AL-NUIASI SURGERY

كيسات لكل السستمات مرتب🔥

#_examin@AlNuaisi

Macleod’s clinical examination 🚨⤵️

مبارك أسود الرافدين 🇮🇶🔥
شلون شفتوا أداء المنتخب اليوم

AL-NUIASI SURGERY pinned «📌مفاتيح حل كيسات الإمتحان الوزاري كل كيس بالامتحان اخذ منه فقط المهم وجاوب. #_Cardiology@AlNuaisi CARDIOLOGY (PROBLEM SOLVING). #Cases Ddx of Chest pain + ST segment Elevation • Transmural myocardial infarction • Prinzmetal angina. • Pericarditis.…»

#_سؤال@AlNuaisi

شاب رياضي كان يلعب طبيعي وماعنده مشاكل اللي صار فجأة توفه🚨

What’s ddx:⤵️

@Alnuaisi_surgerybot

📌مفاتيح حل كيسات الإمتحان الوزاري كل كيس بالامتحان اخذ منه فقط المهم وجاوب.
#_Cardiology@AlNuaisi

CARDIOLOGY (PROBLEM SOLVING).

#Cases

1. S1+S2 +S3 sound +tachycardia = gallop rhythm ➡️ Acute heart failure.
✨
✨
2. Asymmetric pulses in the upper extremities  with absent or weak pulses in the lower extremities; harsh systolic murmur
between the scapulae
Radio radial, Radio femoral delay plus
Rib notching on CXR.

=Coarctation of the aorta
✨

3. Costochondral pain

Sharp localized pain in the anterior chest
that is reproducible with palpation
All other history, invx normal.
✨

4. Atrial flutter.

EKG showing regular undulation
(sawtooth pattern) in the baseline with an
atrial rate of 280–350/min
Heart rate more than 120  bpm
Usually asymptomatic, but may
experience palpitations, syncope, and
lightheadedness with higher heart rates
✨

5. Torsades de pointes (TdP)

A polymorphic ventricular tachycardia  with QRS complexes that progressively
change direction
A prolonged QT internal.
✨

6. Narrow QRS,absence P wave, tachycardia
Heart rate more than 120  bpm.

=AVNRT
💡

7. Undulating baseline with no identifiable
P waves or QRS complexes.

=Ventricular fibrillation
💡

8. Ventricular tachycardia

EKG showing a series of 3 or more successive ventricular contractions (PVCs)
with a wide QRS (usually  120 ms) at a
rate of 100–250 bpm, absence P wave.
✨💡

9. Bee stings, consumption of nuts or shellfish presented with
acute onset generalized rash, flushing, angioedema, headache, and
near syncope, hypotension, tachycardia.

=Anaphylactic shock
✨💡✒️

10. Cool, clammy skin; oliguria; anxiety; confusion, tachycardia, increased vascular
resistance, hypotension
📌History of mi.

=Cardiogenic shock.


#Cardiology
#Cases.
#وزاري

📌مفاتيح حل كيسات الإمتحان الوزاري كل كيس بالامتحان اخذ منه فقط المهم وجاوب.
#_Cardiology@AlNuaisi

CARDIOLOGY (PROBLEM SOLVING).

#Cases

Ddx of Chest pain + ST segment
Elevation
• Transmural myocardial infarction

• Prinzmetal angina.

• Pericarditis.
✒️✒️✒️✒️✒️✒️

1) ANGINA PECTORIS

Old male, smoker or e' hyperlipidemia.
retro-sternal chest pain, ↑ e' exercise,↓ by nitrates and rest, <30 min.

ECG = ↓ST segment.
ST depression
S. Troponin negative
💡💡💡

2) VARIANT ANGINA
Prinzmetal angina=
Young age, no risk factor.

Retro-sternal chest pain not related to exertion.

ECG = ↑ ST segment.⬆️
ST elevation
S. Troponin negative
📌📌📌

3) MYOCARDIAL INFARCTION

old male, smoker + sever chest pain at rest + ↑ ST segment.
ST elevation +-
S. Troponin positive ⬆️⬆️

📌• If complicated with Pulmonary odema dyspnea, orthopnea, pink frothy sputum, sense of impending death.
Bubbling crepitation all over the chest.
💡💡💡💡

4) RHEUMATIC FEVER

5-15 yrs old pt, sore throat (tonsillitis)
after 2-3 wks he developed asymmetrical arthritis, tachycardia, muffling of heart sounds, diastolic murmur.
Or 📌

Pansystolic Murmur ( Rheumatic Fever)
ECG↑ PR interval.
Prolonged PR interval ⬆️
📌📌📌📌

5) IEC = (FEVER + MURMUR)
Infective endocarditis
After a surgery or tooth extraction.
Fever in cardiac Patient . Rheumatic Activity / IEC/Chest Infections.
💡💡💡💡


6) VIRAL PERICARDITIS Viremia (flu like
History of flu or sore throat then after weeks patient with chest pain aggrivated by cough,sneezing
Relieve by rest.
Or 📌

Chest Pain when Taking Breath , FHMA [ Fever , Headache , Malaise , Anorexia ] , Pericardium Rub ,
(Elevated ST concave shape in All Leads ( Viral Pericarditis
✒️✒️✒️✒️✒️✒️


7) . CONSTRICTIVE PERICARDITIS
Patient past history of T. B                 
dyspnea, orthopnea, (neck veins)
+pulsus paradoxus.
📌📌📌📌📌


8) HOCM = Young Athlete + Sudden Death after Exercise. (Autosomal dominant  + murmur ↑ )

Ddx Aortic stenosis 📌
MI
Mitral valve prolapse
Arhythmiogenic RIGHT ventricular cardiomyopathy
✒️✒️✒️💡💡


9) PULMONARY EMBOLISM

Cough, dyspnea, sudden chest pain (pleurisy) unexplained tachypnea pulmonary embolism.
Tachycardia
History of prolonged sitting no movement
In Ecg tachycardia or RBBB or S1 Q3 T3
D. Dimer high ⬆️⬆️
📌📌📌📌📌

10) DISSECTING AORTIC ANEURISM

Old male, un-controlled HTN.
Severe acute chest pain radiating to the back.
unequal pulse volume on both sides.
unequal blood pressure on both sides

11) Left atrial MYXOMA = Young female e' recurrent
syncopal attacks.
In Echo thrombus in left atrial.
🔖🔖🔖

12) MV PROLAPSE = Young female e' atypical
chest pain, recurrent arrhythmiae'
palpitation.
Fever + Murmur + Any thromb- embolic manifest. eg. Hemi-plegia
📌📌📌

13.) Diabetic Patient , Epigastric Pain Not Relieved by Antacids , Nausea , Vomiting ( Inferior MI).
St elevation in leads II, III, AVf
💡💡💡💡

14.) Murmurs
✒️✒️✒️✒️✒️
 Mitral valve stenosis = mid diastolic localized to apex.
✒️✒️✒️✒️

MR = Systolic ("pan Systolic murmur and radiating to Axilla.
💡💡💡💡💡

 AR = early Diastolic murmur in 2nd Aortic Area & AS = ejection Systolic murmur Radiating to Carotid Apex + Syncope
🔖🔖🔖🔖

 Irregular Pulse & Stroke = atrial fibrillation
💡💡💡💡


 Ischemic Pain ( If > Half hour = MI ... If < Half hour = Angina)
✒️✒️✒️✏️✏️

15.)
 Persistant ST Elevation in Patient with MI
( Myocardial Aneurysm [ Late Complication . of MI ]
🖊️🖊️🖊️

16. )
 Symptoms of Low Cop + Muffled Heart sound + Low voltage ECG ( Pericardial Effusion).
Or cardiac tamponade if with Severe chest pain, SOB.
💡💡💡

17. )
 Multiparus Female + Dyspnea & Chest Pain +.
Loud S2 ( Pulmonary HTN “ Repeated Showering.
🔖🔖🔖🔖

18. )
 Chest Pain + Cough + Dyspnea + Hemoptysis + tinge of jaundice ( Pulmonary Infarction).
🔖🔖🔖

19.)
 Acute Shock + Cyanosis + Dyspnea + Low cop ( Massive Pulmonary Embolism).
🧩🧩🧩

20. )
 Long Standing “ severe ” HTN + Disturbed Conscious Level Without Lateralization
( Hypertensive Encephalopathy).
✨✨✨

21. Anorexia , Nausea , Vomiting & Blurring of Vision in Patient with HF ( Digitalis toxicity).

#وزاري

🚨 treatment of STEMI 🫀
1 Aspirin tab 300 mg bolus then 100mg الاسبرين لازم يكرطهن .
2-Ticagrelol tab 180 mg bolus then 90mg *2.
3-Metoprolol (5-15 )mg IV or (50-100 )mg PO ( bolus) then 50 mg 1*2 PO
4-(Actilyse) (100)mg total dose
- هنا نقسم الجرعه ثلاثة
١ _خلا دقيقتين ننطي (ملغ١٥)
٢_خلا نصف ساعه ننطي (ملغ٥٠)
٣_ ننطي اخر ساعه (ملغ٣٥)
هنا كملنه ال 100mg.
5-Enoxaparin 6000 iu 1*2 SC.
6-Atorvastatin 40-80 mg
7-intravenous Nitrates (glyceryl trinitrate 0.6–1.2 mg/hr
8-enalapril (10 mg twice daily).

#_approach
🚨 STEMI ….
جداً مهم ‼️

1-For patients < 120 minutes away from a PCI-capable facility
مريضنا عنده ستمي ووقت الاحوله لل pci اقل من 120 دقيقه شتسوي؟⤵️

A-Immediate cardiology consult and evaluation for emergency revascularization

B-Start medical therapy (Antiplatelet and anticoagulants)
_________

2-For patients > 120 minutes away from a PCI-capable facility and symptom onset < 12 hours
مريضنا عنده ستمي ووقت الاحوله لل pci اكثر من 120 دقيقه شتسوي؟⤵️

A-Immediate cardiology consult, even if no PCI is available

B-Check for absolute and relative contraindications to fibrinolysis

C-If no absolute contraindications present: Administer fibrinolysis

D-Start medical therapy (Antiplatelet and antocoagulants)ا عنده ستمي ووقاحوله لل pci اكثر
3-For all patients with STEMI

A-Adjunctive medical therapy for ACS

B-Continuous telemetry, serial ECG, and serum troponins every 4–6 hours

C-ICU level of care

#cardiology@AlNuaisi
نبلش كارديواا🫀🔥🔥🔥