Walking Uphill - Session 2

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Walking Uphill - Session 2 by Mind Map: Walking Uphill - Session 2

1. Step 6

1.1. Review session 1

1.2. Report new knowledge

1.2.1. relevant vascular anatomy coronary arteries vascular anatomy lower extremity vascular anatomy

1.2.2. ischemic heart disease causes is it atheroscelorosis ?? cardiac X syndrome risk factors modified non modified mechanism diagnosis history and physical examination ECG labrotary radiological

1.2.3. calf muscle cramp prepheral artery disease in lower extremity causes risk factors mechanism diagnosis is there other causes leg trauma thrombosis OA restless leg syndrome hypocalcimeia and hypokalemia

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. widespread atheroscelorsis affecting two organs

2.2. Mechanism

2.3. Presentation

2.4. Supporting data

2.5. 10 minutes

3. Step 7

3.1. Inquiry plan and info gathering

3.1.1. History of presenting complain chest pain started from 3 months radiate to jaw and arm reduced by rest both are getting worse during the last 3 months activity became is so limited there is no associated symptoms central chest pain, heaviness in nature usually during activity he come because of his wife cramp started from 6 months reduced by rest his foot are always cold excerbate by moving

3.1.2. Previous medical / surgical history he had a previous attack before 6-8 years fairly healthy he thinks that cholesterol was around 5.5 at age 70 NO DM or hypertension appendictomy at age 14 .. and broken right arm at age 20 no previous trauma

3.1.3. Drug history / allergy no medication no allergies no

3.1.4. Family history father died of heart attack by age 80 his brother did a coronary bypass surgery at age 70

3.1.5. Social / occupational history smoker .. heavy, 25 cig per day since age 20 1-2 small glasses of wiskey .. red wine occasionally he gets angry quickly, and he gets angina when get angry no finincial stress married with 2 children his diet contains meets , fruit and vegetables, dairy products and does/t eat fast food he stopped smoking after the attack for 6 months and he got the attack

3.1.6. Systemic review no headache or dizziness .. CNS is fine no visual abnormality Resp GIT renal

3.1.7. Physical examination vital signs 175 cm 71 kg pulse is 82 BP 140/82 RR 14 temp not mention inspection comfortable at risk not disstressed nicotine stains at the hand no radial or brachial pulse at the neck, the carotid pulse is regular with no buries palpation apex beat is normal no finding femoral pulse was reduced at the right with bruies dorsalis pedis was reduced in the left and not pulbable at the right posterior tibial pulse also reduced in the left and not palpable at the right auscultation crackles and wheez in the base heart sounds are normal

3.1.8. tests results ECG pathologic Q waves at leads 2,3 and AVF Cholesterol 5.7 .. elevated exercise ECG ultrasound catherisation CBC notmal biochemistry and electrolytes are normal

3.2. 50 minutes