1. History of the Cardiac & Respiratory System المدرس الدكتور سامر نعمة ياسين الفتلاوي M.B.Ch.B, D.M, F.I.C.M.S بورد ( دكتوراه ) في الطب الباطني / المجلس العراقي للاختصاصات الطبية دبلوم عالي في الطب الباطني / جامعة الكوفة – كلية الطب بكالوريوس طب و جراحة عامة / كلية الطب – جامعة الكوفة Samern.alfatlawy@uokufa.edu.iq

3. COUGH Sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes

4. CLASSIFICATION Duration Acute (of sudden onset) if it is present less than three weeks Sub acute if it is present between three and eight weeks Chronic when lasting longer than eight weeks Character Non-productive (dry) Productive (when sputum is coughed up) Timing Only at night (then called nocturnal cough) During both night and day Just during the day Quality Explosive Bovine

5. QuestionstobeAsked Questions to be Asked Duration Site Character and quality If productive ask following about sputum: Color of sputum ( yellow, green, pink) Amount Site Odor Blood Timing Relieving and exacerbating Blood Association ( chest pain, dyspnea, fever, appetite, weight loss ) Severity

6. WHEEZE Continuous, coarse, whistling sound produced in the respiratory airways during breathing

7. QuestionstobeAsked Questions to be Asked Duration Continuous or intermittent? Short of breath? Chest pain? Cough?

8. HEMOPTYSIS Coughing up blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs

9. QuestionstobeAsked Questions to be Asked Amount Character (steaks,clots, fresh) Duration Association Color

12. SYNCOPE Sudden loss of consciousness due to decrease cerebral perfusion it should be differentiated from epilepsy Causes: Arrhythmias LVF Aortic stenosis Hypertrophic cardiomyopathy Vasovagal Postural hypotension Cough syncope Micturition syncope Carotid sinus hypersensitivity

13. Questionsforsyncope Questions for syncope Pre syncope symptoms: chest pain, breathlessness, lightheadedness, nausea, palpitation, fear, dimness of vision, pallor, sweating Duration Tongue biting, urine incontinence Abnormal movement during the attack help to differentiate it from epilepsy After regain consciousness : flushing, loss of memory, any headache, sleeping

15. OEDEMA Swelling due to accumulation of fluid in the interstitial space Causes Cardiac : right sided heart failure Renal : nephrotic syndrome Hepatic : liver cirrhosis Drugs : NSAID and ca channel blockers

16. Questionsforedema Questions for edema Localized or generalized Site Foot, ankle, leg … Sacral : bed ridden or severe Arm : venous obstruction Face : severe or in nephrotic Unilateral or bilateral limbs Duration & progression

18. CYANOSIS Bluish discoloration of skin and mucus membrane due to increase deoxygenated HB > 5 gm / dl Central Cardiac or respiratory Peripheral Decrease arterial perfusion

19. Questionsforcyanosis Questions for cyanosis Site : nose, lips, ears, mouth mucosa or fingers and toes Time of onset Association with clubbing or not

21. Chest Pain

22. Types Central chest pain Peripheral chest pain

23. Causes of Central Chest Pain  MI  Angina  MVP  Pericarditis / Myocarditis  Aortic Dissection  Massive Pulmonary Embolism  Tracheitis  Esophagitis / Esophageal Spasm  GERD

26. Causes of Peripheral Chest Pain  Pneumonia  Pleurisy  Musculoskeletal  Herpes zoster  Rib fracture  Pulmonary Infarction  Pneumothorax  Malignancy

28. Questions For Chest Pain ? 1.Site 2.Onset : sudden or gradual 3.Type : tightness, squeezing, chocking, burning, tearing, stabbing 4.Time : day or night,intermittent or continuous 5.Severity : mild, moderate or severe 6.Radiation : back, neck, shoulder, arm, jaw 7.Precipitating factors: exertion, emotion, movement or breathing 8.Relieving factors : rest or drugs 9.Association: dyspnea, cough ………

30. Dyspnea

31. Definition Is the sensation of using an abnormal amount of effort to breathe Respiratory : Pneumonia, Asthma, Pneumothorax, COPD, Pulmonary Embolism Cardiac : Heart Failure, Ischemic Heart Disease Others : severe Anemia, Obesity …

32. Questions for dyspnea Onset : gradual or sudden Site Quality: Carefully check what the patient is describing. Try to differentiate between true dyspnea; tight or squeezing chest pain or pain on inspiration. Previous episodes: Are the features the same as this presentation? Is there a pattern? Severity :  Mild: only in heavy exercise  Moderate : in mild exercise but not at rest  Severe : in rest Time : night in heart failure, early morning in asthma Aggravating factors : drugs, exercise, emotion, cold weather …. Relieving factors : drugs, rest Association : pain, cough …….

35. Palpitation

36. Definition Subjective awareness of heart beats Questions for palpitation : Onset / End Continuous or paroxysmal? Fast or slow? regular or irregular? extra beats? tap the beat with your hand? Aggravating and relieving Association chest pain, shortness of breath, loss of consciousness/feeling faint, polyuria? Site Time Recurrence

38. Intermittent Claudication Intermittent Claudication

39. Definition Pain in the lower limbs occur during exertion Cause: Peripheral vascular disease Ask about: Site of pain When did it start? Is it relieved by rest? Distance How much does it interfere with lifestyle/work?