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Clinical Manifestations and Diagnosis of Acute Coronary Syndrome

In this article, we will discuss the Clinical Manifestations and Diagnosis of Acute Coronary Syndrome. So, let’s get started.

Clinical Manifestations/Diagnosis

The diagnosis of non-ST-elevation ACS (unstable angina) is based on clinical presentation. It is diagnosed when chest discomfort is severe and has at least one of the three following features:

1. Pain/discomfort occurs at rest or with minimal exertion lasting >10 minutes

2. It is of recent onset (<2 weeks)

3. It has crescendo pattern, i.e. it is more severe, prolonged and more frequent than previous episodes.

The diagnosis is confirmed by elevated levels of biomarkers of myocardial necrosis (CPK-MB and troponins)

There is usually no physical sign but patients with rest pain frequently develop third or fourth heart sound during the episodes, and in some instances exhibit transient left ventricular failure (murmur of mitral incompetence) due to development of heart failure. Patients with ACS (Acute Coronary Syndrome) should be explored for the precipitating cause such as uncontrolled hypertension, anemia, occult thyrotoxicosis and presence of atherosclerosis (carotid, aortic or peripheral artery disease).

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Definition of Epidemic Dropsy

In this article, we will discuss the Definition of Epidemic Dropsy. So, let’s get started.

Definition

It is defined as edema occurring in epidemic form due to consumption of contaminated edible oil (mustard oil) with argemone oil- a toxic ingredient.

It is known to occur in epidemics in India, and recent epidemic of this poisoning has been reported from Delhi and the adjoining areas in 1990.

Mode of Poisoning

It is ingestional. Mustard oil is used as a cooking oil in certain parts of India especially West Bengal from where first epidemic broke. Mustard, sometimes gets contaminated with Mexican poppy (Argemone mexicana) seeds (in India, it is known as Sialkanta, Daurdy, Satyanshi, Brahmdandi or Pila Datura). Consumption of this contaminated oil leads to poisoning called epidemic dropsy. The toxic ingredients of argemone oil are sanguinarine and disanguinarine.

Complications of Acute Dysentery

In this article, we will discuss the Complications of Acute Dysentery. So, let’s get started.

Complications

Acute dysentery is an acute inflammation of the large intestine characterised by diarrhea with blood and mucus in the stool. Its causes a re bacillary (Shigella spp., enterohaemorrhagic E.coli and Vibrio parahaemolyticus) or amoebic infection.

Complications of Acute Dysentery are discussed below:

A. Intestinal

  • Toxic megacolon
  • Rectal prolapse
  • Intestinal perforations

B. Bacteremia

C. Metabolic/toxic

  • Hypoglycemia
  • Hyponatremia and dehydration
  • Toxic encephalopathy

D. Blood

  • Hemolytic uremia syndrome

E. Joint

  • Reactive arthritis (Reiter’s syndrome)

Diseases Associated with Acute Nephritic Syndrome

In this article, we will discuss the Diseases Associated with Acute Nephritic Syndrome. So, let’s get started.

Diseases Associated

A. Primary glomerular diseases

  • Membranoproliferative glomerulonephritis
  • Mesangial proliferative glomerulonephritis
  • Pauci-immune glomerulonephritis (rapidly progressive crescentic)

B. Secondary to systemic diseases

  • Post-infectious glomerulonephritis- bacterial, e.g. post-streptococcal, SABE, viral, e.g. HBV
  • Systemic collagen vascular diseases- Systemic lupus erythematosus, systemic vasculitis, e.g. PAN, Wegener’s granulomatosis (ANCA small vessel vasculitis)
  • Hematological diseases- Henoch-Schönlein purpura, hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura, cryoglobulinemia, serum sickness
  • Glomerular basement membrane (GBM) diseases- Goodpasture’s syndrome

C. Miscellaneous

  • Guillain-Barré syndrome
  • DPT vaccination, IgA nephropathy

Clinical Features and Investigations of Acute Diarrhea

In this article, we will discuss the Clinical Features and Investigations of Acute Diarrhea. So, let’s get started.

Signs and Symptoms

  • Nausea, vomiting
  • Abdominal pain
  • Fever
  • Watery stools
  • Blood in the stool (hematochezia)
  • Excessive thirst

Signs of dehydration may be present

  • Patient irritable
  • Weak pulse, low BP
  • Depressed fontanelle
  • Dry pinched facies
  • Sunken eyeballs
  • Dryness of mouth, tongue, mucous membrane
  • Loss of skin turgor

Investigations

  • Stool examination for leukocytes, ova, parasites, blood and pus cells, etc
  • Stool for fecal lactiferin: It is a sensitive marker of fecal leukocytes, indicates inflammatory diarrhea. It is estimated by ELISA and latex agglutination test
  • Stool immunoassay for bacterial toxins (c.difficile), viral antigen (rota virus) and protozoal antigens (Giardia, E.histolytica)
  • Stool culture for isolation of the infective agent, i.e. enterohemorrhagic and other types of E.coli, Vibrio species and Versinia
  • Complete hemogram
  • Blood biochemistry, e.g. urea, creatinine, electrolytes
  • Blood culture
  • Sigmoidoscopy with biopsies and upper endoscopy with duodenal aspirates and biopsy if indicated
  • Abdominal X-ray or CT scan
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