Post-MI Peri-infarction pericarditis Dressler Syndrome 🔗 Aortic dissection Radiation Cancer Drugs Presentation Sharp chest pain Change intensity with respiration, position Worsen by lying down Improved by sitting up Diagnosis Best initial → ECG...
Read moreCardiomyopathy
Dilated Cardiomyopathy = Systolic Dysfunction = Low EF Etiology Ischemia Alcohol Postviral myocarditis Radiation Toxins → Doxorubicin Chagas disease Presentation SOB on exertion Edema Rales JVD Gallop Diagnosis Best initial → Echo Most accurate → Echo ECG → Nonspecific CXR → Nonspecific Treatment Symptom control Diuretics Digoxin ↓ Mortality ACEi/ARB Beta...
Read moreValvular Heart Disease
General Etiology Congenital Rheumatic fever → Mostly MS Aging → AS Hypertension → Regurgitation Ischemia → Regurgitation Presentation SOB CHF symptoms Murmur Expiration → ⬆︎ Left preload → ↑ Left murmurs Inspiration → ⬆︎ Right preload → ↑ Right murmurs Diagnosis Best initial → TTE More accurate → TEE Most accurate → Catheterization → Valve diameter, Pressure gradient...
Read moreAcute Pulmonary Edema
Etiology Rapid fluid accumulation in lungs Presentation Acute SOB Rales JVD S3 gallop Edema Orthopnea Pink frothy sputum If sufficient time Ascites Organomegaly Diagnosis Best initial → ECG → To determine cardiac cause BNP → Normal excludes diagnosis CXR Vascular congestion Cephalization of flow Enlarged heart Pleural effusion Kerley B lines...
Read moreCHF
Etiology Function loss Systolic dysfunction → ↓ EF Diastolic dysfunction → Normal EF Major causes Hypertension → Cardiomyopathy → Most common Valvular disease MI → Dilated cardiomyopathy Minor causes Alcohol Postviral myocarditis Radiation Adriamycin (Doxil) Chagas Hemochromatosis → Restrictive cardiomyopathy Thyroid disease Peripartum cardiomyopathy Thiamine deficiency Presentation LV failure → Lung symptoms → Dyspnea Left-sided...
Read moreAcute Coronary Syndrome
Unstable Angina / NSTEMI / STEMI Presentation Angina pectoris Shortness of breath Cold sweat S4 gallop → Acute myocardial dysfunction Paredoxical S2 splitting → Delayed relaxation and delayed AV closure Diagnosis First infarction ECG Becomes positive → Immediately Stays positive → ST elevation progresses to Q-wave in about a week Findings ST...
Read moreCoronary Artery Disease
hemoglobin c Risk Factors Major Diabetes → Worst Hypertension → Most common Hyperlipidemia ↑LDL is worst Tobacco → fastest correction benefit Family history of CAD M<55y F<65y Age M>45y F>55y Minor Physical inactivity Alcohol ↓Veggie intake Emotional stress ↑CT calcium score PET scan WRONG ↑Homocysteine Chlamydia ↑CRP Menstruating women never...
Read moreDupuytren Contracture
Etiology Men >40y Genetic predisposition Alcoholism Cirrhosis Hyperplasia of palmar fascia → Constriction Presentation Nodule formation Contracture of 4th and 5th finger Hand flexed Can no longer be properly extended Diagnosis Clinical Treatment Cosmetic concern Triamcinolone Lidocaine Collalgenase injection Impaired function → Surgery
Read moreVasculitis
General Presentations Fever Fatigue/Malaise Weight loss Arthralgia Myalgia LARGE VESSEL Giant Cell (Temporal) Arteritis Risk Factors Polymyalgia Rheumatica Age >50y Female Presentation Headache Scalp pain Temporal tenderness Visual symptoms → Amaurosis fugax Jaw claudication Other arteries involvement ↓ Arm pulses Bruit near clavicle Aortic regurgitation Diagnosis ↑ ESR (>50)...
Read moreDiagnostic Tests in Nephrology
Best initial test → Urinalysis (UA) + BUN + Cr Cast RBC → Glomerulonephritis WBC → Pyelonephritis Eosinophil → Acute interstitial nephritis Hyalin → Dehydration (Tomm-Horsfall accumulation) Borad/Waxy → CRF Granular (Muddy-brown) → ATN (dead tubular cells) Protein UA Dipstick → Only detects albumin 0 = <300mg → Normal (microalbuminuria) Microalbuminuria 30-300 mg/24h Important in diabetics Treatment → ACEi/ARB...
Read moreGlomerulonephritis (Nephritic Syndrome)
General Rules Etiology → Not from toxins/drugs Presentation Proteinuria <1.5 g/d Hematuria Oliguria Uremia Edema Hypertension Chronic All can progress to → Nephrotic syndrome Diagnosis Most accurate → Biopsy UA Hematuria RBC cast Dysmorphic RBC Proteinuria ↓Na ↓Na fractional excretion Treatment Steroids Cyclophosphamide Mycophenolate Goodpasture Syndrome Etiology Antibody to Collagen IV...
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