AJIRA ZETU BLOG

  Dyspnea and Respiratory Distress   Shortness of breath or dysnpea is the sensation of difficulty the breathing. Acute respiratory distress is a more severe form of dyspnea   History Want to always get a detailed history from the patient. When did the shortness of breath start, how long does it last, any exacerbating or alleviating factors. Ask about associated symptoms of chest pain, wheezing, nausea, vomiting, fevers, cough, lower extremity swelling. Ask about orthopnea and paroxysmal noctual dyspnea (PND). Are they getting IV fluids, any recent medications?   Physical examination General: evaluate mental status, are they altered? In respiratory distress with tachypnea, increased work of breathing and using accessory muscles of respiration, nasal flaring? Get vital signs Pulmonary exam: look for decreased breath sounds, rales, wheezes, tracheal deviation, poor air movement Cardiac Exam: listen for murmurs, gallops Extremities: look for lower limb swell...

  Valvular Heart Disease Definition: Valvular heart disease involves outflow obstruction or incompetence of one of four valves of heart. The distribution of disease varies greatly based on population and risk factors. The most valvular diseases are Rheumatic, Congenital or Degenerative. Most common cause of valvular heart disease in Tanzania is Rheumatic heart disease.   Types of valvular disease Aortic Stenosis Pathophysiology: LV hypertrophies in order to overcome outflow obstruction but this compensatory change becomes maladaptive and leads to LV dilatation and CCF Etiology: 1) rheumatic, 2) calcification of normal valve in elderly, 3) calcification/fibrosis of congenital bicuspid valve Symptoms: syncope / angina / CCF (heart failure is a late sign of worsening AS) Exam: pulsus parvus et tardus, soft S2, crescendo/decrescendo systolic murmur at RUSB (if loud enough, can be heard throughout precordium) (as...

  TREATMENT OF HYPERTENSION   Treatment of Chronic HTN When to Treat? See new WHO guidelines for Prevention of Cardiovascular Disease! In general, any patient with severe (Grade 3) HTN and/or signs of complications (stroke, CKD, CAD, CCF, retinopathy etc) should be started on antihypertensive treatment immediately Patients with mild to moderate (Grade 1-2) HTN should be given 3 months to see if they respond to behavioral modification first. If BP remains >140/90 they should then be started on antihypertensives. Counseling All patients with hypertensive should be told to: lose weight (>5kg) if overweight by BMI > 25 reduce salt intake – no added salt in cooking or at table increase physical activity smoking cessation! Reduce alcohol intake (<3 units/day) Patient should also be counseled that, if they start antihypertensives, they will ...

INTRODUCTION TO HYPERTENSION (HTN)   Definition : HTN is simply defined as a persistently abnormal elevation in blood pressure, < 140/90mmHg. HTN is not diagnosed unless BP is elevated on multiple occasions (at least 2-3) or if the patient is complications of HTN (as with patients admitted with hypertensive emergency). We treat HTN because it is a major risk factor for stroke, MI, CCF, CKD, retinopathy and peripheral vascular disease. The risk of hypertensive complications increases continuously throughout the BP range.   Physiology of HTN : HTN is caused by a combination of cardiac output, peripheral vascular resistance and sodium retention (regulated by the renin-angiotensin system). The latter 2 factors are more important. All treatment of HTN targets these factors.   Epidemiology : HTN is a growing problem in sub-Saharan Africa. Early studies indicated HTN was rare in Africa but several recent studies have shown that the prevalence of HTN is now 5-15% (highe...

  Infective Endocarditis (IE)   Definition :   Infection of the endothelium of the heart, usually but not limited to the valves. Can be divided according to either subacute onset (often due to Strep viridians ) or acute onset (less common, often due to Staph aureus ).   Pathophysiology: Infection of the valves with bacteria (or rarely fungi) cases injury to the valve and valvular regurgitation. The bacteria continues to grow on the valve and can form a large mass or vegetation. Parts of this vegetation can embolize to other parts of the body. The immune response to these organisms leads to the production of immune complexes. Essentially, infection of the endothelium causes 1) persistent bacteremia, 2) valvular disfigurement (with vegetations/regurgitation), 3) septic emboli and 4) immune complex phenomenon.   Predisposing conditions: 1.       Abnormal valve* : prior endocarditis, h/o rheumatic heart disease, valvular heart disease...