ist Alini School Opredicing) ‘Cairo Unt reisiy i + Absent Students L Yas ak y feCardiology Sheets Under Supervision Of- Assistant Professor Of Critical Care Medicine , Kasr Alini School Of Medicine Cairo University Introduced by :- YM - than Students 2014 Dont Forget Ue From Your Do5aa ©Dr/Mohiamed Ali, MD Cardiology Sheet © gyell acetal dis Joss lily Lash gaylS gle Gd ond 26 shi! Gye ale lad! ote Gis Gane ule Paragraph SGSe History J) alba Personal history - -) ( Name , Age, sex, Occupation, Residence(Address), Marital state, Special habits ) 4:bus! 025 Complain I -\} Ve Uso lls he Lal ging MISE nll A lg ely IE 4) a Sie 09 cbell hy Gadde Gap Agha ag hie gilli de GSI Gghas V+ Ga dala Ge Complain 3 52 ga 2 Ade Cae gl data) 5550 ye hg gel (585 13S Gal gles Lge Si Chall eS pal US Uylay et pea WIS Oke St Shortness or difficult of breathing (Dyspnea) Awareness of heart beat (palpitation) Chest pain , Syncope, Block out (LCOP) Edema of LL (edema (Systemic venous congestion )) <<< Complain 41; Personal history I J ** Male patient ### 40 years old, Married & has 3 offspring, the youngest is 5 years old. He is worker, born in Mansoura & lives in Shubra , he is moderate smoker(he smokes cigarate for ... year ), without other special habits of medical importance He complains of shortness of breath for 2 weeks or Of 2 weeks duration of onset and course CCamScanner se tpsDr/Mohamed Ali, MD 1- Analysis of complain 2- Symptoms of the related system. 3- Other systems kis & yy 4- Investigation & ttt —_—o 1-Analysis of complain (Onset, Course, Duration, Association, What increase & What decrease, Effect of ttt, Date of Jast attack) If pain + ( site, radiation, character ) Duration il Ga el F pa yll Onset ies V5 Course fal wiV, ds ¥ Association Tass Ube 4d tlie al Glad What increase & what decrease Effect of ttt We 6) Uni Vy lb gs pale cS da I De A Date of last attack $F chal lila (2 Gale YI ye si 2-Symptoms of the related system Analysis Wgleis 34a Symptoms ul (Onset, Course, Duration, What increased What decrease... ) 2 MSNo 288 YSIS Ge Gl C.V.S Symptoms Symptoms of lung congestion (Dyspnea ~Cough ~Hemoptysis-Recurrent chest infection ) Symptom of systemic congestion (LL oedema — Ascites —Hepatic congestion — GIT congestion) Symptoms of low cardiac Output (Syncope-Anginal pain —Blurring of vision — Fasy fatigue ) palpitation Pain Cyanosis Embolic manifestation (Weakness —Chest pain —Hematuria-Pain in Lt hypochondrium) Pressure symptoms ( Hoarseness of voice , Dysphagia, Brassy cough ) CCamSeanner se tees!Dr/Mohiamed Ali, MD Symptoms of pulmonary congestion (Dyspnea. Cough. Hemoptvsis. Recurrent chest infection ) HIS€ aula) oyeae ans Jaa’ 1! °(Exertional Dyspnea)( ust 45,8) olagi chic Jae SE a gam Gualled IOP plaall cs i bal Ys SY! jal! elas Wes oan 44) apie 500 Lbs gb Cue AS gle le He ( Orthopnea) Saal! cule 4) HES( PND) cdi 458 cole sill yo ganas Vy cimall a9) dS all) AaiIY (uitll 4S JY) eae coll Guay (Cough) S43 © G2 405 ( yall ABS Gases Js! 40S ovale JY! Gall AS apa Se duaaty Grade IL pr CueS gh Gad! MEE pay Gee pall! Ja- $9 paluy aadli Jg3l aga! aie ents Grade TIT {88 (Hemoptysis) 2 ay Jest Grade IV yee Aug JS 3} jasell gle 3 Sie GLH Iw !1$8(Recurrent chest infection) bas igh pes Grade of Dyspnea est sy ell Grade L alpitation «se Just 52 Ula! 4 (Mitral valve lesion) +3! Suspect ls Ge t Dyspnea 2553 > or No Yes & Regular Yes & Itregular MR AF on top of MS or MR No mitral valve lesion without dyspnea <<<5s\« 3643 Symptoms of systemic venous congestion (Swelling of LL, RT hypochondrial pain, Dyspepsia) SSL Gab HF da ly CBS ay cogil MF bdo Gils de jal IIIS (Swelling of LL) x j5 lay al daly GIS 02 py Gab $f oalall 5: le Alley le bes Gy 98s Gil pill I Bal 8) Gi pls CaS aa ly 1 AS y alls 5 OF CCamScanner se tpsDr/Mohamed A, MD Adal Yh he Bilateral generalized LL Oedema $8 ued 98 Le ca pey Cel A se a cha 8 ll oll od iE at Ua 4 USL Gt da Re $8 SS (od JSUle ad Jatt JI an yy ll Ys ley JY! Ley alll Gye Hepatic: cell Seal i nye ne CJS il Slay apa hall gle Dysphi laa FY Gar Oy » JS LaNut 3} (ceiiall J2ad gi 4824) Malabsorption 63 in ff Uys Lalusy duslue ae Js Angioneuritic (Asthma c+ glisin) 555 ),8 leds Drugs U8 (RT hypochondrial pain)cs4!| dais (a Ui 43 1198 (Dyspepsia) JSY! su: USkie clad Tricuspid Regurge “J Suspect 2 Cl le LL edema a= No rheumatic tricuspid valve affection alone << MR) $9 chal Cys Mail 90 Gy SNOT ask IS 8 Ai GS gene IS HE 4) oI ands GIS #F Colt ale GIS fF gd GIS 09 YL [89 dye Gi all lee Us coe ARE CaS (SLL! 4! (Eructation ) als 4 058! Ga US fF ols 5 Gye G5 ale Ul oles Gite $8 alli alll 4 $8 Casals 5! agen ase da ff Pressure symptoms (Hoarseness of voice, Dysphagia, Brassy cough) J 11£¢( Hoarseness of voice)q) eli po Ja lI€8 (Dysphagia) ald! i 4:yuna dae Ja Patvitation SE aabiiie ue Voy Aaliiie (52 4d pb INNS ALY y da pu GLE OL pot Lala gist 52 Blood pressure changes (Weaknes ja INNS ayy Gas te lanes Gens Symptoms I Ge ust Ys) {N19 Latcall 43 yaf cof ast and Hematuria) Clay sf la ob JE dees ie ll as Nall Aa 3d EI sl ee deDr/Mohiamed Ali, MD © Symptoms of the related system 1) Wald 0 spl duals Symptoms 5S! o) .fU2 C54 I Symptoms tI 4d ay US 3) Dyspnea Palpitation Low cardiac output symptoms LL edema © chyba! pAS Gabry sli! Blo Ssainy Analysis led o5Y wo dale cul © History - (US chile gas ail eld go) go dazeaill [ Hisory of Cardio Onset, Course, *Onset, Course, Onset, Course, + Onset, Corse, Duration Duration Duration Duration +Exertional lic +Regular or «Form (Dizziness, *Unilateral or Schaei eaay aye Irregular Angina pain, Bilateral (if +Orthopnea Lis *Fast or Slow Syncope) unilateral ask fiade lS le + By (Exertion or “tay which leg) pele oan y Und Jub Discontinuity of “By +Extend or Level SUnani dale tte) +Pitting or non SEN Dees }By (Rest or AGS CE pail cn Continuity of ttt) wa : CarScenner is3 galDr/Mohamed Ali,.MD << Qed Glyabw! (Pulmonary congestion, Systemic congestion,congenital heart diseases, Pressure symptoms, HTN, Chest pain, Recurrent fever, Systemic embolization) © 4:54 GLS 418s (oll Present history I Ss ci Lei pie © 50 dargrill Sail MSS aa) aye ope betes dl 59 ele ee Sageentll 90 B85 ja sj! Dyspnea LL edema LCOP Vv Vv Vv (Mitral Valve disease} (__ Tricuspid Regurge Aortic Valve lesio! Pal J 1 1 ‘ No Regular Irregular Yes (regular) MS MR AF on top of MS or MR AR (MS>MR) 3-Symptom of other systems euall 4 Gl System J ay gle ae pe allel SE hod od pa aah Mlaual 9! gu! aie ff Cyaull dhe I lily 3 all ag ff ge 4d GIT ual Gal ANSI G4 USLe ad Ua Pf 4S pall G8) Gulua' YI 4 USLis 4 J8Neuro UsSIVs gil cod Sati atts Ua Sf aie ang 4b Ua 88 U ll ee pa Usa! cet lds 4d Us Nephro Bagertwrey oS JS Chest i le ubss © Jals Chest cn L555 a3¥ chest Jb BYE ly de> cud 9) 4-Investigation & ttt WOE 4g) cDe Cabs HEF 4 Shea gad che CCamScanner se tpsDr/Mohiamed Ali, MD <<< Present history ll Ji ‘The condition started by gradual onset, progressive course of dyspnea of 10 years duration with intermittent exacerbation, the last one 2 weeks ago on discontinuation of ttt, the dyspnea is grade III, ‘The patient experienced orthopnea, PND, the condition is associated with dry cough with the same onset & course, both increase by exertion, lying flat& discontinuation of ttt, relieve by rest & maintenance of diuretics No hemoptysis or recurrent chest infection was experienced by the patient ‘There was history suggestive of systemic congestion as pitting bilateral lower limb edema 6 years ago of gradual onset & progressive course, extending up to mid leg ‘The lower limb edema was associated with pain in the RT hypochodrium of gradual onset, progressive course 5 years ago, the pain is dull aching & without special radiation, the pain increase by exertion, excessive salt intake, discontinuation of diuretics & the pain relieved by rest& by ttt No symptoms suggestive LCOP (no dizziness, syncope, chest pain or intermittent claudication) ‘The condition associated with rapid regular palpitation 10 years ago , the palpitation become irregular one year later, the palpitation increase by exertion, stress& relieve by rest No symptoms suggestive of congenital heart (no cyanosis, late onset of complain, -ve consanguinity) The patient isn't known to be hypertensive or symptoms suggestive for HTN as headache, tinnitus, and epistaxis) No chest pain is detected by the patient Past 48e lui 4 y+ asl y (DM, HTN, TB, Hepatitis, Bilharziasis, ) 65 454) Gal MI ge ((HPT J} 3 aes DM or HTN 0 G'Ss!)) (Rheumatic fever JI a 42S vary M88 98 JS hb i dee JS 15) Slat HSE el gs col SAnslun cel onic si 5 pete Mares As gai Jl WG oS JS Sen cgines (fC jaa Us IG 938 US aa clés Ua MSS oS Js cso allel! alll a CCamSeanner se tees!Dr/Mohamed Ali, MD Family history -!-° WOE cg Stl) Guat oate ayall Ga an Ua \Menstrual history 4) Je Jus Female 04! ois 3 Date of menarche& menopause Menstruation cycle (rhythm, length, duration of flow, amount& color) Dysmenorrhea Inter menstrual period Last normal menstrual period Contraceptive pills <<RT .... precordial bulge) High arched palate « Apex Weak (pigeon shaped chest, hyper inflated (smoker), regular, 5th space CCamScanner se tpsDr/Mohamed A, MD MR, AR, AF Personal history:- Male patient Fathy Abd El-Wahab 27 years old, not married, lives in Alexandria, parper & smoke (20cigarrate/day) Complain:- He complain of shortness of breathing & chest pain which is exaggerated from 1.5 months Present history:- The condition started 13 years ago by gradual onset, progressive course of exertional dyspnea grade IV with orthopnea & PND, associated with palpitation start regular gradual onset & then become irregular of gradual onset & progressive course which is during rest & disappear with ttt ‘The condition associated with cough with yellow tinged sputum especially during morning The condition associated with gradual onset & progressive course of chest pain increase with cough & inspiration There is pitting edema of the 4 limbs when he was 7 years which is gradual onset & progressive course, bilateral at the level of the ankle & wrist with RT hypochondrium pain of gradual onset & progressive course No symptoms suggested pulmonary congestion (no cough, no hemoptysis, and no recurrent chest infection No dyspepsia No symptoms suggest congenital heart disease (late onset of complain, no cyanosis) No pressure symptoms (no brassy cough, hoarseness of voice, dysphagia) No symptoms suggest embolization (weakness, blindness, and hematuria) He investigated by x-ray, Echo, ECG Treated by Concor, Lasix. Marivan, lanoxin Past history. History of rheumatic fever when he was 7 years old, treated by penicillin No history of HTN, DM, TB, Belhariziasis, allergy 17- CCamSeanner se tees!Dr/Mokamed Ali, MD Family history. 3), Mohammed El-Qady Irrelevant Finding,- « Apex Localized, 6th, outside, systolic thrill, irregular, hyper dynamic + Auscultation = Over mitral Sn - Pansystolic murmer of MR, soft, propagated to axilla = Over AZ Soft early diastolic murmer of AR Increase by leaning forward in full expiration Peripheral signs of AR {Corrigan sign, Suprasternal pulsation, WH pulse, Pistol shot, LT parasternal pulsation, Epigastric pulsation (aorta)} CCamScanner se tpsDr/Mohamed AR, MD Double Mitral, Double Aorta Personal history:- Male patient Ayman Mohammed Salem 44 years old, lives in Fisal, he is loyer , he has 4 siblings , the youngest has 8 years , he has no special habits of medical importance Complain:- Difficulty in breathing and palpitation with gradual onset & progressive course Present history:- The condition started 12 years ago with gradual onset and progressive course of exertional dyspnea, not associated with orthopnea or PND, the condition is associated with regular & rapid palpitation, increase by exertion &decrease by rest, No other symptoms suggestive pulmonary congestion (cough, hemoptysis, recurrent chest infection) No symptoms suggestive L.C.O.P as regard (dizziness, syncope, chest pain, intermittent claudication) No symptoms suggestive systemic venous congestion as regard (LL edema, hepatic congestion, ascites ...) No symptoms suggestive congenital heart disease (cyanosis since birth, consanguity...) No symptoms suggestive of HTN (headache blurring of vision...) & chest pain detected by the patient No symptoms suggestive pressure manifestation No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) The patient investigated by ECG, ESR & no ttt Past history. At the age of 7 years the patient complain of fever , arthritis & treated by long acting penicillin & aspirin & stopped ttt at the age of 21 year , no history of other drugs , there is history of tonsillitis CCamScanner se tpsDr/Mohamed Afi, MD Family history. Irrelevant By, Samah Sidi ye + Double mitral * Over mitral sitt sho yh gh Soft pansystolic murmer of MR propagated to axilla + Double aorta Over Al———» only AS murmer (harsh ejection systolic) Over A2——+ two murmer of aorta (systole & diastole) CarScenner is3 galDr/Mohiamed Ali, MD Mitral Valve Replacement, AF, LVE Personal history:- Male patient, Ragab Anwar Mohammed, 53years old, he is a worker, born and lives in Helwan, married & has 2 kids, youngest is 19. Complain:- He complains of shortening of breath for one month, Present history:- The condition started by gradual onset, progressive course of 14 years duration. The patient experienced orthopnea & PND. He also complained of cough with expectoration with the same onset & course. Both increase by exertion & continuation of ttt & relive by rest & diuretics. The condition was associated with rapid irregular palpitation increases by exertion & relieves by rest. He underwent mitral dilatation then replacement There were signs of systemic congestion, ascites & bilateral L L edema of gradual onset & progressive course extending up to mid leg. No other symptoms of pulmonary congestion (no cough, no hemoptysis, no recurrent chest infection) No other symptoms of systemic congestion (LL edema, hepatic congestion, ascites ...) No symptoms of congenital heart disease (late onset of complain, no cyanosis) No pressure symptoms (no brassy cough, hoarseness of voice, dysphagia) The patient is not hupertensive & no symptoms suggestive of HTN. No chest pain No recurrent fever. No embolization, no symptoms of systemic embolization (weakness, hematuria, & stitching pain in LT hypochondrium) The patient underwent chest x ray, echo, ecg, cbe.Dr/Mohiamed Ali, MD Past history. He maintained on marivan. He was known to have theumatic fever at the age of 10 years (fever-arthritis-with recurrent tonsillitis) and was maintained on penicillin and the patient stopped drugs after one year. Family history:- Irrelevant By , Karim Kamah eye Stading, « Scar of median sternetomy « Apex Localized, 6th space, irregular (increase irregularity by exercise) M1888, mitral Yy aorta y3 Goel! sl jll Gye! click 4! gas\s left parasternal «J} «gle 4eLuull Lal -) apex Is) carotid 4 «timing dee! -¥ stole JI a mitral 53+ Jix systole I a 3) mitral 34 G5 « Neck vein Congested, pulsating, systolic expansion, absent A wave « Pulse Unequal pulse volume CCamScanner se tpsDr/Mohamed Ai, MD Congenital AS Personal history:- Male patient Mohammed Shaaban Ahmed 20 years old, born & lives in Hadaiq El-Quba , student, single, no special habits of medical importance Complain:- Exaggerated Chest pain of one week duration Present history:- ‘The condition started at the age of 8 years by retrosternal chest pain radiated to LT shoulder, increase by exertion & decrease by rest, associated with L.C.O.P symptoms (dizzines angina pain) No pressure symptoms (no brassy cough, hoarseness of voice, dysphagia) No other symptoms of pulmonary congestion (no cough, no hemoptysis, no recurrent chest infection) No symptoms suggestive systemic venous congestion as regard (LL edema, hepatic congestion , ascites ...) No fever No cyanosis No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) No palpitation He investigated by Echo, chest x-ray Not received any ttt Past history. The patient has no history of rheumatic fever No history of HTN or diabetes No history of hepatitis, Not received any drugs No history of any operation No history of fever or trauma CCamScanner se tpsDr/Mohiamed Ali, MD Family history: Irrelevant Diagnosis Case of congenital heart disease, most probably aortic stenosis, not complicated & not compensated By, Asmaa Elwan Finding,- + General examination Weak pulse volume « Local examination = Apex Localized, 5th space MCL, regular, no thrill, heaving (sustained) * Over base of the heart. >>> Thrill (over A1, better felt while the patient is leaning forward in full expiration) = Auscultation *Over mitral area -S4 cs <5: (by cone) - Propagated murmer of AS * Over Al -4S2 - Ejection systolic harsh murmer propagated to carotid & apex increase by leaning forward in full expirationDr/Mohamed AR, MD AVR, TR, AF, DM Personal history:- Male patient Abd El-Rahman Gafer , 40 years old , he is medical worker lives in El-Basatin in Cairo , single , he is heavy smoker of moderate socioeconomic state Complain Exaggerated shortness of breathing of gradual onset, progressive course of one month duration Present history:- ‘The condition started started by exertional dyspnea grade III of gradual onset progressive course of 13 years duration increase by exertion & decrease by rest &associated with intermittent exacerbation , the last attack was one month ago , there was no orthopnea or PND ‘There was no hemoptysis, cough or recurrent chest infection ‘There was history suggestive of systemic congestion as the patient has bilateral lower limb edema of gradual onset, progressive course 23 years ago suffer from pain in RT hypochondrium of gradual onset & progressive course increase by exertion & discontinuation of ttt The patient underwent valve replacement operation of 13 years duration There is no symptoms suggestive of L.C.O.P as regard (dizziness, syncope, chest pain, intermittent claudication) The condition also associated with rapid irregular palpitation of gradual onset & progre: course increase by exertion & decrease by rest No symptoms suggestive congenital heart diseases (no cyanosis, late onset of complain ve consanguinity) The patient isn't known to be hypertensive No symptoms suggestive of HTN as regard (headache, tinnitus, and epistaxis) No pressure symptoms (no brassy cough, hoarseness of voice, dysphagia) No recurrent fever, No chest pain CCamScanners Wee paDr/Mohiamed Ali, MD No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) ‘The patient was investigated by chest x-ray, Echo, CBC & receive Lasix, Aldacton, and warfarin Past history. The patient has past history of rheumatic fever at the age of 5 years (fever, arthritis, tonsillitis) The patient admitted in hospital & do tonsillectomy & long acting penicillin No history of bilharziasis, no history of DM & no allergy documented by the patient Family history:- Irrelevant By , Sara Abd El-Fatah Finding,- « Apex ocalized, 6", irregular, hyper dynamic, no thrill + Epigastric pulsation from above — RT ventricular enlargement « LT parasternal pulsation « Auscultation = Over Mitral - Sl audible but variable - Pan systolic soft murmer of MR propagated to axilla - No thrill -GIll = Over Tricuspid Soft pan systolic murmer over tricuspid area increase by deep inspiration "carvallo’ sign S2 is metallic (click) + Neck vein * Congested pulsating neck vein (upper point angle of Jaw ) sternal angle 1) i Ui; (sitting position) Gal! sia La Absent A wave * Systolic expansion CCamScanner se tpsDr/Mohiamed Ali, MD MVR, AF, Pulmonary hypertension Personal history:- Male patient, Mohammed Sabet Ahme, 34 years old , waiter, born in Hadayeq El-Qupa , lives in Elsalam (Cairo), married & has one daughter 7 years old , heavy smoker without other special habits of medical importance Complain:- Awareness of heart beat one week ago Present history:- The condition started 29 years ago by dyspnea grade III, but without orthopnea or PND, increase by exercise &decrease by rest associated with expectoration, whitish of unknown amount The condition investigated by ECG, Echo & treated by long acting penicillin, Lasix, aspirin One year later the patient underwent mitral valve replacement, then the patient was maintained on warfarin ‘The condition associated with palpitation which is rapid, irregular, increase by exercise No symptoms suggested L.C.O.P as regard (dizziness, syncope, chest pain, intermittent claudication) No symptoms suggestive systemic venous congestion as regard (LL edema, hepatic congestion, ascites ...) No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) No symptoms suggestive congenital heart diseases (no cyanosis, late onset of complain ve consanguinity) The patient ttt by Capot, Marfan, Digitalis Past history:- No HTN, No DM, No fever, No TB, No blood transfusion, No belhariziasis Family history:- Irrelevant By Raghda Khaled CCamScanner se tpsDr/Mohiamed Ali, MD Finding;- + MVR ,AF « pulmonary hypertension S2(pulmonary) > S2 (aortic) ‘camseannerDr/Mohamed AR, MD Marian Syndrome Personal history:- Female patient Samah Yossif Khaiffa , 28 years old , housewife , born & still living in Alexandria, single, no special habit of medical importance Age of menarch 16 years old, regular menstruation, d/c = 4/28, then become irregular when she develop the disease Complain:- Exaggerated awareness of heart beats, fever of 3 months duration Present history:- The condition started 8 years ago by rapid regular palpitation of gradual onset, progressive course, and increase by exertion, decrease by rest, ttt, prayer position The condition was associated with exertional dyspnea grade III of gradual onset, progressive course, associated with orthopnea No other symptoms of pulmonary congestion (cough, hemoptysis, recurrent chest infection) The condition was associated with diffuse-tearing chest pain of gradual onset of gradual onset, progressive course radiated to the back & shoulder No symptoms of L.C.O.P (dizziness, headache, bluing of vision, syncope, chest pain, intermittent claudication) The condition was associated with central cyanosis increase by exertion (-ve consanguinity) 2 months later the patient developed bilateral LL edema of gradual onset, progressive course No other symptoms of systemic venous congestion (dyspepsia, RT hypochondrial pain) The patient is known to be hypertensive of 8 years duration, maintained on Lasilactone, Concor, and Caput 3 months ago the patient developed continuous fever for 1.5 months after tooth extraction, relieved by antibiotic, antipyretic No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) ‘The patient was investigated by Echo, PT, coronary angiography & diagnosed as AR, MR & indicated for surgery The patient was treated surgically by AVR (aortic valve replacement) 8 years ago 29- CCamSeanner se tees!Dr/Mohiamed Ai, MD No symptoms of other system affection except hematemesis gradual onset, progressive course, Past histo: No DM, No RF, No TB, No blood transfusion, No belhariziasis, No allergy There is history of surgery >> © Appendectomy 14 years ago © Fibro adenoma I1 years ago Family history. ‘There is history of similar condition in the family (her father was marfan)& there is history of sudden death By , Shima El-Arabi Findi AVR (on top of AR ) == 2nd sound is metallic MV prolapse — MR == LVE Aortic dissection ——» unequal pulse volume Auscultation MR — S1 audible — late systolic soft murmer + Marafan * Sub laxation of lens (LT eye artificial) + High arched palate * Archinodactally + Hyperemobile joint * Span > height + Lower segment > upper segment + Flat foot * Ptosed organ 6", localized, systolic bulge, regular, no thrill 30 CCamScanner se tpsDr/Mohiamed Ali, MD Double Mitral &Double Aorta Personal history:- Male patient Magdy Kassab Salama 32 years old , born & live in Mansheyet Nasser , painter . married & has 4 offspring, the youngest one is one year old, he is moderate smoker (smoking index=14x20=280),but he stopped 1 year ago Complain:- Exaggerated sense of awareness of heart beats since | weak Present history:- The condition started 19 years ago with palpitation which is regular, fast, with gradual onset, progressive course, increase by exertioné& discontinuation of ttt & decrease with rest & continuation of ttt 2 years later the patient started to develop dyspnea (grade 1) then become grade III No orthopnea or PND No other symptoms of pulmonary venous congestion in the form of cough, hemoptysis or recurrent chest infection No symptoms suggestive systemic venous congestion as regard (LL edema, hepatic congestion, ascites ...) No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) No symptoms suggestive congenital heart diseases (no cyanosis, late onset of complain ve consanguinity) No cyanosis No pressure symptoms (dysphagia, hoarseness of voice, dyspnea) Patient isn't hypertensive & no manifestation of HTN as (HCE, tinnitus, epistaxis, blurring of vision) No constitutional manifestation in the form of night fever, night sweating, loss of weight, loss of appetite) Patient is on penicillin every 15 days & Inderal CCamScanner se tpsDr/Mofamed Ali, MD Past history:- At II years old patient started to develop fever, pharyngitis, arthritis(Red, Hot, Tender), he admitted to hospital & investigated by ECHO, ECG, & ESR as Rheumatic fever & ttt by NSAI Family history:- Irrelevant By, Heba Abd El-Rahman Finda « Apex Localized, regular, 5th MCL, hyper dynamic « Auscultation = Over mitral S1 muffled Pansystolic soft murmur propagated to axilla, G3 (no thrill) * Over Alt GH AS.. Harsh ejection systolic murmur over A2 propagated to carotid AR...Early diastolic + peripheral sings of AR (WHP) CCamScanner se tpsDr/Mohamed A,MD Aortic Resurge Personal history: Male patient Gamal Al-Shahawy 35 years old, lives in Al-Mansura city, he is married & has 2 offspring, the youngest is at 8 years old, he is heavy smoker Complain:- Awareness of heart beats at rest for one week ago Present history:- The condition started by gradual onset & progressive course of palpitation which has regular rhythm, increase by exertion & decrease by medication, it is associated with symptoms of LCOP that presented by (headache, dizziness, blurring of vision ...) No other symptoms of pulmonary venous congestion in the form of cough, hemoptysis or recurrent chest infection No symptoms suggestive systemic venous congestion as regard (LL edema, hepatic congestion, ascites ...) No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) No symptoms suggestive congenital heart diseases (no cyanosis, late onset of complain sve consanguinity) No cyanosis No pressure symptoms (dysphagia, hoarseness of voice, dyspnea) No fever Patient underwent ECG, X-ray on chest, CBC, PT, INR Past history:- Patient experienced tonsillitis, fever, arthritis, which indicating rheumatic fever at the age of 10 years, patient maintained on penicillin which stopped at the age of 30 years Family history:- Irrelevant CCamScanners Wee paDr/Mohiamed Ali, MD Diagnosis Rheumatic heart disease most probably AR Fund By, Mohammed Salah ‘« Symptoms Regular, rapid palpitation Peripheral sings of AR * H&N (Corrigan sign , supra sternal pulsation ) = UL(WHP, fsystole | diastole = LL pistol shot « Apex Sth, hyper dynamic, regular « Auscultation A2 Early diastolic soft murmur over A2 increase by leaning forward in full expiration cl é oi ce Sl 2 SI s2 CCamScanner se tpsMohamed Afi, MD AS & MR Personal history:- Male patient Shaaban Ahmed 52 years old, lives in Shobra, he is builder, married & has 3 siblings, the youngest is 20 years old, and he is heavy smoker without other special habits of medical importance Complain:- The patient complain of exaggerated shortness of breathing for 3 weeks Present history:- The condition started with gradual onset & progressive course of dyspnea of 12 years duration with intermittent exacerbation, the last one 3 weeks ago on discontinuation of ttt, the dyspnea is grade IIT ‘The condition associated with rapid regular palpitation 12 years ago, palpitation become irregular 2 years later Before this complaint patient show symptoms of LCOP (Dizziness, blurring of vision, headache, repeated syncope) which make him underwent aortic valve replacement No other symptoms of pulmonary venous congestion in the form of cough, hemoptysis or recurrent chest infection No symptoms suggestive systemic venous congestion as regard (LL edema, hepatic congestion, ascites ...) No symptoms suggestive embolic manifestation (weakness, hematuria, & stitching pain in LT hypochondrium) No symptoms suggestive congenital heart diseases (no cyanosis, late onset of complain «Ve consanguinity) No cyanosis No pressure symptoms (dysphagia, hoarseness of voice, dyspnea) No fever CCamScanners Wee paDr/Mohiamed Ai, MD Past history:- Patient experienced tonsillitis, fever, arthritis, which indicating rheumatic fever at the age of 12. years, patient maintained on penicillin which stopped at the age of 25 years Diagnosis By, Mohammed Salah Rheumatic heart disease most probably MR with AVR Finda AS — Aortic valve replacement —- Functional AS « Symptoms LCOP x syncopal attack —+ AS (AVR) Dyspnea +regular palpitation» MR « Apex Absent (DD... under rib) + Auscultation Sl Moffled = Mitral Soft pansystolic murmur over mitral propagated to axilla (not associated with thrill ) = Over A2 Short ejection systolic murmur of AS Organic AS Functional AS Very harsh Less harsh Over Al Over A2 With thrill No thrill Propagated No propagation CCamScanner se tpsDr/Mohiamed Ali, MD oeieliy lied!) Sle a os Galle ab IS Gayall J Labags ll g9 I CL JS teal 9S © pie Ul JS 3 o2grga cilS JI finding J! Janis ©) dF Ae) aye Ale Jy) MVR, AVR, PH++ esi GIS 93 Pulmonary i cle lel $2 4] JS due oaya.y SIS findings SI abl ae de ay ode functional AS s AR 2% OSs marfan GS» << Ae cals 3! finings I s2 Apex (localized, 6" space outside MCL, regular, no thrill, hyper dynamic) Peripheral signs of AR(Corrigan sign , Pistol shot, WHP, suprasternal pulsation ) Signs of marfan ( high arched palate, hypermobility of the joint, span > height, archinodactaly) Auscultation Over Al ——> Functional AS Over A2— AR (early diastolic soft murmur) AS (ejection systolic murmur) Hape That Our Sinple Work Benefit Lrery One © Dont Forget Ue From Your Do3aa Cast Suite OkSy Yards © Asmaa Elwan CCamScanner se tps