GOing down hill

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GOing down hill by Mind Map: GOing down hill

1. step one

1.1. difficult words

1.1.1. plump: obese

1.1.2. flustered: confused

1.1.3. dappled: spotted

1.2. cues

1.2.1. male; 4th decade

1.2.2. fat

1.2.3. closed eyes and ehauxted

1.2.4. exahusted

1.2.5. flustered

1.2.6. discolerd dappled ankles

1.2.7. pitting edema

1.2.8. 2 year onset

1.2.9. breathlessness on exertion for few monthes

1.2.10. medical attention not sought inintially

1.2.11. dyspnea worsened

1.2.12. gain weight

1.2.13. swollen ankle

1.2.14. sleep troubled

1.2.15. orhtopnea

2. step2

2.1. problem formulation: an obese man in his forties presented with breathlessness for the last two years which has been worsened recently; associated with ankle swelling and weight gain. he can't sleep flat.

3. step3

3.1. hypothesis generation:

3.1.1. edema is due to undermined hydrostatic pressure or oncotic one

3.1.2. heart problem or failure

3.1.3. renal problem

3.1.4. infection

3.1.5. breathlessness is due to heart failure oe weakness; v\q mismatch

3.1.6. hyperlipedimia: precipitate in heart failure

3.1.7. gaining weight could be the cause. or just a symptom

3.1.8. lung problem

3.1.9. bilatiral edema: kidney, lung, or heart disease.

3.1.10. heart is overwhelmed

3.1.11. dyspnea: obsteructive, distructive or hemoblobin problem.

3.1.12. left sided problem cause pulmunary edema.

3.1.13. CHF causing pulmonary or generalised edema

3.1.14. DVT as underlying cause

3.1.15. OSA as underlying cause

3.1.16. AI good pasture syndrome

3.1.17. Anemia

3.1.18. CHF causing pulmonary or generalised edema

3.2. hypothesis generation:

3.3. hypothesis generation:

4. step4

4.1. hypothesis organisation

4.1.1. Primary problems hypertention Kidney faailure hyperlipidemia lung problems COPD OSA Anemia Good Pasture

4.1.2. Secondary manifestations CHF edema

5. step5


5.1.1. to describe the pathophysiology of developing edema (consider the causes).

5.1.2. to learn about CHF(causes -pathophysiology manifestations- risk factors- infestgations)

6. step6

6.1. revision

6.1.1. EDEMA edema develop from hydrostatic pressure volume increase venous obstruction types transudate exudate other cassification inflammtory non-inflammatory

6.1.2. CHF CAUSES left venticular dysfunction incresed afterload valvular disease COPD OSA IHD CARDIOMYOPATHY thyroid diseas main causees PATHOPHYSIOLOGY low stroke volume less ejection volume franksarling mechanism to compensate RAAS to compansate manifestaions pulmonary edema DYSPNEA orthpnea fatique cardiomegaly risk factors hyperlipidemia diabetes hypertension smoking family history infestigations cbc BNP CXR definition inabilily to pump suffeceint amount of blood

7. step7

7.1. inquiry plan

7.1.1. HISTORY SMOKER 20C\D alchohol 5 cups appendectomy - tosillectomy married chronic cough with grey sputum seasonal infections

7.1.2. examination height 173 w: 100 kg 36.7 c 120\70 mmgh laying RR: 30\m can't lay flat JVP=6 100 beats\m 3cm liver below CM 3rd HS systolic murmer basal carackles

7.1.3. D

8. step8

8.1. diagnostic dicision

8.1.1. CHF

8.2. objectives

8.2.1. management of CHF

9. step9

9.1. revision

10. step10

10.1. managmement

10.1.1. pharma diureteics furosomide metolazone SE no effect on survival ACEI IMPROVE SURVIVAL NOT BEFORE DIURETICS SMALL DOSES SE beta-blocker inhibit remodeling relive heart mouscle beta 1 selective improve mortaltity spirolactone improve mortality angiotensin II receptor antagonist candesartan no cough acute setting morphin digoxin not primary considered evapridin block calcium channel nitrates

10.1.2. non pharma dietary restriction low salt weight reduction our pt alchohol abstenence our pt smoking cessation our pt education weight and dose and diet devises AICD pacemaker remodeling devises heart transplant NOT gold standard comlication usually ypunger pt not for our pt valvular repair exercise

10.1.3. classification of severity NYHA class 1 class 2 class 3 class4

10.1.4. goals control symptoms prevent complication increase survival

11. resourecses and feddback

11.1. cumar

11.2. sherwede

11.3. myoclininc

11.4. e.medicine

11.5. robbin

11.6. uptodate

11.7. abo ossa's lecture