Tetralolgy of fallot, transposition of great arteries, etc. On exam, there is unilateral leftsided sensorineural hearing loss and a diminished corneal reflex. He also complains of ringing in the ear, and has had occasional dizziness. hole in the ventricular septum causing L->R shunt causing oxygen rich blood to go cycle back to the lungs= less oxygen rich blood out to the body= heart needs to work harder -eventually, if not corrected or doesn't heal on it's own, shunt reverses to R->L leading to Eisenmenger syndrome -2nd common congenital heart defect -can occur alone or with other congenital anomalies (eg. A 45 year-old male complains of loss of hearing in his left ear. HTN, AV/MV disease -diastolic or systolic dysfunction -S&S: -DOE*** (first symptom), SOB, edema, orthopnea, cough, PND, nocturia, fatigue -PE findings: S3 or S4 gallop, increased JVP, heave, ascites, rales, murmur, edema DIAGNOSTICS: -EKG-to look for ischemia or arrhythmia causes -echo-to look at EF, wall motion and wall thickness and valves -CXR- to look if heart is enlarged, pulmonary vasculature congestion, kerly B lines, and dec costophrenic angles -MUGA- if echo isnt good enough, will show EF -R heart cath- to look at LVEDP -L heart cath- if cause is unknown and is candidate for intervention -LABS to consider ordering: -CBC -blood cultures -ABG -CTA -cardiac enzymes -BUN/Cr -TSH -BNP PHTN, PV stenosis, RV infarct, TV disease LEFT SIDED: -affects LA, LV, MV and AoV -eg. You should aim for a score of 70 on your PACKRAT, which is 157/225 correct answers. We just took our post-clinical PACKRAT today and found out that I scored a 161 compared to my pre-clinical which was 126. The national mean is 130 and a score of 110 has been correlated to not passing the PANCE. Hello Everyone Wanted to get your thoughts/advice on my PACKRAT scores and studying for the PANCE as I will be taking it on January 20th next year. anemia, pregnancy, hyperthyroid, infection/sepsis RIGHT SIDED: -no pulmonary edema -left heart is totally normal -usually leads to left sided heart failure -eg. The rule of thumb is a PACKRAT score greater than 150 means your odds of passing the PANCE are astronomically high. during this process, catecholamines, vasopressin, angiotensin II and aldosterone are released and cause increased contraction, increased HR, vasoconstriction, and increased Na retention -can be low output, high output, right sided or left sided -low output, left sided and systolic dysfunction are MC LOW OUTPUT: -eg PHTN, valve stenosis, cardiomyopathy (from ischemia/htn), or hypovolemia HIGH OUTPUT: -eg. defined as the inability of the heart and CV system to meet the metabolic needs of the body -results from structural and functional cardiac disorder impairing ability of heart to fill or eject blood -causes congestion of lungs, pleural spaces, abdomen and lower extremities -body starts neurohumoral adaptation: increasing LVEDP to increase CO but the muscle fibers eventually stress too far and dont work.
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