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DAY 1 (27/07/2020) by Kamalia Shahira Binti Kamaruzzaman (2016807344)…
DAY 1 (27/07/2020) by Kamalia Shahira Binti Kamaruzzaman (2016807344) PH2408A
Patient (HY)
Moderate-severe MR, moderate AR with features of pulmonary hypertension
History of admission for ADHF with E. Coli bacteremia
Atrial fibrillation - on warfarin
MCHC anemia
Has hypertension
Valvular disease
Mitral regurgitation
abnormal reversal of blood flow from the left ventricle (LV) to the left atrium (LA).
Aortic regurgitation
leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle
Pneumonia
Community acquired pneumonia (CAP)
pneumonia that is acquired outside the hospital.
Hospital acquired pneumonia (HAP)
refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted
Mini mental state examination (MMSE)
a widely used test of cognitive function among the elderly
consists of 30 questions
it includes tests of orientation, attention, memory, language and visual-spatial skills
score
20 - 24 = mild demetia
13 - 20 = moderate dementia
less than 12 = severe demetia
Heart failure secondary to HAP
Then, treat HF to prevent the worsening of HF
Give oxygen
Usually >95% oxygen
Treat the pneumonia first
Subsets of ADHF
Cold and dry
Warm and wet
Cold and wet (the worst)
Warm and dry
Warfarin in patient with AF
Target INR is 2.0 - 3.0
If too low, dose is not effective and increase risk of stroke
if too high, risk of bleeding
Ward rounds in hospital
Medical doctor
Medical officer
House officer
Consultant