Name:Hammas Khalid

Group 8
Surgery (+ industrial medical practice)
Topic 11
Clinical Task 1
During a routine medical examination of a 22-year-old patient who had no
complaints, auscultation revealed mild diastolic murmur in the third and
fourth
intercostal spaces along the left parasternal line.

Answer.
1)Mitral Stenosis
2)

Echocardiogra
m

Enlargement of left atrium and ventricle Identify valve abnormality Valve

calcification Severity of regurgitation
3) Mitral stenosis can be assessed in parasternal, apical or subcostal views. As with any
stenotic valve the main diagnostic feature in the parasternal long axis view in rheumatic MS, the
anterior mitral leaflet (AMVL) shows diastolic doming or hockey-stick shape.
4) Blood thinners (anticoagulants) to help prevent blood clots.
.Beta blockers, calcium channel blockers or digitalis glycosides to slow your heart rate and allow
your heart to fill more effectively.
. Anti-arrhythmics to treat atrial fibrillation or other irregular heart rhythms associated with
mitral valve stenosis.
5)T he overall 10-year survival rate of untreated patients who have acquired MS is 50-60%, but
the 10-year survival rate reaches 80% if the patient is asymptomatic.
. Once symptoms develop, prognosis worsens significantly. If the patient presents with dyspnea,
the 1-year survival rate is less than 15%

Clinical Task 2.
Patient M., 18 years old, complained of frequent headaches and nosebleeds,
shortness
of breath during exercise.
Answer:
1)Hypertension
2) Patient's description of headaches, swelling of the lower extremities, consecutive uncontrolled
hypertensive blood pressures, combined with the potential for chronic hypertensive damage leading to
organ dysfunction, provides rationale for this differential diagnosis.
3). Elevated blood pressure: Your systolic pressure is 120-129 and your diastolic pressure is less
than 80.
.Stage 1 hypertension: Systolic 130 to 139 or diastolic 80 to 89.
.Stage 2 hypertension: Systolic at least 140 or diastolic at least 90.
.Hypertensive crisis: Your blood pressure is 180/120 or higher.

4) .Diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys
eliminate sodium and water from the body.
 Angiotensin-converting enzyme (ACE) inhibitors.
 Angiotensin II receptor blockers (ARBs).
 Calcium channel blockers.
5) Untreated hypertension is notorious for increasing the risk of mortality and is often
described as a silent killer.
. Mild to moderate hypertension, if left untreated, may be associated with a risk of atherosclerotic
disease in 30% of people and organ damage in 50% of people within 8-10 years after onset.

Clinical Task 3:

Patient 54 was admitted to the clinic with attacks of asthma, chest pain with
light
exercise, palpitations. As a child he often had sore throat, not fully treated.

Answer.

1)Mitral Valve Stenosis

2)
 Echocardiogra
m

Enlargement of left atrium and ventricle Identify valve abnormality Valve

calcification Severity of regurgitation

3) The auscultatory findings characteristic of mitral stenosis are a loud first heart sound, an
opening snap, and a diastolic rumble.
.The first heart sound is accentuated because of a wide closing excursion of the mitral leaflets.

4). anticoagulants, or blood thinners, to reduce the risk of blood clots.

 diuretics to reduce fluid buildup through increased urine output.
 antiarrhythmics to treat abnormal heart rhythms.
 beta-blockers to slow your heart rate.
5) The overall 10-year survival rate of untreated patients who have acquired MS is 50-60%, but
the 10-year survival rate reaches 80% if the patient is asymptomatic.
. Once symptoms develop, prognosis worsens significantly. If the patient presents with dyspnea,
the 1-year survival rate is less than 15%.

Clinical TASK 4.

Patient N., 19 years old, complains of shortness of breath, which increases

with

exercise, fatigue, palpitations. At inspection the lag in physical development,

pallor of
skin is noted.

Answer:

1) Pulmonary Arterial Hypertension

2) The differential diagnosis includes congestive heart failure, coronary artery disease,
pulmonary embolism, and chronic obstructive pulmonary disease. Advanced PAH may
present as clinically evident right-sided heart failure, dizziness, syncope, edema, or
cyanosis.

3)
 .Blood test. A blood test can help your doctor learn what's in your blood.
.Chest X-ray. If you have advanced PAH, a chest X-ray may show the enlarged part of your
heart.
.CT scan.
.MRI scan.
.Electrocardiogram.
.Echocardiogram.
.Heart catheterization.
.Pulmonary function test

4) .Anticoagulant medicines – such as warfarin to help prevent blood clots.

.Diuretics (water tablets) – to remove excess fluid from the body caused by heart failure.
Oxygen treatment – this involves inhaling air that contains a higher concentration of
oxygen than normal.
5)
Survival in patients with primary pulmonary hypertension: results from a national
prospective registry.
. The estimated median survival was 2.8 years, with 1-year, 3-year, and 5-year survival
rates of 68%, 48%, and 34%, respectively. Other series have studied the natural history of
IPAH with similar results.

Clinical Task 5.

Patient H, 49 years old, was admitted to the clinic with complaints of

hemoptysis,
weakness, shortness of breath.

Answer.

1)Pulmonary Embolism

2) Common differential diagnoses include: Acute heart failure. Pneumonia. Chronic

obstructive pulmonary disease exacerbation

3). Chest X-ray.

1. Ventilation-perfusion scan (V/Q scan)
2. Pulmonary angiogram.
 3. Spiral computed tomography.
4. Magnetic resonance imaging (MRI)
5. Duplex ultrasound.
6. Electrocardiogram (ECG or EKG)

4)
. Blood thinners (anticoagulants). These drugs prevent existing clots from enlarging and new
clots from forming while your body works to break up the clots. ...
 Clot dissolvers (thrombolytics). While clots usually dissolve on their own, sometimes
thrombolytics given through the vein can dissolve clots quickly.

5)
. The prognosis of patients with PE depends on two factors: the underlying disease state and
appropriate diagnosis and treatment.
 Approximately 10% of patients who develop pulmonary embolism die within the first
hour, and 30% die subsequently from recurrent embolism.

Clinical Task 6.
Parents of a sick child aged 16 months, complain of cyanosis of the skin of the
child,
which occurs during crying or feeding.

Answer.
1) Infant methemoglobinemia is also called “blue baby syndrome.”

2)Blue baby syndrome is typically caused by abnormalities in the heart, lungs, or blood.
.Normally, after receiving oxygen from the lungs, blood is delivered from the heart to the rest of the body.
When it returns to the heart, the blood is sent to the lungs to collect more oxygen

3)These tests will help determine the cause of blue baby syndrome.
.Tests can include: blood tests. chest X-ray to examine the lungs and the size of the
heart

4)Mild cases of methemoglobinemia may not require treatment.

. The main treatment for severe cases of acquired methemoglobinemia is the drug methylene blue, which
can provide oxygen to the blood.
. Other treatments include ascorbic acid, blood transfusion, exchange transfusion, and oxygen therapy

5)Blue baby syndrome can be scary, but medical advancements have made it possible for doctors to
achieve amazing results when treating congenital heart defects.
. The majority of babies and children who receive medical care for heart defects can go on to live long,
normal, and healthy lives

Clinical Task 7.
The patient, 42 years old, was admitted to the clinic with complaints of pain in
the
heart of angina pectoris, palpitations, dizziness. As a child he often suffered
from sore
throat, suffered from bacterial endocarditis.
Answer.
1)Hypertension
2) Patient's description of headaches, swelling of the lower extremities, consecutive uncontrolled
hypertensive blood pressures, combined with the potential for chronic hypertensive damage leading to
organ dysfunction, provides rationale for this differential diagnosis.
3). Elevated blood pressure: Your systolic pressure is 120-129 and your diastolic pressure is less
than 80.
.Stage 1 hypertension: Systolic 130 to 139 or diastolic 80 to 89.
.Stage 2 hypertension: Systolic at least 140 or diastolic at least 90.
.Hypertensive crisis: Your blood pressure is 180/120 or higher.

4) .Diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys
eliminate sodium and water from the body.
 Angiotensin-converting enzyme (ACE) inhibitors.
 Angiotensin II receptor blockers (ARBs).
 Calcium channel blockers.
5) Untreated hypertension is notorious for increasing the risk of mortality and is often
described as a silent killer.
. Mild to moderate hypertension, if left untreated, may be associated with a risk of atherosclerotic
disease in 30% of people and organ damage in 50% of people within 8-10 years after onset.
Clinical Task 8.
The patient, 44 years old, was admitted to the clinic with complaints of
shortness of
breath, chest pain, heart compression, palpitations, dizziness.

Answer.

1)Hypertrophic Cardiomyopathy

2) Systemic hypertension and aortic stenosis are the most common causes of acquired left ventricular
hypertrophy and should be excluded when HCM is suspected

3) A doctor will base this list on several factors, including a person's medical history and the results of
any physical examinations and diagnostic tests. Many conditions share the same symptoms

4) .Beta blockers such as metoprolol

 Calcium channel blockers such as verapamil (Verelan, Calan SR,)
5)HCM has a relatively benign prognosis (1% cardiac annual mortality) that is 2-4 times
less than previously thought.
.These findings might have important consequences for risk assessment in individual
patients.
.Echocardiography is obligatory to determine the presence, and extent of myocardial
hypertrophy.
5)HCM has a relatively benign prognosis (1% cardiac annual mortality) that is 2-
4 times less than previously thought.
.These findings might have important consequences for risk assessment in
individual patients.
. Echocardiography is obligatory to determine the presence, and extent of
myocardial hypertrophy.

Clinical Task 9.

Patient N., 10 years old, complains of shortness of breath, which increases

with
exercise, fatigue. At inspection the lag in physical development, pallor of
skin is
noted.

Answer.

1)Pulmonary Hypertension

2) he differential diagnosis includes congestive heart failure, coronary artery disease,

pulmonary embolism, and chronic obstructive pulmonary disease.
. Advanced PAH may present as clinically evident right-sided heart failure, dizziness,
syncope, edema, or cyanosis.

3)Initial findings – The initial physical finding of PH is usually increased intensity of the pulmonic
component of the second heart sound, which may become palpable as PH progresses.
.The second heart sound is narrowly split or single (ie, normal) in patients with preserved right ventricular
function.
Blood vessel dilators (vasodilators).
4).
 Guanylate cyclase (GSC) stimulators.
 Endothelin receptor antagonists.
 Sildenafil and tadalafil.

5)While there's currently no cure for PAH, the typical prognosis is much better today
than it was 25 years ago. "The median survival [from time of diagnosis] used to be 2.5
years," Maresta says. "Now I'd say most patients are living seven to 10 years, and some
are living as long as 20 years."

Clinical Task 10.

Patient 54 was admitted to the clinic with attacks of asthma, chest pain
with light
exercise, palpitations. As a child he often had sore throat, not fully treated.

Answer,

1)Cardiac Asthma
 2) The differential diagnoses of asthma include: Bronchiectasis — clinical features include
copious sputum, frequent chest infections, a history of childhood pneumonia, and coarse lung
crepitations. For more information, see the CKS topic on Bronchiectasis

3) Physical exam. The doctor may look for other signs of cardiac asthma and heart failure, such
as abnormal sounds in your lungs when breathing and abnormal heart rate.
1. Blood tests.
2. Electrocardiogram.
3. Echocardiogram.
4. Chest X-ray.
5. Breathing tests.
6. Other imaging techniques

4) The treatments for cardiac asthma depend on the cause (such as heart failure or leaky
valve), but may include heart medicines to control blood pressure and remove excess
fluid, proper diet, and modified daily activities.
,If the cause is a leaky valve or congenital heart defect, over time surgery may be needed.

5) Cardiac asthma can be potentially life threatening, and a proper diagnosis is critical.

However, it can be misdiagnosed as asthma due to the similarities between the symptoms. People
with either condition can experience coughing, shortness of breath, and wheezing.