Going Down Hill Session 2

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Going Down Hill Session 2 by Mind Map: Going Down Hill Session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.2.1. Relevant anatomy

1.2.2. Physiology of heart (as a pump)

1.2.2.1. cycle

1.2.2.2. graph

1.2.2.3. graph 2

1.2.3. Heart failure

1.2.3.1. Pathophysiology

1.2.3.1.1. diagram

1.2.3.2. Causes

1.2.3.3. Diagnosis

1.3. 30 minutes

1.3.1. The scribe does not have to write in this step!

2. Step 8

2.1. Diagnostic decision

2.1.1. Systolic heart failure that is caused by cardiomyopathy (biventricle)

2.2. Mechanism

2.2.1. Obesity+smoking, other risk factors. +alcohol consumption causes the cardiacmyopathy

2.3. Presentation

2.3.1. progressive dyspnea

2.3.2. Fatigue

2.3.3. Orthopnea

2.3.4. confusion

2.3.5. swollen ankles

2.3.6. weight gain

2.4. Supporting data

2.4.1. History and physical examination+ test findings (ECG+Xray)+ liver enzymes were increased

2.4.2. ECHO

2.4.2.1. dialation of all chambers. with mild mitral regurgitation, moderately severe hypokineses of ventricles

2.5. For next session

2.5.1. Alcohol induced cardiopathy

2.5.2. Management

2.6. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain

3.1.1.1. George,43,train driver.

3.1.1.2. He can walk normal distances in a flat ground

3.1.1.3. He noticed that cannot climb without stoping to catch a breath

3.1.1.4. both ankles

3.1.1.5. gained 5 kilos over the past few weeks

3.1.1.6. history of coughing history(gray)

3.1.1.7. He becomes breathless when lying down

3.1.1.8. trouble sleeping when lying in bed, so he uses pillows

3.1.1.9. all symptoms are progressive

3.1.2. Previous medical / surgical history

3.1.2.1. No chronic diseases

3.1.2.2. He had an appendectomy and tonsilloctemy as a child

3.1.2.3. he had an inguinal hernia 7 years ago

3.1.2.4. not particularly prone to infections in the winter

3.1.2.5. no asthma

3.1.3. Drug history / allergy

3.1.3.1. occasional paracetamol

3.1.4. Family history

3.1.4.1. he doesnt know his father

3.1.4.2. mother is alive, no problem

3.1.5. Social / occupational history

3.1.5.1. he smokes 23-30 cigarites since 13

3.1.5.2. lives in a pented house

3.1.5.3. 3-4 cans of beer per day

3.1.6. Systemic review

3.1.7. Physical examination

3.1.7.1. Vital signs

3.1.7.1.1. 100 kg, 173 cm

3.1.7.1.2. 36.7

3.1.7.1.3. pulse is 100 regular reduced vol

3.1.7.1.4. BP: 120/70

3.1.7.1.5. BP: 110/65

3.1.7.1.6. RR:30

3.1.7.2. JVP

3.1.7.2.1. 6cm

3.1.7.3. inspection

3.1.7.4. palpation

3.1.7.4.1. apex beat is displaced laterally

3.1.7.4.2. liver edge is tender and 3cm palpable below the costal margin

3.1.7.4.3. bilateral pitting edema

3.1.7.5. ausciltation

3.1.7.5.1. 3rd heart sound

3.1.7.5.2. lungs, bilateral basal pulmonary crackles which persist after coughing

3.1.8. tests results

3.1.8.1. normal hematology

3.1.8.2. biochemistry

3.1.8.2.1. all liver enzymes are increased

3.1.8.2.2. reduced level of sodium

3.1.8.3. ECG

3.1.8.3.1. ECG Shows sinus rhythmn with left ventricular hypertrophy and non-specific ST-T wave changes.

3.1.8.4. Xray

3.1.8.4.1. The cardiac silhouette is enlarged

3.1.8.4.2. Kerley B lines

3.2. 50 minutes