sujataranijindal

Typical medications used in the acute phase include nifedipine, labetalol, and hydralazine, with ACOG suggesting that labetalol be first line unless a contraindication is present. #Management #Obstetrics #Obgyn #Eclampsia #Preeclampsia #HTN #Pregnancy #Antihypertensives #Labetalol #Hydralazine #Nifedipine #Hypertension

Early and Late Complications of Acute Myocardial Infarction - Timeline of Complications - Ventricular Arrhythmias - Bradyarrhythmias / Heart Block - Cardiogenic Shock - Stroke - Ischemic MR / Papillary Muscle Rupture - Ventricular Septal Rupture - LV Free Wall Rupture - Pericarditis (Dressler Syndrome) #Diagnosis #Cardiology #Timeline #Timetable #PostMI #Complications #Myocardial #Infarction #Early #Late

Primary and Secondary Causes of Mitral Regurgitation Primary (organic) chronic mitral regurgitation: • Leaflet: Rheumatic fever, Infective endocarditis, Myxomatous (MVP), Connective tissue (Marfan, Ehlers-Danlos), Congenital (cleft, cushion defects), Systemic inflammation (SLE, Scleroderma) • Chordae tendineae: Rheumatic fever, Infective endocarditis, Myxomatous (MVP), Spontaneous rupture • Mitral annulus: Rheumatic fever, Calcification (idiopathic), Myxomatous (MVP), Connective tissue (Marfan, Ehlers Danlos) • Prosthetic valve: Paravalvular leak, Infective endocarditis, Ring fracture, Thrombus formation, Leaflet deterioration, Occluder dysfunction Secondary (functional) chronic mitral regurgitation: • Leaflet: Hypertrophic cardiomyopathy, Drug-related • Chordae tendineae: Myocardial infarction, Tendineae rupture • Papillary muscle: Myocardial infarction, Dilated cardiomyopathy, Papillary muscle rupture, Left ventricular aneurysm • Mitral annulus valve: Dilated cardiomyopathy - VA Joint Chiefs @BostonChiefs #Mitral #Regurgitation #differential #diagnosis #cardiology #causes #primary #secondary

Shock Classification Shock Definition: State of cellular and tissue hypoxia due to: reduced oxygen delivery, increased oxygen consumption, inadequate oxygen utilization, or a combination of these processes. Stages: 1. PRE-SHOCK - Compensated shock, cryptic shock. Compensatory responses to diminished tissue perfusion 2. SHOCK - Compensatory mechanisms become overwhelmed, symptomatic tachycardia, dyspnea, cold clammy skin, altered mentation 3. END-ORGAN DYSFUNCTION - Irreversible end-organ damage, multisystem organ failure, and death DISTRIBUTIVE (Warm and Dry): • Most common type (66% of shock) • Septic → dysregulated host response to infection • Neurogenic → in severe traumatic brain or spinal cord injury • Anaphylactic → severe IgE-mediated reaction • Endocrine/Metabolic → addisonian crisis, myxedema, beriberi CARDIOGENIC (Cold and wet) • Cardiomyopathic → myocardial infarction, following cardiac arrest or decompensated heart failure, thyrotoxicosis • Arrhythmic → tachyarrhythmias or bradyarrhythmias • Mechanical → severe aortic or mitral insufficiency, acute valvular rupture, dissection of ascending aorta into valve ring OBSTRUCTIVE (Cold and Dry) • Pulmonary vascular → RV failure from massive pulmonary embolism or severe pulmonary hypertension • Mechanical (impaired venous return/ventricular filling) → tension pneumothorax, cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy HYPOVOLEMIC (Cold and Dry) • Hemorrhagic → leading to reduced intravascular volume. Most commonly due to trauma or gastrointestinal bleeding • Nonhemorrhagic → volume depletion due to loss of sodium and water #Shock #Classification #Types #diagnosis #management #cold #warm #wet #dry #table

Addison vs Cushing #Addison_disease #Cushing_Syndrome

Primary Adrenal Insufficiency Addison's Disease - Damage of the adrenal glands with lack of cortisol, androgens and aldosterone Causes of Adrenal Insufficiency: Most Common Causes: • Autoimmune > Tuberculosis Infiltrative Disorders: • Infection (tuberculosis, fungal infections) - Tuberculosis: can cause adrenal calcification and enlargement • Sarcoidosis • Lymphoma Metastatic Disease -> Adrenals: • Lung cancer • Renal cell carcinoma, and melanoma Bilateral Adrenal Hemorrhage: • Consider if unexpected hypotension develops • Risk factors for BAH include protein C deficiency, anticoagulation, DIC and sepsis - (Neisseria meningitidis, H Flu, pneumococci, pseudomonas) Autoimmune: + 21-Hydroxylase Antibodies: • 50% will develop another autoimmune endocrine disorder - Primary hypothyroidism - Primary ovarian insufficiency - Celiac disease, - Hypoparathyroidism - Type 1 diabetes mellitus Aldosterone Deficiency: Symptoms: • Salt craving • Dizziness • Nausea/vomiting • Fatigue Signs: • Orthostasis • Hypotension Labs: • ↑ PRA • ↓ Serum sodium • ↑ Serum potassium • ↑ H+ (NAGMA from RTA type IV) Cortisol Deficiency: Symptoms: • Fatigue • Weakness • Low-grade fever • Weight loss • Anorexia • Nausea/vomiting • Abdominal pain • Back pain • Arthralgia • Myalgia Cortisol Deficiency: Signs • Hyperpigmentation ("bronzing") - Palmar creases - Extensor surfaces - Buccal mucosa - *Not present in approximately 5% patients • ↓ BP • ↓ Serum cortisol • ↑ Plasma ACTH • ↓ Serum sodium • ↓ Plasma glucose • ↑ Eosinophils (Not always present) ↓ DHEA/Androgens: • Symptoms: Reduced libido • Signs: Decreased axillary or pubic hair • Labs: ↓ Serum DHEAS Diagnosis: • History and physical: - Symptoms/physical exam. - Dark patches on the skin might be a clue • Blood tests: - Check sodium, potassium, AM cortisol and ACTH - + 21-hydroxylase antibodies are found in approximately 90% of autoimmune adrenalitis cases - Serum cortisol < 3 ug/dL -> Primary AI present - ACTH stimulation test: Administer 250 mcg ACTH. Measure at 0, 30, and 60 mins. - Check Serum Cortisol. IF < 18 ug/dL Primary AI present - ACTH test is not affected by use of DEXAMETHASONE - ACTH test is affected by HYDROCORTISONE #Primary #adrenal #insufficiency #addisons #disease #endocrinology #diagnosis #signs #symptoms

Renin-Angiotensin-Aldosterone System (RAAS) #RAAS #Renin #Angiotensin #Aldosterone #System #Pathophysiology

Myxedema coma and thyroid storm are thyroid emergencies associated with increased mortality. Prompt recognition of these states—which represent the severe, life-threatening conditions of extremely reduced or elevated circulating thyroid hormone concentrations, respectively—is necessary to initiate treatment. Management of myxedema coma and thyroid storm requires both medical and supportive therapies and should be treated in an intensive care unit setting. Satyendra Dhar MD, @DharSaty #hypothyroidism, #hyperthyroidism, #ICU, #myxedemacoma, #thyroidemergencies, #thyroidstorm

Lactic Acidosis - Overview and Pathophysiology Lactic acid is an endogenous substrate for gluconeogenesis, that is constantly produced by muscle and other tissues and is increased with exercise/activity. Lactic acid is non-toxic, though it importantly can be a marker for severity of underlying disease. Lactate is the conjugate base of lactic acid (this is why LR does not cause acidosis) Lactic Acidosis is defined as an arterial lactate level ≥ 2 mmol/L PLUS a pH < 7.35 TYPE A: Impaired O2 Delivery (DO2) • Decreased O2 Delivery • Increased O2 Demand TYPE B: Impaired O2 Utilization (VO2) • Drugs/Toxins • Impaired Clearance • Other TYPE D: Bacterial Overgrowth by Mark Ramzy, DO, EMT-P @MRamzyDO and Nick Mark MD @nickmmark #Lactic #Acidosis #types #differential #diagnosis #pathophysiology #classification