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Cardiology Dr . Ahmad Mowafy
P a g e | 1
Cardiology Dr . Ahmad Mowafy
P a g e | 2
branch
liver
80 %
rheumatology liver
Cardiology Dr . Ahmad Mowafy
P a g e | 3
Heart failure
cardiology
cardiology
branch
Cardiology Dr . Ahmad Mowafy
P a g e | 4
Liver
written
Liver
Liver
Liver
Cardiology Dr . Ahmad Mowafy
P a g e | 5
Liver
Jaundice
Liver
Liver
Liver
Liver rheumatology
15
Cardiology Dr . Ahmad Mowafy
P a g e | 6
Cardiology Neuro
cardiology
cardiology
rheumatology
rheumatology cardiology
cardiology
cardiology
cardiology
cardiology
60 % cardiology
cardiology
cardiology
Cardiology Dr . Ahmad Mowafy
P a g e | 7
Neuro endocrine GIT rheumatology Infection blood chest
cardiology
cardiology
2007
In capsule series
In Capsule Series
arrhythmia
rheumatology
attitude
cardiology
cardiology
clinical picture investigations
clinical pictures
clinical pictures
clinical picture cardiology
Cardiology Dr . Ahmad Mowafy
P a g e | 8
Manifestations of low cardic output
Low cardic output
low cardic output
Low cardic output
headache blurred of vision
Syncope
syncope
ischemic heart disease
Oliguria
S
S
skin
skeletal muscle
skin pale and cold skeletal muscle fatigue claudication
cardiology
fatigue and intermittent claudication
pulse
blood pressure pulse
blood pressure
Cardiology Dr . Ahmad Mowafy
P a g e | 9
low cardic output
symptoms and signs
signs
signs
symptoms symptoms
signs of low cardic output
9: 10
9: 10
signs
Syncope Ischemic heart disease Oliguria Pallor
fatigue and intermittent claudication Pulse Blood pressure
signs
signs of low cardic output
signs of low cardic output
signs
cold
pulse
cyanosis
signs of low cardic output
Cardiology Dr . Ahmad Mowafy
P a g e | 10
Low cardic output
Manifestation of
Pulmonary congestionLung congestion
Pulmonary Lung
Lung congestion
Lung
Left side
Lung left
lung congestion
lung congestion
cardiology dyspnea
dyspnea dyspnea
specific left sided heart failure
specific left sided heart failure
Left sided heart failure
specific
dyspnea
dyspnea
Paroxysmal nocturnal dyspnea
Lung congestion
dyspnea
Cardiology Dr . Ahmad Mowafy
P a g e | 11
Coughhemoptysis
Recurrent chest infection
congestion pleura pleural effusion
congestion acute
alveoli pulmonary edema
alveoli
apparatus
mechanism of
alveoli
crepitation
systemic congestion
systemic congestion
congestion
Cardiology Dr . Ahmad Mowafy
P a g e | 12
Insomnia
congested neck vein
Edema lower limb
edema lower limb
Low cardic output
fatigue
Lung congestion ischemia
systemic congestion edema lower limb
then ascites
edema pitting Non pitting
Pittingbilateral Unilateral
bilateral
Unilateral
heart failure
P
Pittingbilateral
insomnia congested neck vein
edema lower limb then ascites
Cardiology Dr . Ahmad Mowafy
P a g e | 13
sweating on slight activity
systemic congestion
systemic congestion
sweating on slight activity
Liver
Enlargedsoft smooth round edge tender
Liver
GIT
dyspepsia
Dyspepsia Heart burn
diarrhea
dyspepsia
related dyspepsia
Heart failure
systemic congestion
Pleural effusion
Pleural effusion systemic congestion
pleura
visceral Pulmonary circulation
Parietal systemic circulation
Cardiology Dr . Ahmad Mowafy
P a g e | 14
Left right
Left right
Pleural effusion
systemic congestion
Low cardic output
cardiology
Manifestation of low cardic output
Lung congestion
systemic congestion
Pericardial effusion
Pericardial effusion
Pericardial effusion
Low cardic output
systemic congestion
Lung congestion
chest pain chest pain
angina
Cardiology Dr . Ahmad Mowafy
P a g e | 15
Palpitation
arrhythmia Palpitation
Palpitation
bigger not better
Mediastinum
mediastinum
pressure manifestation
trachea Lung
dyspnea cough
esophagus
dysphagia
Nerve
left recurrent laryngeal nerve
Hoarsness of voice
Left recurrent laryngeal nerve
right
right
Cardiology Dr . Ahmad Mowafy
P a g e | 16
Low cardic output
Lung congestion
systemic congestion
Chest pain Palpitation Pressure manifestation
stagnation of blood thrombo embolism
cardiology
clinical picture of cardic tamponade
cardiology
cardiology
Cardiology Dr . Ahmad Mowafy
P a g e | 17
clinical picture
rheumatology
rheumatology
cardiology
Investigation
Investigation
Investigation cardiology
Investigation
ECG
ECHO
angio
cardiology
Investigations
Investigations
Investigations
cardiology
Cardiology Dr . Ahmad Mowafy
P a g e | 18
X-ray ECG ECHO Catheterization
To detect the cause and to detect chamber enlargement
Detect the cause detect the chamber enlargement
ECHO
detect paradoxical movement of the myocardium
paradoxical movement of the myocardium
ECG
ECG To detect the cause and detect chamber enlargement
ECG
ECG
Angina ECG angina
Myocardial infarction
dry pericarditis
Cardiology Dr . Ahmad Mowafy
P a g e | 19
arrhythmia arrhythmia ECG
ECG
ECG
detect the cause and detect chamber enlargement
investigations
myocardium infarction
cardic enzymes
Myocardial infarction
cardic enzymes
ECG
Infective endocarditis
infective endocarditis
culture
pulmonary
20 :40
Cardiology Dr . Ahmad Mowafy
P a g e | 20
pulmonary embolism
myocardial infarction
infective endocarditis
Pulmonary embolism
Pulmonary embolism
Pulmonary embolism
dissecting aorta
CT
angio CT
CT
CT dissecting aorta
Cardiology Dr . Ahmad Mowafy
P a g e | 21
dissecting aorta
dissecting aorta
CT
constrictive pericarditis
CT
Investigations
Investigations
Investigations
Investigations
Investigations
treatment
Investigations
etiology
Investigations
Heart failure
Cardiology Dr . Ahmad Mowafy
P a g e | 22
investigations
cardiology
definition
etiology
clinical pictures
differential diagnosis
treatment
cardiology
Liver
cardiology
Liver
Liver
heart failure angina
Cardiology Dr . Ahmad Mowafy
P a g e | 23
cardiology
endocrine
endocrine
Infection
cardiology
cardiology
cardiology branch
heart failure
Heart failure heart failure
definition
definition etiology etiology Heart failure
etiology
heart failure
etiology Hyper tension
ischemic heart disease
etiology
etiology
etiology
Cardiology Dr . Ahmad Mowafy
P a g e | 24
Pathophysiology
cardic reserve
etiology
clinical pictures
investigation cardiology
Investigations Investigations break
Investigations
treatment
definition of heart failure
Definition
definition heart failure
definition of heart failure
syndrome in which the heart can't maintain adequate cardic output
clinical syndrome in which
can't maintain adequate cardic output
adequate
Normal cardic output
high cardic output heart failure
High cardic output heart failure
cardic output Heart failure
Cardiology Dr . Ahmad Mowafy
P a g e | 25
heart failure
High cardic output
normal
adequate cardic output
adequate
syndrome in which the heart can't maintain adequate
adequate
cardic output
definition of heart failure
In spite of normal ventricular filling
ventricle
shock
Heart failure
In spite of normal venous return
In spite of normal
Cardiology Dr . Ahmad Mowafy
P a g e | 26
ventricular filling
etiology
Etiology
etiology
etiology
Heart failure
right left sided heart failure
Left sided heart failure
Left
etiology
the most common causes are
Coronary heart disease Hyper tension
etiology
etiology
clinical pictures
Item clinical picture of the cause
clinical picture of the cause
cause
coronary heart disease
Cardiology Dr . Ahmad Mowafy
P a g e | 27
hyper tension
Heart failure
Left side of the heart
left atriumleft ventricle
Left atrium
atrium
left sided heart failure 70 % pressure gradient
left atrium
failure
left atrium Essential for life
left atrium
left atrium failure
left atrium failure
Left atrium failure
Mitral stenosis
left atrium
bigger not better
Left sided heart failure
Mitral stenosis
Mitral stenosis valvular heart disease
related
left sided heart failure
Cardiology Dr . Ahmad Mowafy
P a g e | 28
Mitral stenosis left ventricle Left ventricle
left ventricle mitral stenosis
female female
Femalefemale
female
Femalefemale
female
female
Mitral stenosis
left atrium
Myxoma
benign tumor Left atrium
left atrium
atrium
left ventricle
Cardiology Dr . Ahmad Mowafy
P a g e | 29
Left ventricle
Left ventricular failure
Myocardial disease
myo Myocardial infarction
Myocarditis
myopathy cardiomyopathy
after load
after load
pre load
Load
Load
Load after load
pre load
after load
after load
systemic hyper tension
systemic hyper tension
the most common causes are coronary and systemic hyper tension
Cardiology Dr . Ahmad Mowafy
P a g e | 30
systemic hyper tension
most common causes
Systemic hyper tension
Aortic stenosis
Coarctation of the aorta
Pre load Pre load
pre load
Pre load venous return
venous return
after load
Pre load
Hyper dynamic circulation
Cardiology Dr . Ahmad Mowafy
P a g e | 31
Valvular heart disease
Mitral stenosis
Mitral regurge aortic regurge
Mitral regurge aortic regurge pre load
valvular heart disease
mitral aortic regurge
left sided heart failure
valvular heart disease
congenital heart disease
VSD
VSD
VSD
congenital heart disease
left sided heart failure
congenital heart disease
PDA in left and ASD in right
PDA ASD
congenital heart disease
left sided heart failure
Cardiology Dr . Ahmad Mowafy
P a g e | 32
coronary heart disease
hyper tension
acute heart failure
diastolic heart failure
acute
diastolic
causes of diastolic heart failure
diastolic heart failure
systolic heart failure
diastolic heart failure
etiology
acute heart failure
diastolic heart failure
acute heart failure diastolic heart failure
precipitating factor
Precipitating factors
Precipitating factors
Cardiology Dr . Ahmad Mowafy
P a g e | 33
Precipitating factors
A
Anemia Arrhythmia
Heart failure
Precipitating factor
Heart failure
P pregnancy
Physical effort
i
infection
iatrogenic
infection Infection Infective endocarditis
iatrogenic calcium channel blocker
heart failure
endocrine
Load
endocrine
Cardiology Dr . Ahmad Mowafy
P a g e | 34
diastolic acute
cardic reserve
cardic reserve
Heart failure
cardic reserve
heart failure
cardic output
Cardiology Dr . Ahmad Mowafy
P a g e | 35
cardic output Stroke volume heart rate
stroke volume
stroke volume
heart rate
Heart rate
sympathetic
sympathetic
heart rate
cardic reserve
cardic reserve
heart rate
150
150
tachycardia
Cardiology Dr . Ahmad Mowafy
P a g e | 36
tachycardia
Heart rate
heart rate
120 70
physiological
Physiological
Heart rate
heart rate
Beta blocker
cardic output
stroke volume heart rate
Cardiology Dr . Ahmad Mowafy
P a g e | 37
Tachycardia
cardic reserve
Left ventricle
left ventricle
dilatation
fibers Starling law
within limit
ventricular dilatation
fibers
after load
against resistance
Hypertrophyhypertrophy
without blood supply
ischemia
Cardiology Dr . Ahmad Mowafy
P a g e | 38
cardic reserve
adverse effect
side effects
ANP PNP Atrial naturtic peptide
ANP
ANP
failure
ANPANP
shock
dyspnea
dyspnea chest
MCQ
chest X-ray
ECG
ECHO
ANP
chest dyspnea
ANP
Cardiology Dr . Ahmad Mowafy
P a g e | 39
ANP
ANP lasix
heart failure heart failure
: : - : :
heart failure
Heart failure
lasix
lasix
Lasix
ANP lasix
heart failure
heart failure
lasix
sympathetic
renin renin
RBCs
Low cardic output
Renin ANP
Cardiology Dr . Ahmad Mowafy
P a g e | 40
cardic reserve
cardic reserve heart failure
cardic reserve
Heart failure
symptoms
etiology heart failure
definition
Heart failure
clinical pictures treatment differential diagnosis
Investigations
clinical pictures
clinical pictures
Clinical pictures
clinical picturescardiology
Cardiology Dr . Ahmad Mowafy
P a g e | 41
clinical pictures cardiology
clinical pictures of cardiology
left sided heart failure
Left sided heart failure
Left ventricle
Manifestation of low cardic output
manifestations Low cardic output
dizziness
tinnitus blurring of vision
syncope
ischemic heart disease
manifestions of lung congestion
Cardiology Dr . Ahmad Mowafy
P a g e | 42
left ventricle
left atrium
left atrium
Lung
Pulmonary veins
pulmonary veins
Left atrium
left atrium
Pulmonary veins
pulmonary congestion pulmonary veins
Manifestions of lung congestion
Lung congestion
clinical pictures of left sided heart failure
Low cardic outputcardiology
Left sided heart failure
Left Lung congestion
lung congestion
clinical pictures of the cause
Cardiology Dr . Ahmad Mowafy
P a g e | 43
coronary disease
systemic hypertension
Pressure manifestations
dilatation hypertrophy
even source
thrombo embolism
stagnation of blood
Manifestations of thrombo embolism
clinical pictures
Cardic signs
Cardiology Dr . Ahmad Mowafy
P a g e | 44
clinical pictures
cardic signs
cardic signs
Manifestations of low cardic output
symptoms signs
symptoms signs
lung congestion systemic congestion
signs of low cardic output
symptoms signs
Cardiology Dr . Ahmad Mowafy
P a g e | 45
cardic signs
IQ IQ
left
left ventricular enlargement
Left ventricular
Left ventricle
MCQ
left ventricular enlargement
Cardiology Dr . Ahmad Mowafy
P a g e | 46
MCQ
right ventricular enlargement
bilventricular enlargement
right ventricle
Left ventricle
clinical
left ventricle right ventricle
Cardiology Dr . Ahmad Mowafy
P a g e | 47
Most anterior
right ventricle
most posterior
left
right ventricle
most anterior
Left ventricle
apex
clinical
clinical
apex of the heart
Left ventricle
right ventricle
spleen
Left ventricle
Cardiology Dr . Ahmad Mowafy
P a g e | 48
right ventricle
spleen
left ventricle
left ventricle
apex
Localized Localized
diffused
diffused
right ventricle
right ventricle
normal
cardiology
chamber
According
Cardiology Dr . Ahmad Mowafy
P a g e | 49
longitudinal axis
Longitudinal axis left ventricle
right ventricle
longitudinal axis
Left ventricle
longitudinal axis
apex
outward and downward
apex
According the longitudinal axis
Longitudinal axis
Palpation
right ventricle
longitudinal axis
Outward
According
Cardiology Dr . Ahmad Mowafy
P a g e | 50
During systole
apex
bulge
systolic bulge
contraction
rotation
IQ
systolic bulge
Cardiology Dr . Ahmad Mowafy
P a g e | 51
systolic bulge
systolic bulge
due to rotation of the heart
left ventricular enlargement
rheumatology
rheumatology
rheumatology
left ventricular enlargement
Localized
outward and downward
systolic bulge
Left ventricular enlargement
tachycardia
tachycardia
Cardiology Dr . Ahmad Mowafy
P a g e | 52
tachycardia pulse
Pulse
pulsus alterns
Pulsus alternas
Pulse
pulse
heart failure
Pulse
pulsus alterns
heart
Left ventricular failure
left ventricle
left ventricle
left ventricle
Left ventricular failure
left ventricle
fibers healthy
fibers diseased
healthy diseased
diseased
Cardiology Dr . Ahmad Mowafy
P a g e | 53
healthy fibers
diseased fibers
healthy
diseased
fibers healthy
Cardiology Dr . Ahmad Mowafy
P a g e | 54
healthy
healthy diseased
Healthy
Healthy
stress
Pulsus alterns
Normal heart sound
S1 and S2
systole distole
first heart sound second heart sound
S1S2S2 S1
S1 S2 systole
S2 S1diastole (
clinical first heart sound second heart sound
first second
Cardiology Dr . Ahmad Mowafy
P a g e | 55
timing carotid
systole diastole
tachycardia
first second
diastole
atrium ventricle
left ventricle
left ventricle
Left ventricle
Cardiology Dr . Ahmad Mowafy
P a g e | 56
ventricle
Vibration
Heart failure ventricle
ventricle
S3
S3Heart sound
tachycardia
gallop
Gallop
Left ventricle
left ventricle
cuspus valve
Cardiology Dr . Ahmad Mowafy
P a g e | 57
regurge
apex
Pan systolic murmur of mitral regurge
valvular heart disease
murmur Mitral regurge
left ventricle
signs
clinical pictures
Low cardic output
Lung congestion
cardic signs
cardic signs
left ventricular enlargement
pulse
Cardiology Dr . Ahmad Mowafy
P a g e | 58
clinical pictures
right
Right
right Left
Lung congestion systemic congestion
right ventricular
Investigations
Investigations
Investigations
Pulsus alterns right
Pulsus alterns
Pulse
Pulse Left ventricle
right ventricle
right pulsus alterns
Cardiology Dr . Ahmad Mowafy
P a g e | 59
Investigations
Investigations
Investigations
Investigations
Investigations
X-ray ECG ECHO cath
key investigations
heart failure
X-ray
ECG
ECHO
ECHO
ECHO
ECHO
ECG
X- ray
to detect the cause, to detect the chamber enlargement
ECHO
Cardiology Dr . Ahmad Mowafy
P a g e | 60
Ejection fraction
EF
EF Ejection fraction
ejection fraction
100
50
ejection fraction
50/100 50 %
heart failure
ejection fraction
stroke volume
diastole systole diastole
end diastolic volume
stroke volume 70
end diastolic volume physiology 140
Ejection fraction 10 %
Cardiology Dr . Ahmad Mowafy
P a g e | 61
ejection fraction
Investigations
ANPANP
acute dyspnea ICU
9092
92
92
Investigations treatment
Cardiology Dr . Ahmad Mowafy
P a g e | 62
treatment of heart failure
Treatment
treatment of the cause
precipitating factors
failure
failure
Logic
Liver
Cardiology Dr . Ahmad Mowafy
P a g e | 63
Liver
hypo kalemia
hypokalemia Liver
D D D
diuretic
diuretic
diuretics
heart failure digitalis
Heart failure
digitalis
diuretics
diuretics
Load
vaso dilator
after load
preload
diuretics
lasix thiazide
Cardiology Dr . Ahmad Mowafy
P a g e | 64
spironolactone
spironolactone
Lasix thiazide
Mechanism of action
Kidney
kidney
lasix loop of Henle
thiazide
Distal tubules DD
loop
thiazide
distal
95 % absorption
mechanism of action
re absorption of
H ions
side effects
side effects
Hypo
Hypokalemia Hypokalemia
Hyperglucose
hyper glycemia
Cardiology Dr . Ahmad Mowafy
P a g e | 65
hyper glycemia Hyperlipidemia Hyperurecemia Hypercalcemia
side effects
Hyperglycemialipidemia urecemia calcemia
calcemia
thiazide Hyper calcemia
Lasix Hyper calcemia
hyper calcemia
thiazide hypercalcemia
lasix Hypocalcemia
lasix
Ototoxicity
lasix
4080
160
lasix
Cardiology Dr . Ahmad Mowafy
P a g e | 66
lasix
lasix symptomatic treatment
load
symptomatic treatment
congestion
Heart failure congestion
Digitalis digitalis
action
action
cardiology
cardiology
digitalis
digitalis action
contractility
heart failure
conductivity
conductivity
A.V. node
atrial arrhythmia
conductivity
arrhythmia atrium ventricle
ventricle
conductivity
Atrial arrhythmias
contractility Heart failure
Cardiology Dr . Ahmad Mowafy
P a g e | 67
conductivity
atrial arrhythmias
para sympathetic effect
para sympathetic
contractility
para sympathetic contractility
parasympathetic
ventricle
digitalis
digitalis
digitalis
excitability
digitalis
Para sympathetic tachycardia
excitability
arrhythmia of digitalis
digitalis
digitalis
magic product
digitalis
digitalis arrhythmia
Cardiology Dr . Ahmad Mowafy
P a g e | 68
heart failure
arrhythmia
digitalis toxicity
arrhythmia digitalis
type two second degree heart block
digitalis
arrhythmia
sinus tachycardia
bradycardia
sinus tachycardia
arrhythmia
arrhythmia
heart block
digitalis heart block
digitalis type two second degree heart block
arrhythmia
MCQ
digitalis
contra indication of digitalis
digitalis toxicity
paroxysmal
ventricular tachyarrhythmia
arrhythmia
Cardiology Dr . Ahmad Mowafy
P a g e | 69
V Tac
ventricular tachycardia
digitalis
digitalis
arrhythmia ventricle
arrhythmia atrium
ventricle
excitability
digitalis ventricular tachycardia
excitability
absolute contraindication
digitalis
digitalis toxicity
ventricular tachycardia
Heart rate
A.S. node
ectopic focus
excitability
ventricular tachycardia
digitalis arrhythmia
Cardiology Dr . Ahmad Mowafy
P a g e | 70
arrhythmia
atrium
atrium
ventricular
no absolute contra indication digitalis
absolute contraindication in very severe heart failure
absolute contraindication
ventricular tachycardia
severe heart failure
absolute contra indication
ventricular tachycardia
Absolute contraindication
severe heart failure
Severe contraindication
relative contraindication
Relativearrhythmia
atrial arrhythmia
Cardiology Dr . Ahmad Mowafy
P a g e | 71
Relativepeptic ulcer
Peptic ulcerpara sympathetic effect
peptic ulcer
digitalis
digitalis
digitalis toxicity
Partial
Peptic ulcer partial
Partial
complete
complete heart block
Complete heart block
partial heart block
partial
impulse Impulses
digitalis Partial complete
Cardiology Dr . Ahmad Mowafy
P a g e | 72
partial p
heart block
Partial P
digitalis toxicity
digitalis toxicity
400
400Metabolism
digitalis toxicity
digitalis toxicity
renal failure
digitalis digoxin
digoxin Digitoxin digitoxin
Digitoxin
Digitoxin digoxin
kidney digoxin
Liver Digitoxin
digoxin
digoxin
Cardiology Dr . Ahmad Mowafy
P a g e | 73
Digoxin ( lanoxin ) : excreted mainly by the kidney ( tab = 0.25 mg , amp = 0.5 mg ) Digitoxin : metabolised mainly in the liver ( Digitoxin hepatic )
digoxin
renal failure
hypo thyroidism
Metabolism
Hyper thyroidism
Hyper thyroidism tachy arrhythmia
arrhythmia
digitalis arrhythmia
hyper thyroidism
digitalis
toxicity
Hypokalemia
hypercalcemia
digitalis toxicity MCQ
arrhythmia
digitalis toxicity Hypokalemia
HypocalcemiaHypercalcemia
Hypo phosphatemia
Hypo kalemia Hyper calcemia
digitalis toxicity
non cardic
cardic
Non cardic
Anorexianasuea vomiting
Cardiology Dr . Ahmad Mowafy
P a g e | 74
first symptom
digitalis
anorexia
digitalis toxicity
Yellow vision
gynecomastia
psychosis
cardic
cardic manifestations of digitalis toxicity
paroxysmal supra ventricular tachycardia
Ventricular tachycardiaHeart block
arrhythmia
arrhythmia
extrasystole
arrhythmia
Cardiology Dr . Ahmad Mowafy
P a g e | 75
digitalis arrhythmia
type two second degree heart block
Nephrology
rheumatology
digitalis arrhythmia
Type two second degree heart block
www.facebook.com/dr.tafreegh
Cardiology Dr . Ahmad Mowafy
P a g e | 76