Continuing Medical Education Programs Dr. Anika Niambi Al-Shura, Lecturer Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Level 1 Course Titles Health Communications in TCM Cardiology Integrative Anatomy and Patho-physiology in TCM Cardiology Integrative Examination in Cardiovascular Disease Integrative Diagnosing of Cardiovascular Diseases Integrative Study of Hematology in Cardiology Integrative Hyperlipidemia Treatments in Cardiovascular Disease Integrative Cardiovascular Clinical Therapies Copyright 2014 Niambi Wellness. All rights reserved
Niambi Wellness continuing medical education programs presents Copyright 2014 Niambi Wellness. All rights reserved
Integrative Diagnosing of Cardiovascular Disease Copyright 2014 Niambi Wellness. All rights reserved
Diagnosing in Cardiovascular This course is approved by the following agencies: National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) for 8 PDA points and Florida State Board of Acupuncture for 10 CEUs. The companion textbook: Diagnosing in Cardiovascular Chinese Medicine must be ordered at www.elsevier.com Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Course Description This course covers the finer details of cardiovascular patient examination techniques and clinical pearls used in western medicine, together with TCM examination techniques. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Course Objectives Understand the 6 basic signs and symptoms connected to cardiac diseases and their clinical significance. Learn the methods and techniques used in physical examination to detect the signs. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Course Modules Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Module 1: Chest pain Module 2: Breathing Difficulties Module 3: Heart Rhythm Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Module 4: Fainting Spells Module 5: Swellings Module 6: Gait Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Module 1 Chest Pain Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Contents Chapter 1: Clinical Significance Chapter 2: Inquiry and Examination Copyright 2014 Niambi Wellness. All rights reserved
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Chapter 1: Clinical Significance Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Contents Part 1: Etiology Part 2: Answers to Textbook Questions Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Part 1: Etiology Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain may be transmitted by the sympathetic, vagus, and phrenic nerves, and well as nerves along the intercostal areas. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The sensation may be felt upon the skin, between the rib bones within the intercostal muscles, under the diaphragm, around pleural tissue, inside of the esophagus, or through the sections of the heart including the aorta. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Sometimes the breathing may become laboured. Weak or impaired gastrointestinal functioning may mimic or complicate symptoms. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Part 1: Textbook Answer Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Answer #1 Xiong bi In Chinese medicine, when chest pain is a positive sign of an adverse health condition it may be called xiong bi or chest obstruction. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Answer #2: Pulmonary and other (esophageal disorders) Esophageal disorders are in the “other” category of differential diagnosis and includes contraction, acid reflux or esophagitis. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Sources of pain are differentiated in Western medicine as: Cardiovascular Pulmonary Other causes Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Answer #3: Stagnation Patients will complain about symptoms which are most bothersome and considered common to heart problems. Copyright 2014 Niambi Wellness. All rights reserved
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Chapter 2:Inquiry and Examination Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Contents Part 1: Examination Part 2: Acute Chest Pain Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Contents Part 3: Chronic Chest Pain Part 4: Answers to Textbook Questions Copyright 2014 Niambi Wellness. All rights reserved
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Part 1:Inquiry and Examination Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Chest pain is an unpleasant and possibly severe sensation, which originates or radiates around the chest. It is characterized by a feeling of pressure, tightness, or discomfort. Copyright 2014 Niambi Wellness. All rights reserved
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Cardiovascular Causes Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Obstruction: aorta disorders Ischemia: myocardial infarction Non-ischemic: aneurysm and pericarditis Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Pulmonary Causes Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Chest wall: pneumothorax and pleuritis Functional: pneumonia, sarcoidosis, cancer and tuberculosis Vascular: hypertension and embolus Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Cough or dyspnea often accompany chest pain, which may also give any clues about respiratory complications. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Cough= sharp sound expelled from the lungs and throat and out of the mouth Dyspnea= difficult or laboured breathing Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Other Causes Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Gastrointestinal Esophageal problems Peptic ulcers GERD Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Psychological: Neurosis Depression Anxiety Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Part 2: Acute Chest Pain Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Hyperventilation Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain occurs with rapid breathing and during heightened anxiety or emotional upset. Copyright 2014 Niambi Wellness. All rights reserved
Pneumonia and Pneumothorax Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Pain due to puncture, microbial infection, or obstruction which can be identified on x-ray. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Pericarditis Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain is due to ischemic pain behind the sternum radiating to the left arm. The pain occurs and is worse while lying down and relieved by sitting up. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved A pericardial friction rub may or may not be heard in auscultation. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The EKG may show ST segment elevations in multiple leads. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved This may confuse a diagnosis towards acute myocardial infarction. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved However this is not true in all cases. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Also a chest x-ray may often be considered normal. Copyright 2014 Niambi Wellness. All rights reserved
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Myocardial Infarction Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain is similar in quality and location to angina pectoris, but lasts longer, and is more intense. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain often occurs at rest and is not relieved by nitroglycerin. It may be accompanied by: Diaphoresis Dyspnea Nausea Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved The patient usually needs to be hospitalized for treatments. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved An electrocardiogram will show Q waves and ST segment depressions. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Blood work should include cardiac enzyme test. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Unstable Angina Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved These patients have coronary artery disease. The pain is relieved by rest or nitroglycerin. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved These patients have coronary artery disease. The pain is relieved by rest or nitroglycerin. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The patient usually needs to be hospitalized for treatments. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved An electrocardiogram will show Q waves and ST segment depressions. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Blood work should include cardiac enzyme test. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Aortic Dissection Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain is located in the anterior and posterior areas within the chest. It is described as a feeling of something being ripped, and is not relieved with nitroglycerin. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved The pulse may be absent. There may be regurgitation heard at the aortic position in auscultation. Copyright 2014 Niambi Wellness. All rights reserved
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Part 3: Chronic Chest Pain Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Esophageal Disorders Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Esophagitis is due to acid reflux and causes burning sensation. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Symptoms can occur with flow of stomach acid such as: After meals Bending at the waist Lying down Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Esophageal spasms are contractions of the wall of the esophagus. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Motor disorder is pain due to the contraction and spasm of the muscular wall of the esophagus. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Dysphagia is a common symptom in these patients. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Chest Wall Pain Copyright 2014 Niambi Wellness. All rights reserved
This pain is aggravated by Movement Palpation Chest tissue manipulation Bending or rotating the arms Twisting at the waist © Copyright 2012 Niambi Wellness. All rights reserved
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Coronary Artery Disease Copyright 2014 Niambi Wellness. All rights reserved
Coronary artery disease presents in the clinic as recurrent angina pectoris. © Copyright 2012 Niambi Wellness. All rights reserved
Evidence of pain due to coronary artery disease, is getting relief within 3 minutes of taking nitroglycerin. © Copyright 2012 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Myocardial Ischemia Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved The pain usually awakens a sleeping patient. An emotional episode also triggers an attack. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Some patients get relief from taking nitroglycerin, and calcium channel blockers. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Q waves and ST segment depressions and elevations occur during pain episodes. Copyright 2014 Niambi Wellness. All rights reserved
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Copyright 2014 Niambi Wellness. All rights reserved Mitral Valve Prolapse Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved These patients should be monitored for endocarditis and arrhythmias. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Check in auscultation for a late systolic murmur or mid-systolic click. Copyright 2014 Niambi Wellness. All rights reserved
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Part 4: Answers to Textbook Questions Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Answer block #4 qi deficiency blood stasis blood stagnation phlegm stasis #5 Separation of yin and yang Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Answer block #6 valvular or aortic disease #7 infections such as bronchitis, pneumonia or rheumatic fever #8 hypertension #9 a high homocysteine level is a risk factor for atherosclerosis in coronary artery disease. Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Answer block #10 Usually an EKG will show Q waves and ST segment elevations. #11 Blood work including cardiac enzymes #12 EKG #13 Chest X-ray #14 EKG Copyright 2014 Niambi Wellness. All rights reserved
Copyright 2014 Niambi Wellness. All rights reserved Answer block #15 pain is relieved after taking nitroglycerine #16 pain is not relieved by rest or nitroglycerine #17 pain is worse while lying down and relieved by sitting up Copyright 2014 Niambi Wellness. All rights reserved
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Module 1 Review Questions Copyright 2014 Niambi Wellness. All rights reserved
review interactive practice quiz. Complete the Module 1 review interactive practice quiz. Copyright 2014 Niambi Wellness. All rights reserved
Please continue on to Module 2 Copyright 2014 Niambi Wellness. All rights reserved