A Breathless Pregnancy Session 2

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A Breathless Pregnancy Session 2 by Mind Map: A Breathless Pregnancy Session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.2.1. anatomy and physiology of valves

1.2.2. RELATED valvular diseases

1.2.2.1. causes

1.2.2.2. mechanism

1.2.2.3. complications

1.2.2.4. diagnosis

1.2.3. pregnancy effects on heart

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. mitral stenosis caused by rhuematic heart disease with heart failure

2.2. Mechanism

2.2.1. bacterial infection (beta hemolytic group A strept) which started as upper respiratory tract infection, causing autoantibody againt heart tissues. (which can be aggreviated by pregnancy)

2.3. Presentation

2.3.1. severe dyspnea, tachycardia, swollen ankle and cough with pink frothy sputum and in distress

2.4. Supporting data

2.4.1. history, physical exam, ECG and radiological findings

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain

3.1.1.1. SOB and palpitations and sputum and cough started this after noon

3.1.1.2. shes 32

3.1.1.3. swollen ankles few weeks ago

3.1.1.4. first time to hospital

3.1.2. Previous medical / surgical history

3.1.2.1. frequent sore throat at childhood

3.1.3. Drug history / allergy

3.1.4. Family history

3.1.4.1. father dies of heart attack at 55

3.1.4.2. mother diabetic and hypertensive

3.1.5. Social / occupational history

3.1.5.1. aboriginal

3.1.5.2. little alcohol (modest)

3.1.5.3. her husband is a lorry driver

3.1.6. Systemic review

3.1.7. Physical examination

3.1.7.1. temp 36c

3.1.7.2. pulse is 150 irregular

3.1.7.3. bp 90/60

3.1.7.4. rr 35

3.1.7.5. acutly distressed

3.1.7.6. sitting upright

3.1.7.7. sweating and coughing pink sputum

3.1.7.8. ankle swelling

3.1.7.9. elevated JVP reach jaw angle

3.1.7.10. Heart sounds

3.1.7.10.1. diastoloic murmur over apex

3.1.7.11. crackles heard all over chest

3.1.7.12. accesory mm use

3.1.8. tests results

3.2. 50 minutes