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Case 6 Fainting

This note corresponds to: Tut12 Case 6 tutorial - Fainting 1 e-Case

Learning outcomes

Prep

In the prep quiz you are asked to give the following things:

  • Normal blood pressures for 2 ages,
  • Give a run down on BMI
  • Annotate a cardiac cycle chart, labeling each event, g
  • Give an outline of heart murmurs, associating different valvular defects with different time of hearing in the cardiac cycle
  • Describe cardiac blood flow during systole
  • Locations to find an arterial pulse
  • What is an apex pulse
  • The relationship between right artrial pressure changes and JVP
  • and the effects of exercise on cardiac output and blood flow distribution

I will explain associated ideas around each

Blood pressure
BMI
Cardiac cycle chart
Heart murmurs and valvular disease
Cardiac blood flow
Locations to find an arterial pulse
Apex pulse
Relationship between right arterial pressure changes and JVP
Exercise and cardiac output/ blood flow distribution

Tutorial 1

Fainting and syncope

PT. 1

list what it is and what can cause it.

gathering information on the causes

delve into cardiovascular causes / different structural anomalies of the heart

symptoms of different cardiovascular causes maybe link to later bit

how to check for differenct causes At the bedside (forming a differential diagnosis)

murmurs and their role in determining structural anomalies

signs ans symptoms of aortic valve stenosis

cardiac investigations

notes from consultant summary?

Transcatheter aortic valve implatation


PT. 2 
Infective endocarditis and mitral valve stenosis

see types of murmurs

how to differentiate a murmur (maybe see above)

signs and symptoms of mitral valve stenosis

Compare and contrast aortic v mitral stenosis

IDL

IDL task 1

you are asked to:

  1. Understand the importance of an accurate diagnosis of ARF and:
  • Consequences of over diagnosis
  • consequences of missed diagnosis
  • consequences of misdiagnosis
  • categories of definitive, probable and possible ARF and the Aotearoa NZ diagnosic criteria (modified jones criteriea)
Summary of this
  1. Read the NZ guidelines for the prevention diagnosis and management of ARF and RHD
Put reading summary here
  1. Answer the questions asked relating to: What the jones criteria are: why we have created a modified jones criteria diagnostic criteria leading to an ARF diagnosis importance of these guidleines and current practices around handling juvenile ARF
IDL task 2

You have been asked to:

  1. Understand that
    1. In new zealand the incidence of ARF varies with different parts of the country
    2. awareness of the health status of the area in which one practices is vital for their susceptable patients
    3. strategies are needed for reducing rates of ARF in susceptible populations
  2. read the Rheumatic fever roadmap rheumatic fever guidance materials
    1. from this outline goals of the different levels of prevention strategies in addressing rheumatic fever and RHD in NZ
    2. outline epidemiology of GAS, ARF, and RHD and the pattern of these conditions
IDL task 3
  1. understand
    1. the pathogenesis of RHD and its relation to ARF
    2. RHD predisposes to Infective endocarditis but other heart valve pathologies can also lead to IE
    3. Prophylaxis is vital to prevetn IE for individuals who have heart valve disease when they undergo an event which can lead to bacteraemia (surgery, dental procedure)
    4. if one understands the natural history of endocardiait sotu can identify stages at which help is best administered.
    5. and of course latest evidence is a guide which you need to use
  2. Read this paper: [paper goes here]
    1. what was the primary causative organism in nz for IE and how does this compare internationally
    2. what clinical and demographic features are associates with a patient with IE
    3. what is there a higher risk for and why, in patients with coagulase negative staph infections
    4. how where IE causing bacteria idenified when blood cultures were negative
    5. Why do you think that for many of the patients recruited in to the study, the time of onset of the I.E was unknown?
    6. what are vegetation and why are they so colonisable
    7. what was surprising about this study
    8. outline the relationship between GAS and streptococcus viridians in a patient with previous rheumatic fever

Tutorial 2

In this tutorial you were asked:

  1. how would you approach treatment fo sore throats in general practice, with respect to the implications of antibiotics
  2. what are key factors related to the prevention of repeat episodes of RF?
  3. a bit about ethics of reasons you may or may not get an operation
  4. and a medical imaging quiz where you may be asked to review Xrays?

Post quiz

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