Health Guide

  Gastro-esophageal reflux disease (GERO)  Overview GE reflux is generally a result of transient relaxation of the lower esophageal sphincter (LES). The transient relaxation is a vagally mediated reflex, which is the physiologic mechanism of belching. Transient relaxations occur at increased frequency with gastric distension and in the upright position. Hiatal hernia is risk factor for factor for GERD. LES pressure is increased by motilin, acetylcholine, and possibly gastrin. Therefore, drugs that increase these mediators tend to decrease reflux. LES pressure is decreased by progesterone (pregnancy increases GE reflux), chocolate, smoking, and some medications, especially those with anticholinergic properties.  Suspect GE reflux disease (GERD) in patients with a persistent, nonproductive cough, especially with hoarseness, continual clearing of the throat, and a feeling of fullness in the throat. This cough is commonly worse at night when the patien...

sudden↑in pulmonary venous pressure ➡️ Acute left sided heart failure e.g. myocardial infarction. ➡️On top of chronic LSHF : MS with aggravating factor as AF.  Clinical   S/S  :  Severe dyspnea at rest & orthopnea. Sense of impending death. Sweating & irritability. Cyanosis. Crepitation .  Cough with frothy pink sputum. Diagnostic Testing • Radiographic abnormalities include cardiomegaly, interstitial and perihilar vascular engorgement, Kerley B lines, and pleural effusions. • The radiographic abnormalities may follow the development of symptoms by several hours, and their resolution may be out of phase with clinical improvement. Treatment   Supplemental oxygen should be administered initially to raise the arterial oxygen tension to >60 mm Hg. Mechanical ventilation is indicated if oxygenation is inadequate by noninvasive means or if hypercapnia coexists. ◦ Placing the patient in a sitting position improves pulmonary function. ◦ ...

CARDIAC TAMPONADE The normal pericardium is a fibroelastic sac containing a thin layer of fluid that surrounds the heart. When larger amounts of fluid accumulate (pericardial effusion) or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may occur: 1.Cardiac tamponade –  2.Constrictive pericarditis –  3.Effusive-constrictive pericarditis –  The Beck triad of acute cardiac tamponade includes jugular venous distention (JVD) from an elevated central venous pressure(CVP), hypotension, and muffled heart sounds. In trauma,only one-third of patients with cardiac tamponade demonstrate this classic triad, although 90% have at least one of the signs. The simultaneous appearance of all three physical signs is a late manifestation of tamponade and usually seen just prior to cardiac arrest. Other symptoms include shortness of breath, orthopnea, dyspnea on exertion, syncope, and symptoms of inadequate perfusion. The clinical...

Mitral stenosis describes the obstruction of blood flow across the mitral valve from the left atrium to the left ventricle. This leads to increases in pressure within the left atrium, pulmonary vasculature and right side of the heart. It is said that the causes of mitral stenosis are rheumatic fever, rheumatic fever and rheumatic fever. Rarer causes that may be seen in the exam include mucopolysaccharidoses, carcinoid and endocardial fibroelastosis Features dyspnoea ↑left atrial pressure → pulmonary venous hypertension haemoptysis due to pulmonary pressures and vascular congestion may range from pink frothy sputum to sudden haemorrhage secondary to rupture of thin-walled and dilated bronchial veins mid-late diastolic murmur (best heard in expiration) loud S1 opening snap indicates mitral valve leaflets are still mobile low volume pulse malar flush atrial fibrillation secondary to ↑ left atrial pressure → left atrial enlargement Features of severe MS length of murmur increas...