Breathless Pregnancy

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Breathless Pregnancy by Mind Map: Breathless Pregnancy

1. step1

1.1. difficult words

1.1.1. Aboriginal

1.1.1.1. indigenous

1.1.2. hunched over

1.1.2.1. bent forward

1.1.3. verandah

1.1.3.1. open pillared gallery

1.1.4. frothy

1.1.4.1. foamy

1.2. cues

1.2.1. pregnant lady

1.2.2. shortness of breath

1.2.3. distress

1.2.4. hunch over

1.2.5. coughing with pink frothy sputum

1.2.6. heart start to race

1.2.7. tired with progression

1.2.8. swollen ankles

1.2.9. 6 months of pregnancy

1.2.10. the baby is fine

1.2.11. 4 other pregnancies were fine

2. step2

2.1. problem formulation

2.1.1. A pregnant lady brought to the hospital with sever shortness of breath, a new onset of palpitation, productive cough with pink frothy sputum and a swollen ankles. A history of tiredness for the last few weeks.

3. step3

3.1. hypothesis generation

3.1.1. cardiopulmonary problems

3.1.2. preeclampsia

3.1.3. pink frothy suggested for pulmonary edema caused by LHF

3.1.4. swollen ankles suggested by having cardiac problem

3.1.5. anemia related to pregnancy

3.1.6. tiredness caused by having edema

3.1.7. pressure in the IVC caused by the uterus enlargement

3.1.8. infections that affects the heart

3.1.9. ischemia to part of the heart MI

3.1.10. infection in the lung ( pneumococcus pneumonia)

3.1.11. arrythmia

4. step4

4.1. hypothesis organization

4.1.1. cardiovascular system

4.1.1.1. preeclampsia

4.1.1.2. prei partum CM

4.1.1.3. valvular disease

4.1.2. respiratory system

4.1.2.1. pneumonia

4.1.3. hematology system

4.1.3.1. anemia

5. step5

5.1. learning objective

5.1.1. to know about cardiovascular changes in pregnancy

5.1.2. to know more about ( preeclampsia and prei partum CM ) causes risk factor pathophysiology and manifistation and the investigation

5.1.3. to know about the relation between the valvular disease and pregnancy+ HF

6. step6

6.1. review learning objective

6.1.1. the physiological changes during pregnancy

6.1.1.1. the blood volume increases especially during the first and the second trimester

6.1.1.2. the stroke volume increase

6.1.1.3. there will be a high state of profusion

6.1.1.4. estrogen effect

6.1.1.5. increase the heart rate from 10-15 from the normal

6.1.2. preeclampsia

6.1.2.1. it is a hypertension caused by endothelium disfunction followed by the secretion of anti angiogenic

6.1.2.2. preeclampsia may lead to eclampsia which manifistes as a sizure

6.1.2.3. risk factors

6.1.2.3.1. obesity

6.1.2.4. investigation needed

6.1.2.4.1. CBC

6.1.2.4.2. 300 ml/day proteinureia

6.1.2.5. manifestation

6.1.2.5.1. gain weight

6.1.3. prei partum CM

6.1.3.1. the development of heart failure either post partum or peri ( 3 months before or 5 months after) with no identified cause of heart failure. it is systolic heart failure

6.1.3.2. te most affected part is the cardia muscles

6.1.3.3. manefstations

6.1.3.3.1. causes include some infections especially viral

6.1.3.3.2. symptoms including

6.1.3.3.3. defective heart contractilety

6.1.3.4. it is very rare disease

6.1.4. valvular disease

6.1.4.1. most common is the material stinosis

6.1.4.1.1. start by increase the pressure in the LA leading to hypertrophy of the atrium. an consequence it cause pulmonary hypertension and eventually leads to RHF

6.1.4.1.2. manifistation

6.1.4.1.3. causes

6.1.4.1.4. complication

6.1.5. the most common heart disease in the pregnancy is material valve

7. step7

7.1. inquiry plan

7.1.1. history taking

7.1.1.1. present history

7.1.1.1.1. minimal eggsertuin dyspnea

7.1.1.1.2. the symptom for few weeks

7.1.1.1.3. sweating

7.1.1.1.4. last period was 6 months late

7.1.1.1.5. the day of presentation come with productive cough

7.1.1.1.6. pregnancy is control

7.1.1.1.7. the last pregnancy was vaginal

7.1.1.2. past history

7.1.1.2.1. these is no any surgeries

7.1.1.2.2. no medications in use

7.1.1.2.3. as a child frequent pharyngitis

7.1.1.2.4. she had no any chronic diseasea

7.1.1.3. family history

7.1.1.3.1. her father died of heart attach at the age 55

7.1.1.3.2. her mother diabetic

7.1.1.4. personal history

7.1.1.4.1. no smoking history

7.1.1.4.2. low consumption of alcohol

7.1.2. physical examination

7.1.2.1. vital signs

7.1.2.1.1. T= 36 C

7.1.2.1.2. RR= 35

7.1.2.1.3. HR=150

7.1.2.1.4. BP= 90/60

7.1.2.2. mild ankle swollen

7.1.2.3. all peripheral pulse was felt

7.1.2.4. JVP was rised

7.1.2.5. ascultation

7.1.2.5.1. crackles in the lung due to pulmonary edema

7.1.2.6. use of accessory muscles

7.1.3. investigation

7.1.3.1. Back to black board

8. step8

8.1. diagnostic plan

8.1.1. material stenosis with atrial fibrillation

8.1.1.1. pulmonary edema

8.1.1.2. aterial fibrillation

8.1.1.3. CXR carly B line for P edema

8.1.2. learning objectives

8.1.2.1. management of material stenosis with atrial fibrillation

8.1.2.2. prevention of rheumatic fever

8.1.2.3. prognosis of PPCM

9. step10

9.1. management

9.1.1. the goal

9.1.1.1. to reduce the symptoms

9.1.1.2. and decrease the load on the heart

9.1.1.3. using some diuretic to treat the pulmonary edema

9.1.2. pharmacological

9.1.2.1. start with the treatment of RV heart failure

9.1.2.1.1. diuretic to treat the edema

9.1.2.2. treatment of rheumatic fever

9.1.2.2.1. penicillin E

9.1.2.3. atrial fibrillation

9.1.2.3.1. using anti rhythmic agents

9.1.2.3.2. using the anticoagulation

9.1.2.4. material stinosis

9.1.2.4.1. if the treatment dose not show any improvement we will consider the surgery

9.1.3. NON-pharmacological

9.1.3.1. reduce the use of salt

9.1.3.2. quitting the smoking

9.1.3.3. exercise

9.1.4. prevention of rhumatic fever

9.1.4.1. primary prevention

9.1.4.1.1. cause by GAS using penicillin or amoxicillin

9.1.4.1.2. alternative drug is erythromycin when the patient is allergic to the penicillin

9.1.4.2. secondary prevention

9.1.4.2.1. IM penicillin 1 every 4 weeks for if it was carditis and there is no residual 10 years or until reach 25 YO

9.1.4.2.2. If there is no carditis using for 5 years or until it reach 21 year old

9.1.4.2.3. life long if the patient have the RHD causing carditis and there is residuals

9.2. prognosis of PPCM

9.2.1. the mortality rate is 10%

9.2.2. 40% needs heart transplant

9.2.3. 50% of the patient who have the disease recover and have normal life

10. resources

10.1. Kumar

10.2. Up to date

10.3. medscape

10.4. Davidson