Thread: CVA

Ee Lik Wee
041303026
Group B3


Acute Stroke
Def: characterised by the rapid appearance(usually over minutes)of a focal deficit of brain function.,most commonly a hemiplegia with or without signs of focal higher cerebral dysfunction,hemisensory loss,visual field defect or brain-stem deficit

Classification of stroke (clinical) :
i)Transient ischaemic attact
-resolve within 24 hrs
ii)Progressing stroke
-focal neurological deficit worsen after the
patient first present
iii)complete stroke
-focal deficit persist and not progressing

D/D of Stroke and TIA:
-Primary cerebral tumours
-metastatic cerebral tumours
-subdural hematoma
-Cerebral abscess
-Hypoglycemia
-Encephalitis
-Focal seizures

Clinical examination of Stroke Pts:
Skin
-xanthelasma
-Rashes(arteritis,splinter h'age)
-Limb ischaemia/DVT

Eyes
-Diabetic changes
-Retina emboli
-HTN changes
-Arcus senilis

CVS
-BP(HTN,hypotension)
-Heart rhythm(AF)
-Murmurs
-JVP
-Peripheral pulses and bruits

RS
-Pulm. oedema
-Resp. infection

Abdomen
-Urinary retention

Locomotor
-Injuries sustained during collapse with stroke
-Comorbidities which influence fucnt. abilities

YU GEN HONG
031303641
GROUP B1

MYOCARDIAL INFARCTION (MI)

Acute myocardial infarction (MI), aka heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. which results in ischemia or oxygen shortage causing damage and potential death to the heart tissue.


What happens when you have a myocardial infarction?

If you have an MI, a coronary artery or one of it's smaller branches is suddenly blocked. The part of the heart muscle supplied by this artery loses it's blood (and oxygen) supply. This part of the heart muscle is at risk of dying unless the blockage is quickly undone. (The word 'infarction' means death of some tissue due to a blocked artery which stops blood from getting past.) If one of the main coronary arteries is blocked, a large part of the heart muscle is affected. If a smaller branch artery is blocked, a smaller amount of heart muscle is affected. In people who survive an MI, the part of the heart muscle that dies ('infarcts') is replaced by scar tissue over the next few weeks.

risk factors
Risk factors for atherosclerosis are generally risk factors for myocardial infarction:

• old age
• male sex
• smoking
• herypercholesterolemia (more accurately hyperlipoproteinemia, especially high low density lipoprotein and low high density lipoprotein)
• Diabetes (with or without insulin resistance)
• high blood pressure
• obesity (defined by a BMI of more than 30 kg/m2, or alternatively by waist circumference or waist-hip ratio).

PATHOPHYSIOLOGY
Acute myocardial infarction is a type of acute coronary symtoms, which is most frequently a manifestation of coronary artery diesease. The most common triggering event is the disruption of an artherosclerotic plaque in an coronary artery, which leads to a clotting cascade, sometimes resulting in total occlusion of the artery. Atherosclerosis is the gradual buildup of cholesterol and fibrous tissue in plaques in the wall of arteries (in this case, the coronary arteries).

Heart attack rates are higher in association with intense exertion, be it psychological stress or physical exertion, especially if the exertion is more intense than the individual usually performs.

SYMPTOMS
chest pain - angina pectoris
pain which may radiate to the left arm, jaw, neck and back.
Shortness of breath (dysnpoea) occurs when the damage to the heart limits the output of the left ventricle, causing left ventricle failure and consequent pulmonary edema. Other symptoms include diaphoresis (an excessive form of sweating), weakness,nausea ,vomiting ,and palpitation and even sudden death can occur in myocardial infarctions.

Diagnostic criteria
WHO criteria have classically been used to diagnose MI; a patient is diagnosed with myocardial infarction if two (probable) or three (definite) of the following criteria are satisfied:

1. Clinical history of ischaemic type chest pain lasting for more than 20 minutes
2. Changes in serial ECG tracings
3. Rise and fall of serum cardiac biomarkers such as creatine kinase,troponin I, and lactate dehydrogenase isozymes specific for the heart