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Classification of Myocardial Infarction (MI)

In this article, we will discuss the Classification of Myocardial Infarction (MI). So, let’s get started.

Classification

Type 1 – Spontaneous MI – It is related to ischemia due to a primary coronary event such as plaque rupture, ulceration, fissuring, erosion or dissection resulting in coronary thrombosis

Type 2 – Supply/Demand mismatch – MI secondary to ischemia due to either increased oxygen demand or decreased oxygen supply e.g. coronary artery spasm, coronary embolism, anemia, arrhythmia, hypertension or hypotension.

Type 3 – Suspected MI-related death – Sudden unexpected cardiac death often with symptoms suggestive of myocardial infarction.

Type 4a – PCI related MI (percutaneous coronary intervention) – Rise in cardiac biomarkers accompanied by symptoms along with electrographic, angiographic or imaging evidence of ischemia after PCI (MI associated with PCI).

Type 4b – Stent thrombosis – Confirmed stent thrombosis in the context of ischemia and dynamic cardiac biomarkers changes (MI associated with stent thrombosis).

Type 5 – CABG related MI (coronary artery bypass graft) – Rise in cardiac biomarkers accompanied by electrographic, angiographic or imaging evidence of ischemia after CABG (MI associated with CABG).

 

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Tension Pneumothorax

In this article, we will discuss about Tension Pneumothorax. So, let’s gets started

Tension Pneumothorax

In tension pneumothorax, the mean pleural pressure is positive which means that air in the pleural cavity is under tension which causes compression collapse of the lung. It develops due to persistent air leak (air entry) inside the pleural cavity by the communication which opens during inspiration and closes during expiration preventing the air to escape. In this way, with each successive breath, the intrapleural pressure increases which eventually causes the mediastinum to shift to the opposite side and increased intrapleural pressure also puts pressure on the surrounding blood vessels.

There is decreased venous return to the heart and along with decreased cardiac output causing hypotension (cardiac tamponade) and cyanosis.

Clinical Features

Dyspnea, cough and acute exacerbation of pneumothorax symptoms

Trachea and mediastinum shifts to the opposite side

Decreased or absent breath sounds, there may be amphoric breathing present at a localized place.

Hyperinflated chest with decreased or absent chest wall movement of the involved side

Tachypnea, tachycardia, hypotension, cyanosis, and paradoxical pulse.

 

 

Clinical features of Pneumothorax

In this article, we will discuss about the Clinical features of Pneumothorax. So, let’s get started.

Clinical features

Chest pain ( Pain is sharp, pleuritic, and is localized to the same side of pneumothorax)

Dyspnea

Fullness of intercoastal spaces

Decreased chest wall movement

Hyper-resonant percussion note

Decreased breath sounds, vocal fremitus, and vocal resonance in closed and tension pneumothorax. s

Increased vocal fremitus, vocal resonance, presence of whispering pectoriloquy (on development of large bronchopleural fistula), and amphoric bronchial breathing.

Accumulation of fluid or pus in the pleural cavity in case ocharacterized by f an associated infection (open pneumothorax or pneumothorax due to tuberculosis) along with physical signs of horizontal shifting level of dullness and succussion splash, and additionally there is signs of toxemia

Recurrent spontaneous pneumothorax occurs with emphysema due to the rupture of bullae occurring on the same side.

 

 

Signs and Symptoms of Pleural Effusion

In this article, we will discuss about the various Signs and Symptoms of Pleural Effusion . So, let’s get started.

Sign and Symptoms

Chest pain often referred to the left shoulder or upper abdomen because of diaphragmatic irritation.

Dyspnea

Dry cough

Shortness of breath

Difficulty in inspiration

Orthopnea

Fever

Persistent hiccups

Lower extremity edema

Paroxysmal nocturnal dyspnea

Rotator Cuff Tendinopathy

It refers to the pain and weakness of rotator cuff musculature Rotator cuff comprises of four main muscles viz. Subscapularis, Supraspinatus, Infraspinatus, Teres Minor responsible for abduction and rotation movement of shoulder

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EPIDEMIOLOGY

Commonly affects athletes involved in sporting activities like Cricket, Swimming, Throwers etc and it can be age related problem affecting old aged patients their is an incidence of 11.2 cases per 1000 patients per year

CLININCAL PRESENTATION AND PATHOPHYSIOLOGY

Their is a difference between tendinitis and tendinopathy. Tendinitis is an inflammation of tendons whereas tendinopathy is deterioration of tendons. Rotator Cuff tendinopathy is clinically presented with

Pain, Weakness, Loss of strength to bear load aur lift weight on shoulders along with tenderness around shoulder joint painfull overhead movement localised swelling may also be present

MECHANISM

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PHYSICAL EXAMINATION AND DIAGNOSIS

For Physical examination two clinical tests are performed namely

Empty can test and Hawkins test

Other tests include Modified Belly press test, Palpation, ROM testing the latter two are not so significant In order to see how the tests are performed visit

https://www.physio-pedia.com/Rotator_Cuff_Tendinopathy

Other diagnostic tools include ultrasound, radiographs, radionucleotide isotope scan, magnetic resonance imaging (MRI), computed axial tomography (CT), electromyography

Ultrasound reveal partial tear of tendon fibres partial thickened tears and thickened subacromial bursa MRI also reveals rotator cuff tears

DIFFERENTIAL DIAGNOSIS

Osteoarthritis

Biceps tendinopathy

Frozen Shoulder

Cervical Disc Disease

Cervical Spondylosis

MEASUREMENT

For measuring extent of rotator cuff tendinopathy VAS score, SPADI (Shoulder pain and disability index) have be adopted extensively by physiotherapist

PHYSIOTHERAPY MANAGEMENT

Physiotherapy is the gold standard treatment for rotator cuff tendinopathy along with Medical Management in majority cases and rarely require surgical intervention if Conservative treatment doesn’t work Medical Management includes NSAIDS, Shoulder immobilisation etc Surgery involves Arthroscopic intervention Physiotherapy treatment includes step wise procedure firstly Stretching, ROM exercises and then Muscle Strengthening exercises for pain management Ultrasound, TENS etc Modalities can be applied Kinesiotaping have shown better result in patients with Rotator Cuff Tendinopathy. Other techniques include

Isometric exercises

Kinetic Chain exercises

Correcting scapulohumeral rhythm

Corrective Posture

Pilates technique

for more info visit

https://www.physio-pedia.com/Rotator_Cuff_Tendinopathy

Thyroidectomy

In this article, we will briefly discuss Thyroidectomy. So, let’s get started.

Thyroidectomy

It is the partial or complete removal of the thyroid gland.

Types

  • Lobectomy and isthmusectomy
  • Bilateral subtotal thyroidectomy
  • Near-total thyroidectomCausesy
  • Total thyroidectomy

Causes

  • Carcinoma
  • Large nodular thyroid compressing the airway

Complications

  • Recurrent laryngeal nerve paralysis
  • Hemorrhage
  • Hypoparathyroidism
  • Infection

 

Management of Cor Pulmonale

In this article, we will discuss in brief the Management of Cor Pulmonale. So, let’s get started.

Management

  • The patient is rested in a supine comfortable position.
  • Treatment of the basic cause.
  • The patient is advised to avoid smoking.
  • O2 therapy: O2 therapy to be given intermittently.
  • Salt restriction and diuretics: Salt restriction is advised to avoid fluid retention and RV volume overload. Intravenous diuretics such as furosemide, etc are given to relieve fluid overload.
  • Bronchodilators: They are given intravenously to relieve bronchospasm (due to acute exacerbation) and to improve oxygenation.
  • Carbonic-anhydrase inhibitor, e.g. acetazolamide to be given in order to relieve hypercapnia.
  • Antibiotics are given to treat superadded infection causing acute exacerbation.
  • Reduction of afterload by angiotensin-converting enzyme inhibitor (ACE inhibitors) in patients with left heart failure causing right heart failure.

Clinical Consequences of Vomiting

In this article, we will discuss the Clinical Consequences of Vomiting. So, let’s get started.

Clinical Consequences (Complications)

Repeated vomiting, if forceful may lead to pressure rupture of the esophagus (Boerhaave’s syndrome).

It may cause a linear mucosal tear at or near the cardioesophageal junction leading to hematemesis (Mallory-Weiss syndrome).

Prolonged vomiting may lead to fluid loss (dehydration), loss of HCL (metabolic alkalosis), loss of potassium ions K+ (hypokalemia), and loss of nutrients (malnutrition).

Vomiting in an unconscious patient or in patient with depressed consciousness may result in aspiration pneumonia.

Components of a Single Exercise Session

In this article, we will discuss the various Components of a Single Exercise Session. So, let’s get started.

Components

Warm-up: At least 5-10 minutes of low to moderate-intensity aerobic exercise or resistance exercise with lighter weights.

Conditioning: 0-60 minutes of aerobic, resistance, neuromuscular and/or sports activities.

Cool-down: At least 5-10 minutes of low to moderate-intensity aerobic exercise or resistance exercise with lighter weights.

Stretching: At least 10 minutes of stretching exercises performed after the warm-up or cool-down phase.

Clinical Features of Cor Pulmonale

In this article, we will discuss the Clinical Features of Cor Pulmonale. So, let’s get started.

Clinical Features

Productive cough

Dyspnea

Chest discomfort

Headache

Abdominal pain

Lower extremity swelling

Ascites

Physical Signs include:

Orthopnea

The patient sits with elbows supported on a table and legs dangling by the side of the chest

Pursed lip breathing and cyanosis (presents in patients with COPD with acute exacerbation)

Periorbital edema

Jugular venous distention (raised JVP) and ‘VY’ (wave) collapse due to tricuspid regurgitation

Peripheral edema

Systemic Signs

Respiratory system may show signs of COPD (barrel-shaped chest, restricted chest movements and expansion, hyper-resonant note and vesicular breathing with prolonged expiration, muffled breath sounds)

Signs of RV hypertrophy or failure e.g. parasternal heave, loud P2, midsystolic and early diastolic (Graham-steel) murmur and pansystolic or holosystolic murmur of tricuspid regurgitation (Carvallo’s sign) may be present.

Abdominal distention may be present along with tender hepatomegaly. Hepatojugular reflex may be present.

PT Master Guide
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