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Palpitation💓 - Coggle Diagram

- - - - pregnancy🤰
      - AV shunt
      - anemia
        
        case3：76y/o male
        
        Iron deficiency anemia
        
        type 2 DM
        
        diabetic kidney disease
        
        may lead to
        
        1 more item...
        
        下肢末梢麻木蒼白，瞼結膜蒼白
        
        ABI shows no peripheral vascular disease
        
        Hemorrhoid bleeding
        
        shortness of breath and chest discomfort
        
        HR100
        
        EKG reveal sinus tachycardia, subtle systolic murmur, mild diastolic dysfunction
        
        BP：115/65 RR：22
        
        chest X-ray📸 reveal no pulmonary disease
        
        lab examination
        
        blood test🩸
        
        HCT, Hemoglobin, MCV, MCH, MCHC, RDW-CV, RBC, WBC low
        
        1 more item...
        
        glucose level high(type 2 DM), heatic function normal
        
        Ferritin low, TIBC high, serum iron low
        
        1 more item...
        
        endoscopic finding
        
        esophageal angiodysplasia
        
        1 more item...
        
        gastric and duodenal ulcer
        
        1 more item...
        
        gastric polyps
        
        1 more item...
        
        PH：type 2 DM, dyslipidemia, smoking over 50 years
        
        FH：type 2 DM(Dad), Grave's disease(Mom)
      - Paget's disease
    - - cardiomegaly
        
        12 lead EKG:
        sinus tachycardia (138 beats/min)
        left ventricular hypertrophy
        
        Left ventricular hypertrophy
        
        Heart failure
        
        Orthopnea
        
        Paroxysmal nocturnal dyspnea
        
        Treatment
        
        β-adrenergic receptor antagonist
        
        1 more item...
        
        X-ray: cardiothoracic ratio=0.647>0.5
      - ventricular
        
        premature ventricular contraction
        
        ventricular tachycardia
        
        ventricular fibrillation
        
        acute left ventricular failure
      - atrial
        
        atrial fibrilation
        
        atrial flutter
        
        myxoma
      - pacemaker disease
      - conduction system abnormality
      - valvular disease
        
        Two dimensional ECG
        Mitral valve regurgitation
    - - aortic aneurysm
  - - - panic
      - Somatization disorder
      - Generalized anxiety disorder
      - depression😞
  - - - Amphetamine
        
        Increase the release of neurotransmitter
        
        Unknown reason causes AMI
      - Coccaine
        
        Dopamine reuptake inhibitor
        
        Hypertention
        
        Atheroscelerosis
        
        Palpitation
      - caffeine☕
        
        Increase NE and epinephrine release
        
        Palpitation
      - nicotine🚬
        
        AF and atrial flutter
        
        The main reason of SVT
        
        SA node abnormal
      - Alcohol🍺
        
        Reduce the chance of atherosclerosis
        
        Increase the risk of MI
        
        Hypertension
        
        Differences between individuals in drinking alcohol causing palpitation
    - - Beta blocker withdrawl
        
        Increase the activity of the beta receptor
      - Anticholinergic
        
        Decrease the activity of vagus nerve
        
        Relax the blood vessel
      - Sympathomimetic
      - Vasodilator
        
        Nitric oxide
        
        Nifedipine等鈣離子阻斷劑🚫
        
        Hydralazine、Nitroposside等直接血管擴張劑
  - - - stress
      - exercise
      - Pheochromocytoma
        
        症狀
        
        典型：5P
        
        palpitation
        
        Fever 39.9
        
        Pulse 92 beats/min
        
        pressure
        
        History：Hypertension
        
        Fluctuated blood pressure(2nd)
        
        pain(胸痛/頭痛)
        
        Headache
        
        Acute onset of substernal chest pain radiating to the back
        
        疑似 no ST elevation myocardial infarction
        
        5 more items...
        
        perspiration
        
        Profuse sweating
        
        pallor
        
        其他(2nd)
        
        abdominal fullness
        
        vomiting
        
        Lab
        
        心肌酵素高(1st,2nd)
        
        CK 468U/I with an MB fraction 20 U/I
        
        Troponin I：4.3 ng/ml
        
        WBC高(netrophils 88%)
        
        Blood and urine culture：無微生物
        
        ▲排除感染
        
        Ceftriaxone用了一個禮拜無改善
        
        C-reactive protein：7.1 mg/L(過高)
        
        24-hour urine for catecholamines and vanillylmandelic acid (VMA) 上升
        
        ★診斷
        
        AST ALT過高(2nd)
        
        檢查
        
        ECG：no significant ST-T elevation(1st)、diffuse ST segment depression(2nd)
        
        TTE：dilated LV chamber without regional wall motion abnormality, and LV systolic contractility was preserved
        
        CT : well-defined mass at left adrenal gland without calcification (6.7*6.8)
        
        ★腎上腺有mass(通常單側，10%雙側)
        
        abdominal sono：無感染源；Suspicious mass at splenic fossa
        
        ▲排除感染
        
        Chest X ray：無感染源
        
        Other hormonal studies
        
        ACTH正常
        
        ▲排除primary aldosteronism and Cushing’s syndrome
        
        Serum aldosterone concentration正常
        
        dehydroepiandrosterone sulfate 正常
        
        Serum cortisol正常
        
        pathological specimen
        
        9X5X4.2 cm with adrenal cortex compressed peripherally
        
        Treatment
        
        left laparoscopic adrenalectomy(主要治療方式)
        
        BP不穩
        
        a-adrenergic blocker
        
        好發於中年病患
        
        48 y/o man
    - - Grave’s disease
        
        Ophthalmopathy
        
        T3,T4,FT4上升，TSH下降
      - Case1: 76-year-old women
        
        Toxic adenoma
        
        PE
        
        Left thyroid mass 4cm
        
        no recent history of body weight loss, exophthalmos, moist skin, or tremor
        
        影像學
        
        Tc99m thyroid scan
        
        right lobe🫁
        
        Non-visualization
        
        5.07 cm in length and 2.93 cm in width
        
        autonomous functioning nodule in the left lobe with suppression of the rest of the thyroid gland
        
        with a focal hot spot, approximately 2.37 cm in length and 1.95 cm in width
        
        thyroid sonogram
        
        mixed echoic nodule about 39.4x24.7x43.3mm
        
        Lab
        
        TSH降低，FT4正常
        
        甲亢引起
        
        Symptoms
        
        通常單側
        
        第二常見甲狀腺亢進疾病
      - Toxic multinodular goiter
    - - Hashimoto's disease
        
        Anti-TG, Anti-TPO very high
        
        reduced exercise tolerance, tiredness, severe fatigue
        
        Thyroid gland grade 1, diffuse, and no nodule nor lymph node palpated
        
        TSH high, Free T4 low