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Cardiovascular Symptomatology Based on Physiopathology

Cardiovascular Symptomatology Based on Physiopathology. نشانه شناسي بيماريهاي قلب و عروق بر اساس فيزيوپاتولژي (رفتارشناسي سيستم قلبي عروقي ). By: Amir F.Z.Parsa , M.D. Director Division of Cardiology Tehran University of Medical Sciences .

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Cardiovascular Symptomatology Based on Physiopathology

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  1. Cardiovascular Symptomatology Based on Physiopathology نشانه شناسي بيماريهاي قلب و عروق بر اساس فيزيوپاتولژي (رفتارشناسي سيستم قلبي عروقي ) By: Amir F.Z.Parsa, M.D. Director Division of Cardiology Tehran University of Medical Sciences

  2. Questions that we confronted with and must be answered What is symptomatology? What is difference between symptom and sign? What is difference between symptomatology and etiology? What is difference between etiology and pathophysiology? Why should we know cardiac symptomatology? What is presenting symptom? What is chief complain? How can we matched chief complain with the diagnosis? Why should we be logical? What is difference between knowledge and judgment?

  3. Cardiac Cardinal Symptoms • Chest pain or discomfort • Dyspnea • Palpitation • Syncope • Cyanosis & clubbing • Edema

  4. Chest Pain

  5. Chest Pain What is pain?

  6. Origin of Chest Pain Supradiaphragmatic organs (intra-thoracic organs) Subdiaphragmatic organs Chest wall & Dorsal lumbar

  7. Mechanism of Cardiac Pain • Biochemical substances • P.substance (Th.Lewis) • Bradykinin, Serotonin, Adensin & et cet…. • Mechanical factors (Wenckebach)

  8. Neural transmission of cardiac pain

  9. Perception of Chest Pain Specificity theory (simple neural transmission) Gate control theory (Melzac & collegues)

  10. Pathogenesis of Cardiac Pain • Myocardial ischemia • Myocardial injury • Decreased blood supply (infarction) • Inflammation (myocarditis) • Myocardial dilatation

  11. Physiology of Cardiac Circulation & Metabolysm

  12. Factors Influencing Cardiac Oxygen Consumption Heart rate Myocardial contractility Afterload & preload

  13. Etiology of Myocardial Ischemia or Injury • Factors that influence supply (coronary) • Atherosclerotic • Vasculitis • Spasm • Increased resistance (arteriolar) • Factors that influence demand (myocardial) • Heart rate, pre-load and after-load (e.g. tachycardia myocardial hypertrophy; HCM- AS- Hypertension…)

  14. Behavior of Cardiac & Non-Cardiac Chest Pain Onset of pain Duration of pain Quality of pain Locations & distributions of pain Accompanying symptoms

  15. Symptoms of Myocardial Ischemia • Angina pectoris • Location • Duration • Quality • Behavioral manner • Alternatives of angina pectoris

  16. Location of Chest Pain (Angina)

  17. Alternatives of Angina Pectoris Dyspnea or suffocation (chest tightness) Fatigue or exhaustion

  18. Characteristics of Chest Pain • Angina pectoris • Typical • Atypical • Non-anginal chest pain

  19. Clinical Presentation of CHD Stable angina pectoris Unstable angina pectoris Prolonged chest pain

  20. Causes of Prolonged Chest Pain Myocardial infarction Aortic dissection Systemic & pulmonary hypertension Pericardial and/or pleural inflammation Gasterointestinal origin Musculoskeletal & Neural (chest wall) origin

  21. GasterointestinalCauses of Chest Pain Esophageal spasm Esophageal reflux Peptic ulcer & gastritis Cholecystitis Pancreatitis Splenic flexure syndrome Cafe coronary

  22. Musculoskeletal Causes of Chest Pain Costocondritis and/or myositis(tietze’s syndrome) Herpes zoster Scalenusanticus Radicular pain (radiculopathy) Shoulders osteoarthropathy

  23. Dyspnea What is dyspnea?

  24. Dyspnea Unpleasant awareness of breathing and respiratory distress , disproportionate to the degree of activity

  25. Dyspnea Exhilarating Unpleasant Breathlessness

  26. Respiratory Dysfunction Increased airway resistance Decreased lung compliance Respiratory muscle weakness

  27. Ventilatory Drives Intrapulmonary receptors stimuli (congestion or inflammation) Abnormal blood gases (Hypercapnea-hypoxia) Central nervous system stimuli (Anxiety)

  28. Mechanism of Dyspnea Respiratory muscle tension-length misalignment Increased respiratory center activity (Tachypnea)

  29. Pathogenesis of Dyspnea Pulmonary congestion Increased pulmonary arterial pressure Abnormal blood gases

  30. Clinical Presentation of Cardiac Dyspnea Exertionaldyspnea (fatique) Orthopnea Paroxismalnucturnaldyspnea (PND) Acute pulmonary edema (cardiac asthma)

  31. Differential Diagnosis of Dyspnea Lung diseases (acute & chronic) Pulmonary hypertension & emboli Massive pleural effusion Overweight or pregnancy Hyperventilation & acidosis

  32. Palpitation What is palpitation?

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