1. step4
1.1. hypothesis organisation
1.1.1. Primary problems
1.1.1.1. hypertention
1.1.1.2. Kidney faailure
1.1.1.3. hyperlipidemia
1.1.1.4. lung problems
1.1.1.4.1. COPD
1.1.1.5. OSA
1.1.1.6. Anemia
1.1.1.7. Good Pasture
1.1.2. Secondary manifestations
1.1.2.1. CHF
1.1.2.2. edema
2. step5
2.1. OBJECTIVES
2.1.1. to describe the pathophysiology of developing edema (consider the causes).
2.1.2. to learn about CHF(causes -pathophysiology manifestations- risk factors- infestgations)
3. step6
3.1. revision
3.1.1. EDEMA
3.1.1.1. edema develop from hydrostatic pressure
3.1.1.1.1. volume increase
3.1.1.1.2. venous obstruction
3.1.1.2. types
3.1.1.2.1. transudate
3.1.1.2.2. exudate
3.1.1.3. other cassification
3.1.1.3.1. inflammtory
3.1.1.3.2. non-inflammatory
3.1.2. CHF
3.1.2.1. CAUSES
3.1.2.1.1. left venticular dysfunction
3.1.2.1.2. incresed afterload
3.1.2.1.3. valvular disease
3.1.2.1.4. COPD
3.1.2.1.5. OSA
3.1.2.1.6. IHD
3.1.2.1.7. CARDIOMYOPATHY
3.1.2.1.8. thyroid diseas
3.1.2.1.9. main causees
3.1.2.2. PATHOPHYSIOLOGY
3.1.2.2.1. low stroke volume
3.1.2.2.2. less ejection volume
3.1.2.2.3. franksarling mechanism to compensate
3.1.2.2.4. RAAS to compansate
3.1.2.3. manifestaions
3.1.2.3.1. pulmonary edema
3.1.2.3.2. DYSPNEA
3.1.2.3.3. orthpnea
3.1.2.3.4. fatique
3.1.2.3.5. cardiomegaly
3.1.2.4. risk factors
3.1.2.4.1. hyperlipidemia
3.1.2.4.2. diabetes
3.1.2.4.3. hypertension
3.1.2.4.4. smoking
3.1.2.4.5. family history
3.1.2.5. infestigations
3.1.2.5.1. cbc
3.1.2.5.2. BNP
3.1.2.5.3. CXR
3.1.2.6. definition
3.1.2.6.1. inabilily to pump suffeceint amount of blood
4. step7
4.1. inquiry plan
4.1.1. HISTORY
4.1.1.1. SMOKER 20C\D
4.1.1.2. alchohol 5 cups
4.1.1.3. appendectomy - tosillectomy
4.1.1.4. married
4.1.1.5. chronic cough with grey sputum
4.1.1.6. seasonal infections
4.1.2. examination
4.1.2.1. height 173
4.1.2.2. w: 100 kg
4.1.2.3. 36.7 c
4.1.2.4. 120\70 mmgh laying
4.1.2.5. RR: 30\m
4.1.2.6. can't lay flat
4.1.2.7. JVP=6
4.1.2.8. 100 beats\m
4.1.2.9. 3cm liver below CM
4.1.2.10. 3rd HS
4.1.2.11. systolic murmer
4.1.2.12. basal carackles
4.1.3. D
5. step8
5.1. diagnostic dicision
5.1.1. CHF
5.2. objectives
5.2.1. management of CHF
6. step9
6.1. revision
7. step10
7.1. managmement
7.1.1. pharma
7.1.1.1. diureteics
7.1.1.1.1. furosomide
7.1.1.1.2. metolazone
7.1.1.1.3. SE
7.1.1.1.4. no effect on survival
7.1.1.2. ACEI
7.1.1.2.1. IMPROVE SURVIVAL
7.1.1.2.2. NOT BEFORE DIURETICS
7.1.1.2.3. SMALL DOSES
7.1.1.2.4. SE
7.1.1.3. beta-blocker
7.1.1.3.1. inhibit remodeling
7.1.1.3.2. relive heart mouscle
7.1.1.3.3. beta 1 selective
7.1.1.3.4. improve mortaltity
7.1.1.4. spirolactone
7.1.1.4.1. improve mortality
7.1.1.5. angiotensin II receptor antagonist
7.1.1.5.1. candesartan
7.1.1.5.2. no cough
7.1.1.6. acute setting
7.1.1.6.1. morphin
7.1.1.7. digoxin
7.1.1.7.1. not primary considered
7.1.1.8. evapridin
7.1.1.8.1. block calcium channel
7.1.1.9. nitrates
7.1.2. non pharma
7.1.2.1. dietary restriction
7.1.2.1.1. low salt
7.1.2.2. weight reduction
7.1.2.2.1. our pt
7.1.2.3. alchohol abstenence
7.1.2.3.1. our pt
7.1.2.4. smoking cessation
7.1.2.4.1. our pt
7.1.2.5. education
7.1.2.5.1. weight and dose and diet
7.1.2.6. devises
7.1.2.6.1. AICD
7.1.2.6.2. pacemaker
7.1.2.6.3. remodeling devises
7.1.2.7. heart transplant
7.1.2.7.1. NOT gold standard
7.1.2.7.2. comlication
7.1.2.7.3. usually ypunger pt
7.1.2.7.4. not for our pt
7.1.2.8. valvular repair
7.1.2.9. exercise
7.1.3. classification of severity
7.1.3.1. NYHA
7.1.3.1.1. class 1
7.1.3.1.2. class 2
7.1.3.1.3. class 3
7.1.3.1.4. class4
7.1.4. goals
7.1.4.1. control symptoms
7.1.4.2. prevent complication
7.1.4.3. increase survival
8. resourecses and feddback
8.1. cumar
8.2. sherwede
8.3. myoclininc
8.4. e.medicine
8.5. robbin
8.6. uptodate
8.7. abo ossa's lecture
9. step one
9.1. difficult words
9.1.1. plump: obese
9.1.2. flustered: confused
9.1.3. dappled: spotted
9.2. cues
9.2.1. male; 4th decade
9.2.2. fat
9.2.3. closed eyes and ehauxted
9.2.4. exahusted
9.2.5. flustered
9.2.6. discolerd dappled ankles
9.2.7. pitting edema
9.2.8. 2 year onset
9.2.9. breathlessness on exertion for few monthes
9.2.10. medical attention not sought inintially
9.2.11. dyspnea worsened
9.2.12. gain weight
9.2.13. swollen ankle
9.2.14. sleep troubled
9.2.15. orhtopnea
10. step2
10.1. 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.
11. step3
11.1. hypothesis generation:
11.1.1. edema is due to undermined hydrostatic pressure or oncotic one
11.1.2. heart problem or failure
11.1.3. renal problem
11.1.4. infection
11.1.5. breathlessness is due to heart failure oe weakness; v\q mismatch
11.1.6. hyperlipedimia: precipitate in heart failure
11.1.7. gaining weight could be the cause. or just a symptom
11.1.8. lung problem
11.1.9. bilatiral edema: kidney, lung, or heart disease.
11.1.10. heart is overwhelmed
11.1.11. dyspnea: obsteructive, distructive or hemoblobin problem.
11.1.12. left sided problem cause pulmunary edema.
11.1.13. CHF causing pulmonary or generalised edema
11.1.14. DVT as underlying cause
11.1.15. OSA as underlying cause
11.1.16. AI good pasture syndrome
11.1.17. Anemia
11.1.18. CHF causing pulmonary or generalised edema