Disease and Treatment

Premature Ejaculation

2011-07-11T20:47:00.000-07:00

Premature ejaculation is ejaculation that occurs too early, usually before, upon, or shortly after penetration. It most common among adolescent boys and may be intensified by feelings that sex is sinful. This disorder can be a significant problem for couple if not treated properly. If the man ejaculates before his partner reaches orgasm then she may be left feeling unsatisfied and may become resentful.

Etiology:
Premature Ejaculations are mostly caused by:

Fear of discovery (making the partner pregnant or contracting a sexually transmitted diseases and anxiety about performance)
Problem in relationship
Inflammation of the prostate gland
Nervous system disorder

Treatment:

Stop-and-start technique: the man learns to tolerate high level of excitement without ejaculating. This technique involves penis stimulation, either manually or through intercourse, until the man feel that he will soon ejaculate unless stimulation stops. He signals his partner to stop stimulation which is resume after 20-30 seconds. It can be done by manual stimulation and later during intercourse.
Psychotherapy: especially when premature ejaculation is caused by serious psychologic problems.
Medication: such as fluoxetine, paroxetin or sertraline to delay ejaculation, taken either daily or an hour or so before sexual intercourse.

Acne

2011-07-09T07:54:00.000-07:00

Definition

Acne is defined as a skin disorder resulting from the blockage of hair follicles in the skin. Excess cells produced in the follicle combine with sebum, an oily substances secreted by gland connected to the follicle. When a plus forms in the follicles and it is infected with bacteria then a pimple erupts. The bacteria then secret various chemicals than prompt an inflammatory response from the immune system.

Acne commonly associated with teenagers even it can occur in children, adult and women on the time of menopause. It is mostly appear on the parts of the body with the largest number of hair follicles such as face, chest, upper back and upper arms. Some of acne are mild while others are severe.The less severe from consist of comedones, which are hair follicles blocked by plugs of sebum.

Based on the data from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), about 80 percent of United States people develop acne at between the ages of eleven and thirty. Boys are more likely than girls to develop acne during adolescence while among adult, women are more likely than men. Some older women are troubled by acne during menopause.

Cause and Symptoms

Acne is resulted from the interaction of four factors that are most common in adolescence even they can occur in adult as well. They are:
Androgens, hormones produced by the adrenal gland present in women and men.
Propionibacterium acnes, normally live on the skin to grow inside the follicle.
Chemicals produce by the bacteria that trigger an inflammatory response.
White blood cells.

Risk Factors:

Heredity
Changes in the body's hormonal levels such as in pregnant women, early menopause, teenagers, and on menstrual period.
Exposure to greasy or oily substances.
Clothing or athletic equipment such as backpacks, shoulder straps, helmets, headsets, etc.
Climate, especially in humidity or high level of air pollution.

Diagnosis

The diagnose is based on the appearance of the skin.

Treatment

There are one or more of four way for acne treatment:

Lowering production of sebum
Speeding up the removal of dead skin cells
Fighting bacterial infection
Reducing skin's inflammatory response to infection

Some medications are topical, applied to the skin, while others are taken by mouth. Some can be purchased over the counter but others require a prescription from medical doctor. The treatments are depend on the severity of the acne, the extend of scarring and the possibility of side effects for specific patients.

Conjunctivitis

2010-05-14T21:49:00.000-07:00

Conjunctivitis is defined as an inflammation or infection of conjunctiva. Conjunctiva is the transparent membrane lines the eyelid and as part of eyeball. Conjunctivitis causes small blood vessel in conjunctiva become more prominent that as trigger to the ping or red cast on the whites of eyes. It rarely affects to sight but it can make discomfort because of an irritating condition.

Conjunctivitis is contagious and early diagnosis as well as proper treatment can help limit its spread. The disease can be triggered by bacteria, virus or even allergic agent.

The Symptoms:

The most common symptoms of conjunctivitis are:
Redness in one or both eyes
Itchiness in one or both eyes
A gritty feeling in one or both eyes
A discharge in one or both eyes that forms a crust during the night
Tearing
Feeling something on one or both of eyes that cannot be removed

Specific Causes of Conjunctivitis:

Viruses, usually produces a watery or mucous discharge
Bacteria, usually produces a thicker, yellow or green discharge
Allergies. In response to allergens, human body will produce an antibody called immunoglobulin E (IgE) that causes mast cell in mucous lining of eyes release inflammatory substances includes histamines. Specific signs will be itching, tearing, inflammation and swelling.
Foreign object and Chemical splash, they can irritate conjunctiva. It can be determined as a mucous discharge that usually clear up within about a day.

Tip and Trick on Conjunctivitis:

It can be contagious, so seek diagnosis and treatment early
Keep children with conjunctivitis away from child care facilities or school until the treatment started
An examination by a qualified eye physician is important

Prevent Conjunctivitis:

Wash hand thoroughly and frequently
Do not touch or rub eyes with your hand
Change pillowcase often
Change towel and washcloth daily and don’t share with others
Do not use eye cosmetic, especially mascara
Follow doctor’s instruction when need to use contact lens

Verrucae (warts)

2009-07-03T03:49:00.000-07:00

Verrucae (warts) is A flesh-colored growth characterized by circumscribed hypertrophy of the papillae of the corium, with thickening of the malpighian, granular, and keratin layers of the epidermis, caused by human papilloma virus; also applied to epidermal verrucous tumors of nonviral etiology

Treatments:

Salicylic acid
Liquid nitrogen

Varicella Zoster

2009-07-03T03:37:00.000-07:00

Herpes zoster is an infection caused by a herpes virus (varicella-zoster virus), characterized by an eruption of groups of vesicles on one side of the body following the course of a nerve due to inflammation of ganglia and dorsal nerve roots resulting from activation of the virus, which in many instances has remained latent for years following a primary chickenpox infection; the condition is self-limited but may be accompanied by or followed by severe postherpetic pain. It common occurs in the elderly or immunocompromised person.

Signs and Symptoms:

Unilateral and painful vesicular eruptions
Fever
Dysesthesias
Malaise
Headache

Treatments:

Antivirals such as acyclovir or valacyclovir within 72 hours of appearance of lesions
IV antivirals for patients with immunocompromised

Scabies

2009-07-03T02:45:00.000-07:00

Scabies is An eruption due to the mite Sarcoptes scabiei. The female of the species burrows into the skin, producing a vesicular eruption with intense pruritus between the fingers, on the male or female genitalia, buttocks, and elsewhere on the trunk and extremities. It is associated with crowded and dirty living conditions. Mites are passed from person to person.

Etiology:
Sarcoptes scabiei (burrows into the skin to lay eggs)

Signs and Symptoms:

Pruritus that worsens at night and after hot showers caused by a hypersensitivity reaction to mite feces
Excoriations, papules, and vesicles on the wrists and between the fingers, elbows, and intertriginous areas

Treatments:

5% permethrin cream
Antihistamines for pruritus
Wash clothing and bedding to prevent reinfestation
Also treat close contacts

Pityriasis Rosea

2009-07-03T02:41:00.000-07:00

Pityriasis rosea is a mild and self-limited cutaneous eruption associated with HHV-6

Signs and Symptoms:

Pruritus
Diffuse eruption of round to oval erythematous papules and plaques covered with a fine
Christmas-tree pattern on the trunk with a classic herald patch, a solitary patch that precedes the rest of the rash

Treatments:
Lesion are self-limited but pruritus may require treatment

Necrotizing Fasciiti

2009-06-28T11:37:00.000-07:00

Necrotizing fasciitis is infection of skin and fascia caused by group A streptococci, mixed aerobic-anaerobic bacteria, or Clostridium perfringens. It develops rapidly and has high mortality without emergent treatment.

Signs and Symptoms:

Pain and unexplained fever
Swelling, tenderness, induration, or bullae
Extending of infection to fascia and spreads rapidly
Predisposing factors: DM, peripheral vascular disease, breaches in the skin or mucosa, and surgery
Necrotizing fasciitis of the perineal region is called Fournier's gangrene

Treatments:

Surgery
Antibiotic therapy after gram stain and culture of tissue

Molluscum contagiosum

2009-06-28T11:31:00.000-07:00

Molluscum contagiosum is an infection caused by a poxvirus. It is commonly found in young children and AIDS patients

Signs and Symptoms:

Discrete, dome shaped, and shiny papules (2-5 mm) with central umbilication
The lesions are asymptomatic unless inflamed or irritated
In adult: lesions on the perianal and perigenital areas
In child: lesions on the trunk, extremities, and face

Treatments:

The lesions resolve (months to years) spontaneously
Liquid nitrogen cryotherapy
Curettage
Trichloroacetic acid

Lice

2009-06-28T11:27:00.000-07:00

Types of Lice:

Pediculus capitis - infection of the scalp
Pediculus corporis - infection of the body
Phthirus pubis - infection of the pubic area

Signs and Symptoms:

Pruritus
Nits fluoresce blue under Wood's lamp

Treatments:

Permethrin shampoo or cream
Sources of reinfection (such as combs, bed sheets, clothing) should be decontaminated

Lyme Disease

2009-06-28T11:23:00.000-07:00

Lyme Disease:

"Bull's eye" erytheuma
Occurs in moist and warm areas of the body (axillae, behind the knees, inguinal area) where the tick initially bites
Fatigue
Malaise
Arthralgias
Headache
Lymphadenopathy
Neurologic deficits
History of tick bite

Rocky Mountain Spotted Fever

2009-06-28T11:15:00.000-07:00

Rocky Mountain Spotted Fever:

Rash on the palms and soles then spreads to the trunk and face
High fever
Chills
Headache
History of tick bite

Scarlet Fever

2009-06-28T11:11:00.000-07:00

Scarlet Fever:

Rash on the trunk as sandpaper-like
Strawberry tongue
Circumoral pallor
Most occurs in untreated streptococcal pharyngitis
Penicillin is drug of choice to prevent rheumatic fever

Chickenpox (varicella)

2009-06-28T10:37:00.001-07:00

Chickenpox (varicella):

Macules on the trunk cause papules and vesicles, ruptured and crusting
Crops of lesions
Dewdrop on a rose petal: a clear vesicle on an erythematous base
Fever
Risk for bacterial superinfection of lesions

Fifth Disease

2009-06-28T10:17:00.000-07:00

Fifth Disease (Erythema infectiosum):

Caused by parvovirus B19
Slapped-cheek rash over the cheeks
Maculopapular rash on the trunk and extremities 1-2 days later
Malaise
Low-grade fever

Infectious Rashes: Rubella

2009-06-28T10:09:00.000-07:00

Rubella (German measles):

Maculopapular rash (spreading from the head downward)
Suboccipital swelling
Postauricular nodes
Low-grade fever
Malaise
Arthralgias

Infectious Rashes: Measles / Rubeola

2009-06-28T10:05:00.000-07:00

Measles / Rubeola:

Koplik's spots (white spots on buccal mucosa) usually occurs 3 days after a high fever
Maculopapular rash (spreading from the head downward)
Cough
Coryza
Conjunctivitis

Impetigo

2009-06-28T08:51:00.000-07:00

Impetigo is a contagious and autoinoculable skin infection caused by staphylococci or streptococci. It commonly in children than adults

Signs and Symptoms:

Pruritus with honey-colored crusts on the face, neck, and extremities
Nonbullous impetigo: superficial pustules with surrounding erythema
Bullous impetigo: erythematous macules as thin-walled vesicles or bullae on an erythematous base.

Treatments:

Mild soap for washing the lesions
Topical mupirocin
Systemic antibiotics
Patient's towels and washcloths should be segregated

Herpes Simplex

2009-06-28T07:43:00.000-07:00

Herpes simplex is a recurrent vesicular eruption of mucocutaneous surfaces due to HSV infections. It is a painful eruption.

Signs and Symptoms:

First outbreaks are longer and more sever than recurrent eruptions
Prodromal tingling, burning, or frank pain with lymphadenopathy
Fever, discomfort, malaise, and edema on involved area
Grouped vesicles on erythematous base
Recurrent infections are limited to mucocutaneous areas

Treatments:

Acyclovir ointments
Oral or IV acyclovir
Daily acyclovir therapy for patient with more than 6 outbreaks per year

Fungal Infections: Tinea Corporis/Capitis

2009-06-28T07:38:00.000-07:00

Tinea corporis / capitis is an infection of the body/scalp caused by fungus

Signs and Symptoms:

Pruritus
Ring-shaped (ringworm)
Erythematous
Scaling plaques

Treatments:

Tinea corporis: topical anti-fungal
Tinea capitis and tinea unguium (nail infection): oral anti-fungals

Fungal Infections: Pityriasis versicolor

2009-06-28T07:33:00.000-07:00

Pityriasis versicolor is also named by tinea versicolor. It is caused by Malassezia furfur.

Signs and Symptoms:

Small, scaling, hyper or hypopigmented macules
Lesions: asymptomatic or mild itching
Chest and back is the common site of infections

Diagnosed by:

Treatments:

Topical anti-fungal agents
Selenium sulfide shampoo

Cellulitis

2009-06-28T07:29:00.000-07:00

Cellulitis or folliculitis is skin infections due to streptococci or staphylococci.

Signs and Symptoms:

Folliculitis: hair follicles infection commonly on facial hair
Cellulitis: red, hot, and swollen skin lesions, fever and chills

Treatments:

Oral antibiotics such as cephalexin or dicloxacillin for mild to moderate cases
In cases of systemic toxicity, comorbid condition, DM, extremes of age, or hand or orbital involvement, patient should be hospitalized and give IV antibiotics

Acne Vulgaris

2009-06-28T07:23:00.000-07:00

Acne vulgaris is a condition in which the hair follicles are blocked by sebum and keratinous material. This blockage causes formation of cyst/comedones. Propionibacterium acnes within comedones break down sebum into free fatty acids.

History and Physical Exams:

Acne is associated with changes in androgen levels
Found primarily in puberty
More common in males than in females
Open comedones - blackheads and closed comedones - whiteheads on the face, neck, arms, back, and buttocks
Drugs are related to acne: lithium, steroids, OCPs, androgens

Treatments:

Treatments are according to the severity of acne
Mild case: topical clindamycin or erythromycin, benzoyl peroxide, topical retinoids
Moderate case: treatments in mild case plus oral antibiotics
Severe case: oral isotretinoin (Accutane)

Vitiligo

2009-06-28T07:17:00.000-07:00

Vitiligo is a depigmentation due to loss of melanocytes and associates with autoimmune and thyroid disease. It more common in dark-skinned peaople with a family history.

Signs and Symptoms:
Irregular white patches

Treatments:

Topical artificial tanning cream
Steroid/tretinoin creams
Phototherapy

Steven-Johnson Syndrome

2009-06-28T06:07:00.000-07:00

Steven-Johnson Syndrome/Toxic Epidermal necrolysis (SJS/TEN) is a life threatening exfoliative mucocutaneous disease. It often caused by a drug induce immunologic reaction such as sulfa drugs, carbamazepine, phenytoin, valproic acid, quinolones, cephalosporins, phenobarbital, allopurinol, aminopenicillins, and corticosteroids.

Signs and Symptoms:

History of new drug exposure within 1-3 weeks
Flu-like prodrome
Skin tenderness
Painful mouth lesions
Nikolsky's sign is positive
Coalescing red macules and flaccid blisters with full-thickness epidermal loss
Sepsis from superimposed bacterial skin infections that leads to death

Treatments:

Eliminate the offending agents
Analgesia and IVIG
Hospitalize in the burn center to manage skin and fluid losses

Seborrheic Dermatitis

2009-06-28T06:01:00.000-07:00

Seborrheic dermatitis is a chronic superficial inflammatory. It may be a reaction to Pityrosporum yeast

Signs and Symptoms:

Pruritus during neonatal and postpubertal periods
Yellowish, greasy, and erythematous scaling patches and plaques on the scalp, ear, and face

Treatments:

1% hydrocortisone and topical antifungals
Shampoos contain of selenium sulfide or zinc pyrithione to treat the scalp

Psoriasis

2009-06-28T05:52:00.000-07:00

Psoriasis is epidermal hyper-proliferation caused by a T-cell-mediated inflammatory

Signs and Symptoms:

Dark red plaques with silvery-white scales and sharp margins on extensors surface
Nail pitting, oil spots, and lifting of the nail plate
Joint stiffness, tenderness, pain on psoriatic arthritis
Malaise and fever

Treatments:

Mild to moderate cases: topical steroids and topical calcipotriol
Phototherapy and immunosuppressants: methotrexate
Biologic agents: infliximab, etanercept

Lichen Planus

2009-06-27T08:53:00.000-07:00

Lichen planus is an inflammatory dermatosis on skin and mucous membranes

Signs and Symptoms:

Flat-topped, purple, polygonal pruritic papules with overlying network of white lines - Wickham's striae
Reticulate white hyperkeratosis on mucosal surface

Treatments:

Antihistamines and topical steroids
Cyclosporine, oral prednisolone, oral retinoids, and PUVa in severe cases

Erythema Nodosum

2009-06-27T08:46:00.000-07:00

Erythema nodosum is an inflammation of the subcutaneous fat. It produces tender erythematous nodules most on the anterior tibial areas. It is most commonly found in young women.

Etiology:

Hypersensitivity reaction to drugs (OCP - NSAID)
Infection
Sarcoid
Rheumatic fever
IBD

Signs and Symptoms:

Painful erythematous
Malaise
Arthralgia
Fever

Treatments:

NSAIDs
Potassium iodide
Leg elevation and bed rest
Systemic corticosteroid

Erythema Multiforme

2009-06-26T21:37:00.000-07:00

Erythema multiforme is an acute, self-limiting, inflammatory skin eruption.

Etiology:

Drugs (penicillin, sulfonamides, phenytoin)
Infection
Vaccination
Malignancy

Signs and Symptoms:

Malaise and myalgias
Lesions on the extremities
Erythematou s

Treatments:

In mild cases, it resolves spontaneously
Discontinue the inciting agent/drugs
Acyclovir, if it due to HSV

Contact Dermatitis

2009-06-26T21:28:00.000-07:00

Contact dermatitis is defined when a skin rash is developed from contact with a substance to which the patient has previously been sensitized. It is a delayed type IV hypersensitivity reaction. The agents include poison ivy, poison oak, nickel, perfumes, soaps, detergents, and cosmetics.

Signs and Symptoms:

Pruritus and rash
Malaise and fever
Edema
Lymphadenopathy
Erythematous, weepy, and crusted patches, plaques, or papulovesicles

Treatments:

Cool compresses or oatmeal preparation, topical steroids for mild cases
Extended course of systemic corticosteroids and antihistamines for severe cases

Pemphigus

2009-06-26T21:19:00.000-07:00

Pemphigus is a shallow, painful corrosions and blisters on epidermal and mucosal surfaces. It is caused by autoantibodies against desmocollins and desmogleins in the epidermis. The onset is between 40 and 60 years of age.

Signs and Symptoms:

Shallow croisons on mucous membranes, developing slowly that may involve the skin
Shallow ulceration from blisters that are easily ruptured
Nikolsky's signs
Epistaxis, hoarseness, weakness, malaise and weight loss

Diagnosis:

Immunologic staining of skin biopsy
Acantholysis is seen on biopsy
Increased serum levels of antibodies to desmoglein 1 and 3

Treatments:

Oral steroids - imunosuppressants
Plasmapheresis if the cases are severe
Care the lesions as burns

Bullous pemphigoid

2009-06-23T07:32:00.000-07:00

Bullous pemphigoid is a chronic blistering eruptions on an inflamed base. It is more common in > 60 years of age. It is due to autoantibodies to BP1 and BP2 found in the basement membrane of the skin.

Signs and Symptoms:

Prodromal erythematous, pavular lesion that is large, tense and pruritic bullae
Rarely involves the mucous membranes
Pruritic (usually not painful)
No Nikolsky's sign

Treatments:

Topical steroids if mild cases
Oral Steroid if severe

Atopic Dermatitis or Eczema

2009-06-23T07:26:00.000-07:00

Atopic dermatitis or eczema is an inflammatory skin disorder characterized by pruritus.

Signs and Symptoms:
Dry, scaly, itchy patches and plaques with excoriations in the flexural areas (elbows, knees, antecubital fossae, buttocks) and neck

Etiology:

Skin irritants such as dry skin, wool clothing and perfume
Stress
Airborne allergens (dust mites, pollens)
Foods (eggs, milk, peanuts, seafood, wheat, soybeans)
Asthma and allergic rhinitis

Treatments:

Mild soaps and emollients
Topical steroids
Topical tacrolimus
PUVA phototherapy
Methotrexate

Erythrasma

2009-06-23T07:18:00.000-07:00

ERYTHRASMA

Etiology:

Corynebacterium minutissimun
Diabetics
Warm climates

Physical Examinations:

Enlarging area of pink or brown macular patches on flexor surfaces (axilla, groin)
Typically asymptomatic

Diagnosis:

Wood's light : fluoresce coral pink or red
KOH prep is negative

Treatments:
Topical or oral erythromycin

Acanthosis Nigricans

2009-06-23T07:11:00.000-07:00

Acanthosis nigricans is a velvetly hyperpigmentation of the skin. It associates with Insulin resistance, endocrine disorders, obesity, drugs, and malignancy.

Etiology:
The etiology is unclear but may be related to the growth factors on skin

Signs and Symptoms:
Dark, thickened, dirty-appearing, velvety plaques predominantly in the flexural areas such as axillae, neck, and under the breast and groin

Treatments:
Treat the underlying disorder such as weight reduction for obesity and insulin resistance

Peripheral Vascular Disease

2009-06-20T10:09:00.000-07:00

Peripheral vascular disease is an occlusion of the blood supply to the extremities by atherosclerotic plaques. It most commonly affect to the lower extremities.

Signs and Symptoms:

Intermittent claudication (leg pain when walking and relieved by rest)
Dorsal foot ulcerations may develope
Painful, cold, and numb on foot
Aortoiliac disease: buttock claudication and femoral pulses are absent, impotence in male
Femoropopliteal disease: calf claudication, pulses below the femoral artery are absent
Small vessel disease: foot pulses are absent
Acute ischemia: caused by embolization from the heart
Severe chronic ischemia: mucle atrophy, pallor, cyanosis, hair loss, and gangrene/necrosis

Diagnostic Procedures:

Palpation of pulses and auscultation for bruits
Measurement of ankle and brachial systolic BP
Droppler ultrasound
Arteriography and digital substraction angiography

Treatments:

Control the underlying causes
Eliminate tobacco
Hygiene and foot care
Exercise
Aspirin, cilostazol, and thromboxane inhibitors
Angioplasty and stenting
Surgery (artery bypass) or amputation

Deep Venous Thrombosis

2009-06-20T10:04:00.000-07:00

Deep venous thrombosis is a clot formation in the large veins of the extremities or pelvis. The disease can be diagnosed by doppler ultrasound.

Predisposing Factors:

Venous statis due to immobilization
Incompetent venous valves in the lower extremities
CHF
Traumatic injury to the lower extremities
Hypercoagulable states
Obesity
Indwelling venous catheters

Signs and Symptoms:

Homan's signs: tendernes on calf with passive foot dorsiflexion
Pain, erythema and swelling unilateral lower extremities

Treatments:

Initial anticoagulation with IV heparin or low-molecular-weight heparin, followed by PO walfarin for a total of 3-6 months
IVC filter in patient with contraindication to anticoagulation
Hospitalized patients: DVT prophylaxis consisting of rapid mobilization, antithromboembolic stockings, leg exercises, and SQ heparin

Aortic Dissection

2009-06-20T09:53:00.000-07:00

Aortic dissection is a transverse tear in the intima of a vessel. The blood enters the media and creates a false lumen and hematoma that propagates longitudinally. The most common sites of origin are above the aortic valve and distal to the left subclavian artery. It occurs often in age 40-60 years of age and a greater frequency in men than in women.

Etiology:
Hypertension (most)

Signs and Symptoms:

Sudden tearing / stabbing pain in the anterior chest in ascending dissection
Interscapular back pain in descending dissection
Hypertensive
Signs of pericarditis or pericardial tamponade may be seen
A murmur of aortic regurgitation may be heard
Neurologic deficits may be seen

Treatments:

If hypertensive, reduce the BP and heart rate. Do not use thrombolytics
Surgical emergency for ascending aortic dissection
Medical therapy for descending dissection aorta

Aortic Aneurysm

2009-06-20T08:56:00.000-07:00

AORTIC ANEURYSM

Etiology:
Atherosclerosis (most are abdominal and more than 90% originate below the renal arteries

Risk Factors:

Hypertension
High cholesterol
Other vascular disease
Family history
Smoking
Age
Gender (males > females)

Signs and Symptoms:

Usually asymptomatic
Pulsatile abdominal mass or abdominal bruits
Ruptured aneurysm
Hypotension
Severe and tearing abdominal pain radiating to the back

Treatments:

If asymptomatic, monitoring is appropiate for lesions less than 5 cm
Surgical repair if lesion is more than 5.5 cm on abdominal or more than 6 cm on thoracic or if enlarges rapidly
Emergency surgery for symptomatic or ruptured aneurysms

Mitral Valve Prolapse

2009-06-20T08:40:00.000-07:00

MITRAL VALVE PROLAPSE

Risk Factors:
Young women (found in 7% of the population)

Signs and Symptoms:

Benign and asymptomatic
Murmur: late systolic murmur with mid-systolic click
Can progress to mitral regurgitation

Treatments:
Treatments are unnecessary unless symptomatic

Mitral Regurgitation

2009-06-20T08:31:00.000-07:00

MITRAL REGURGITATION

Risk Factors:

Rheumatic heart disease
Myocardial Infarction
Infective endocarditis
Severe mitra valve prolapse

Signs and Symptoms:

Signs of left-sided heart failure that can progress to right-sided heart failure
Murmur: high-pitched, holosystolic murmur at the apex that radiates to the axilla
Laterally displaced PMI with left ventricular heave
Atrial fibrillation
Fatigue

Treatments:

ACEIs
Vasodilators
Diuretic
Digoxins
Anticoagulants
Valve repair or replacement

Mitral Stenosis

2009-06-20T08:26:00.000-07:00

MITRAL STENOSIS

Risk Factors:
Rheumatic heart disease

Signs and Symptoms:

Symptoms of CHF (left and right side)
Murmur: mid-diastolic rumble with opening snap at the apex
Atrial fibrillation
Pulmonary rales
Increased intensity of S1 and P2
Right ventricular heave

Treatments:

Avoid inotropic agents
Beta-blocker and diuretics
Digoxins
Anticoagulants
Balloon valvuloplasty

Aortic Regurgitation

2009-06-20T08:17:00.000-07:00

AORTIC REGURGITATION

Risk Factors:

Rheumatic heart disease
VSS
Infective endocarditis
Congenital bicuspid valve
Marfan's syndrome
Syphilis

Signs and Symptoms:

LVH symptoms
Angina
CHF
Widened pulse pressure
Laterally displaced PMI
Three murmur: high-pitched (blowing diastolic murmur at the left sternal border); Austin Flint-low-pitched (mid-diastolic rumble); mid-systolic murmur at the base

Treatments:

Aortic valve replacement
Afterload reducers (ACEIs, vasodilators)
Diuretics
Digoxin

Aortic Stenosis

2009-06-20T08:00:00.000-07:00

AORTIC STENOSIS

Risk Factors:

Rheumatic heart disease
Congenital aortic stenosis
Bicuspid valve

Signs and Symptoms:

Classic triad of exertional dyspnea, angina, and syncope
Can develops to CHF or even death
Murmur: midsystolic crescendo-decrescendo heard best at the second intercostal space radiating to the neck
Pulsus parvus et tardus: weak, delayed caroid upstroke
Sustained apical beat
Paradoxically split S2

Treatments:

Avoid afterload reducers
Valve replacement

Cardiac Tmponade

2009-06-19T03:53:00.000-07:00

Cardiac tamponade is an excess fluid in the pericardial sac. It compromises ventricular filling and decreases output.

Risk Factors:

Pericarditis
Malignancy
SLE
TB
Trauma

Signs and Symptoms:

Fatigue, dyspnea, tachycardia and tachypnea that worsen rapidly and causes shock and death
Beek's triad (hypotension, distant heart sound, and distended neck veins)
Narrow pulse pressure
Pulsus paradoxus
Kussmaul's sign (JVD on inspiration)

Treatments:

Aggressive volume expansion with IV fluids
Pericardiocentesis immediately
Balloon pericardotomy
Pericardial window

Pericarditis

2009-06-19T03:44:00.000-07:00

Pericarditis is an inflammation of the pericardial sac. It often with an effusion and can compromise cardiac output via tamponade or constrictive pericarditis. Most commontly idiopathic.

Etiology:

Collagen vascular disease
Aortic dissection
Radiation
Drugs
Infections
Acute renal failure (uremia)
Cardiac (Myocardial Infarction)
Rheumatoid Fever
Injury
Neoplasms
Dressler's syndrome

Signs and Symptoms:

Pleuritis chest pain that worsens in the supine position and with inspiration
Dyspnea
Cough
Fever
Pericardial friction rub
Elevated JVP
Pulsus paradoxus

Treatments:

Treat the underlying causes, eg. steroid/immunosuppressants for SLE, ASA/NSAIDs for viral pericarditis, dialysis for uremia
Pericardiocentesis with continuous drainage for tamponade or large effusion

Hypertension - Urgency and Emergency

2009-06-17T23:10:00.000-07:00

Hypertensive urgency is defined as systolic BP > 180 mmHg and diastolic BP > 130 mmHg with asymptomatic or moderately symptomatic such as headache, chest pain, and syncope.

Hypertensive emergency is defined as signs or symptoms of impending end-organ damage such as acute renal failure or hematuria, altered mental status or evidence of neurologic disease, intracranial hemorrhage, ophthalmologic problems (papilledema), unstable angina or MI, or pulmonary edema.

Malignant hypertension is defined as progressive renal failure and/or encephalopathy with papilledema.

Treatments:

Treatment is to decrease blood pressure slowly to prevent cerebral hypoperfusion or coronary insufficiency
Oral drugs: beta-blocker, clonidine, and ACEIs
IV agents: nitroprusside, nitroglycerin, labetalol, necardipine, or hydralazine
Diuretics are used if there are signs of fluid overload

Hypertension

2009-06-17T23:02:00.000-07:00

Hypertension is defined as a systole BP > 140 mmHg and/or a diastolic BP > 90 mmHg based on three measurements, each separated by two weeks. It is classified as Stage 1 Hypertension and Stage 2 Hypertension.

Stage 1 (essential) Hypertension

It represent 95% of hypertension cases. Systolic BP 140-139 mmHg, Diastolic BP 90-99 mmHg. Risk factors: family history of hypertension or heart disease, high-sodium diet, smoking, obesity, race (African-American > Caucasians), elderly

Signs and Symptoms:

Asymptomatic until complications develop
Retinal changes
S4 gallop
Systolic click
Loud S2
If untreated will damage to the heart, brain, kidney, vasculature, and eye

Treatments:

Lifestyle management
Diuretics and beta-blocker
Test for end-organ complication periodically; renal and cardiac complications

Stage 2 Hypertension

Stage 2 hypertension is due to an identifiable organic cause. Systolic BP is > 160 mmHg and diastolic BP is > 100 mmHg.

Etiologies and Treatments:
Treatments for stage 2 hypertension are treatment of underlying causes:

Renal disease (stage 1); treatments: ACEIs
Renal artery stenosis; treatments: angioplasty and stenting, ACEIs, and open surgery
OCP use; treatment: discontinue OCPs
Pheochromocytoma; treatment: surgical removal of tumor
Conn's syndrome (hyperaldosteronism); treatment: surgical removal of tumor
Cushing's syndrome; treatment: surgical removal of tumor
Coarctation of the aorta; treatment: surgical repair

Myocardial Infarction (MI)

2009-06-17T22:27:00.000-07:00

Myocardial infarction usually caused by occlusive thrombus or prolonged vasospasm in a coronary artery.

History and Physical Exams:

Acute onset substernal chest pain that is described as pressure or tightness and radiate to the left arm, neck, or jaw
Shortness of breath, diaphoresis, light-headedness, nausea, vomiting, anxiety, syncope
Tachycardia, bradycardia, arrhythmias, new mitral regurgitation, hypotension, pulmonary edema, and ventricular fibrillation
Sudden death from a lethal arrhythmia (ventricle fibrillation)
Clinically silent MIs in elderly, diabetic, postmenopausal and postorthopic heart transplant patients

Diagnosis

ST-segment elevation or new LBBB on ECG
ECG changes: peaked T waves, ST-segment elevation, Q wave, T-wave inversion, ST-segment normalization, T-wave normalization
Inferior MI : ST-segment elevation in leads II, III, and aVF
Anterior MI : ST-segment elevation in leads V1-V4
Lateral MI : ST-segment elevation in leads I, aVL, and V5-V6
Serial cardiac enzymes: troponin and CK-MB.

Treatments:

Acute treatments is Morphine, Oxygen, Nitroglyserin sublingualy, Aspirin, and IV beta-blocker.
Glycoprotein
Heparinization, angiography and revascularization
Consider thrombolysis with tPA, urokinase, or streptokinase
PTCA
CABG - Coronary Artery Bypass Graft (for depressed ventricular function, unable to PTCA, stenosis of left main, and triple-vessel disease)
Long term treatments: ASA, beta-blocker, ACEIs, and statins
Dietary changes and exercises

Angina - Unstable Angina

2009-06-17T22:19:00.000-07:00

Unstable Angina

The angina is unstable if it is new and accelerating or occurs at rest.

Treatments:

Acute treatments is Morphine, Oxygen, Nitroglyserin sublingualy, Aspirin, and IV beta-blocker.
Glycoprotein
Heparinization, angiography and revascularization

Angina Pectoris

2009-06-17T22:01:00.000-07:00

Angina pectoris is substernal chest pain due to myocardial ischemia. Angina pectoris can be distinguished from prinzmetal's (varian) angina by definition that prinzmetal's angina is caused by vasospasm of coronary vessels.

Signs and Symptoms:

Substernal chest pain precipitated by exertion and relieved by rest or nitrates
Pain radiates to the arms, jaw, and neck
Shortness of breath
Nausea or vomiting
Light-headedness
Diaphoresis
Hypertension
Tachycardia
Apical systolic murmur or gallop

Diagnoses:

ST segment depression or T-wave flattening on ECG
Cardiac enzymes to rule out myocardial infarction

Treatments in Acute Case:

Morphine
Oxygen
Nitroglycerin sublingually
Aspirin
IV beta-blocker

Treatments in Chronic Case:

Nitrates
Beta-blockers
Calcium channel blockers
ASA
Risk factor reduction such as smoking, cholesterol, hypertension

Hypercholesterolemia

2009-06-17T21:50:00.000-07:00

Hypercholesterolemia is defined as a total cholesterol level more than 200 mg/dL.

Risk Factors:

Increased blood cholesterol
Increased LDL
Increased triglycerides
Decreased HDL

Etiology:

Obesity
Diabetes Mellitus
Alcoholism
Hypothyroidism
Nephrotic syndrome
Hepatic disease
Cushing's disease
OCP use
Diuretic use
Familial hypercholesterolemia

Data Findings:

No specific signs and symptoms for most patients
Xanthomas - eruptive nodules in skin over tendons
Xanthelasma - yellow fatty deposits in skin around eyes
Lipemia retinalis - creamy of retinal vessels

How to diagnosed:

Hypercholesterolemia is diagnosed by:
Fasting lipid profile for patient more than 20 year and repeat ever five years
Total serum cholesterol > 200 mg/dL on two different occation
LDL > 130 mg/dL or HDL <>

Treatments:

Treatments are based on risk stratification
Diet and exercise

CHF - Diastolic Dysfunction

2009-06-17T21:48:00.000-07:00

CHF - Diastolic Dysfunction is characterized by decreased ventricular compliance with normal contractile function. the ventricle is unable either to actively relax or to passively fill properly

Physical Examinations:

Stable and unstable angina
Shortness of breath
Dyspnea on exertion
Arrhythmias
Myocardial infarction
Heart failure
Sudden death

Treatments:

Beta-blocker
ACEIs
Diuretics
Rate control drugs
Blood pressure management

CHF - Systolic Dysfunction

2009-06-17T21:43:00.000-07:00

CHF - Systolic Dysfunction is determined by an EF < style="font-size:130%;">Physical Examination:

Dyspnea on exertion or at rest if severe
Chronic cough
Fatigue
Lower extremity edema
Orthopnea
Paroxysmal nocturnal dyspnea
Abdominal fullness

Treatments in acute:

Correct underlying causes such as arrhythmia, alcohol-induced failure, thyroid and valvular disease
Diuretics
ACEIs

Treatments in chronic:

Beta-blocker and ACEIs together
Daily aspirin and a statin
Chronic diuretics
Low-dose spironolactone
Treatment of arrhythmias
Limitation of dietary sodium and fluid intake
Warfarin
Mechanical left ventricular assist device or cardiac transplantation

Congestive Heart Failure

2009-06-17T21:28:00.000-07:00

Congestive heart failure is the clinical condition in which the heart is unable to pump enough blood to meet the oxygen demand of the heart and other body tissues.

Risk Factors:

CAD
Hypertension
Valvular heart disease
Pericardial disease
Cardiomopathy
Pulmonary hypertension

Classification and Treatments:
According to the AHA/ACC the classification and treatments of CHF are:

CHF stage A

Present of the risk factors
No structural or functional abnormalities
No signs and symptoms of CHF
Treatments: managing the treatable risk factors, ACEIs

CHF stage B

Present of structral heart disease without symptoms of CHF
Treatments: ACEIs and beta blocker

CHF stage C

Present of structural heart disease with prior or current symptoms of CHF (shortness of breath, fatigue, exercise intolerance)
Treatments: diuretic, ACEIs, beta-blocker, digitalis, dietary salt restriction

CHF stage D

Marked symptoms of CHF at rest despite maximal medical therapy
Treatments: mechanical assist devices, heart transplant, continuous IV inotropic drugs, hospice care

Classification CHF according to New York Heart Association:

CHF Class I

No limitation of activity
No symptoms with normal activity

CHF Class II

Slight limitation of activity
Comfortable at rest or with mild exertion

CHF Class III

Marked limitation of activity
Comfortable only at rest

CHF Class IV

Any physical activity causes discomfort
Symptoms are present at rest
Complete rest in bed or chair

Cardiomyopathy - Restrictive Cardiomyopathy

2009-06-14T06:14:00.000-07:00

Restrictive Cardiomyopathy

The myocardium elasticity is decreased causes impaired diastolic filling without significant systolic dysfunction.

Etiology:

Infiltrative disease: sarcoidosis, hemochromatosis, amyloidosis
Scarring and fibrossis

Signs and Symptoms:
Signs and symptoms are similar to left and right heart failure

Treatments:

Correct the underlying causes
Sodium restriction
Diuretics

Cardiomyopathy - Hypertrophic Cardiomyopathy

2009-06-13T04:47:00.000-07:00

Hypertrophic Cardiomyopathy

Etiology:

Left ventricular hyperthropy
Idiopathic hypertrophic subaortic stenosis (IHSS)
Hypertension
Aortic stenosis

Signs and Symptoms:

Dyspnea, palpitation and chest pain
Syncope after exertion
Arrhythmias and increased left atrial pressure
Mitral regurgitation
Sustained apical impulse
S4
Systolic ejection murmur

Treatments:

Beta blockers are used as initial therapy
Calcium channel blockers are second-line therapy
Surgical
avoid athletic competition and training

Cardiomyopathy - Dilated Cardiomyopathy

2009-06-13T04:25:00.000-07:00

Dilated Cardiomyopathy

It is a most common cardiomyopathy.

Etiology:

Idiopathic
Left ventricular dilatation and systolic dysfunction
Ischemia
Long-standing hypertension
Alcohol
Wet beriberi
Coxsackievirus
Chagas' disease
Parasites
Cocaine
Myocarditis
Doxorobicin
HIV
AZT use

Diagnosis
It can be diagnosed by:

Echocardiography
ECG: nonspecific ST-T changes, low-voltage QRS, sinus tachycardia, ectopy, LBBB
X-ray: enlarged, baloon-like heart and pulmonary congestion

Treatments:

Stop the consumption of alcohol
Anticoagulation to decrease thrombus risk
Implantable cardiac defibrillator

Ventricular Fibrillation

2009-06-06T10:50:00.000-07:00

Ventricular Fibrillation

Etiology:
Associated with CAD and Myocardial Infarction

Signs and Symptoms:

Syncope
Hypotension
Pulselessness

ECG Findings:
Totally erratic tracing

Treatments:

Electrical cardioversion immediately
Advanced Cardiac Life Support Protocol

Venticular Tachycardia

2009-06-06T10:28:00.000-07:00

Venticular Tachycardia

Etiology:
It is associated with CAD and MI

Signs and Symptoms:

Asymptomatic, or
Palpitations
Hypotension
Angina
Syncope
Can progress to ventricular fibrillation

ECG Findings:

Wide QRS complexes with regular rapid rhythm
Three or more consecutive PVCs
AV dissociation

Treatments:

Cardioversion
Antiarrhytmics: amiodarone, lidocaine, procainamide)

Premature Ventricular Contraction (PVC)

2009-06-06T10:24:00.000-07:00

Premature Ventricular Contraction (PVC)

Etiology:

Ectopic beats from ventricular foci
Hypoxia
Electrolyte abnormalities
Hyperthyroidism

Signs and Symptoms:

Asymptomatic
Palpitation

ECG Findings:

Wide QRS that is not preceded by a P wave
PVCs are followed by a compensatory pause

Treatments:

Treatments are focused on underlying cause
Beta blocker or other antiarrhytmics are given if symptomatic

Paroxysmal Atrial Tachycardia

2009-06-04T03:59:00.000-07:00

Paroxysmal Atrial Tachycardia

Etiology:
Rapid ectopic pacemaker in the atrium (not sinus node)

Signs and Symptoms:

Palpitations
Shortness of breath
Angina
Syncope
Light-headedness

ECG Findings:
P wave with an unusual axis before each normal QRS
Rate is more than 100 bpm

Treatments:
Adenosine

Atrioventricular Reciprocating Tachycardia (AVRT)

2009-06-04T03:50:00.000-07:00

Atrioventricular Reciprocating Tachycardia (AVRT)

Etiology:

Circular movement of an impulse down the AV node and back up to the atrium through a bypass tract
Seen in Wolff-Parkinson-White syndrome

Signs and Symptoms:

Shortness of breath
Palpitation
Angina
Light-headedness
Syncope

ECG Findings:
Retrograde P wave is often seen after a normal QRS

Treatments:

Valsalva
Caroted massage
Adenosine
Cardioversion if hemodynamically unstable

Atrioventricular Nodal Reentry Tachycardia (AVNRT)

2009-06-04T03:27:00.000-07:00

Atrioventricular Nodal Reentry Tachycardia (AVNRT)

Etiology:
A reentry circuit in the AV node depolarizes the atrium and ventricle simultaneously

ECG Findings:

P wave is often buried in QRS or shortly after
Rate 150-250 bpm

Treatments:

Valsalva
Carotid massage
Adenosine
Cardioversion if hemodynamically unstable

Multifocal Atrial Tachycardia

2009-06-04T03:02:00.000-07:00

Multifocal Atrial Tachycardia

Etiology:

Multiple atrial pacemakers
Reentrant pathways
COPD
Hypoxemia

Signs and Symptoms
Asymptomatic

ECG Findings:

Three or more unique P wave morphologies
Rate more than 100 bpm

Treatments:

Treat the underlying disorder
Verapamil or beta blocker

Atrial Flutter

2009-06-04T02:58:00.000-07:00

Atrial Flutter

Etiology:

Circular movement of electrical activity around the atrium at a rate 300 bpm

Signs and Symptoms:

Asymptomatic
Palpitations
Syncope
Light-headedness

ECG Findings:

Regular rhythm
P wave appear “sawtooth:

Treatments:

Anticoagulation and rate control
Cardioversion

Atrial Fibrillation

2009-06-04T02:35:00.000-07:00

Atrial Fibrillation

Etiology:
Acronym of P I R A T E S :

Pulmonary disease
Ischemia
Rheumatic heart disease
Anemia / atrial myxoma
Thyrotoxicosis
Ethanol
Sepsis

Signs and Symptoms:

Asymptomatic
Shortness of breath
Irregularly irregular pulse
Chest pain
Palpitations

ECG Findings:
Wavy baseline without discernible P waves with variable and irregular QRS response

Treatments:

Anticoagulation
Rate control (calcium channel blocker, beta blocker, digoxin)
Cardioversion (only for new onset <>

Sinus Tachycardia

2009-06-04T02:29:00.000-07:00

Sinus Tachycardia

Etiology:

Normal response to fear, pain and exercises
Hyperthyroidism
Dehydration
Infection
Pulmonary embolism

Signs and Symptoms:

Palpitation
Shortness of breath

ECG Findings:

Ventricular rate less than 100 bpm
Normal P waves before every QRS complex

Treatments:
Treatments are according the underlying causes

Third Degree (complete) AV Block

2009-06-04T02:22:00.000-07:00

Third Degree (complete) AV Block

Etiology:
There is no electrical communication between the atria and ventricles

Signs and Symptoms:

Syncope
Dizziness
Acute heart failure
Hypotension

ECG Findings:
No relationship between P wave and QRS complexes

Treatments:
Pacemaker placement

Second Degree AV Block (mobitz II)

2009-06-04T02:01:00.000-07:00

Second Degree AV Block (mobitz II)

Etiology:
Fibrotic disease
Previous septal MI

Signs and Symptoms:
Syncope
Progression to third-degree AV block

ECG Findings:
Unexpected dropped beat without a change in PR interval

Treatments:
Pacemaker placement

Second Degree AV Block (Mobitz I)

2009-06-03T19:16:00.000-07:00

Second Degree AV Block (Mobitz I)

Etiology:

Drug effect from digoxin, beta blocker, and calcium channel blocker
Increased vagal tone

Signs and Symptoms:
Asymptomatic

ECG Findings:
PR interval is increase until a dropped beat occurs (Wenckebach)

Treatments:
Stop the offending drugs

First Degree AV Block

2009-06-03T19:12:00.000-07:00

Etiology:

It can be occurred in normal individuals
Associated with increased vagal tone and with beta blocker and calcium channel blockers

Signs and Symptoms:
Asymptomatic

ECG Findings:
PR interval more than 200 msec

Treatments:
None necessary

Left Bundle Branch Block (LBBB)

2009-06-03T19:09:00.000-07:00

Etiology:
It usually a sign of organic heart disease (hypertension, valvular disease, cardiomyopathy, CAD)

Signs and Symptoms:
Asymptomatic

ECG Findings:

QRS duration more than 120 msec
Wide QS complex in V1
Wide, tall R wave with no Q wave in V6

Treatments:

Often no specific treatments
Pacemaker may be used in post MI LBBB with conduction defects

Right Bundle Branch Block (RBBB)

2009-06-03T13:50:00.000-07:00

Etiology:

It can occur in normal individuals
COPD
Valvular disease
Chronic CAD
Following the surgical repair of a VSD

Signs and Symptoms:
Asymptomatic

ECG Findings:

QRS complex more than 120 msec
QRS complex with a wide R wave
QRS pattern with a wide S wave in V6

Treatments:
No specific treatments

Sinus Bradycardia

2009-06-03T13:46:00.000-07:00

Etiology:

Normal response to cardiovascular conditioning
Can result from sinus node dysfunction or from beta blocker or calcium channel blocker excess

Signs and Symptoms:

May be asymptomatic
Light-headedness
Syncope
Hypotension

ECG Findings:

Ventricular rate less than 60 beats per minute
Normal P wave before every QRS complex

Treatments:

No specific treatments if asymptomatic
Atropine is used to increase heart rate
Pacemaker placement