Cardiology Dr.

Ahmad Mowafy

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Cardiology Dr. Ahmad Mowafy

branch

liver 80 %

liver

rheumatology

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Cardiology Dr. Ahmad Mowafy

Heart failure

cardiology cardiology branch

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Cardiology Dr. Ahmad Mowafy

Liver

written

Liver Liver Liver

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Cardiology Dr. Ahmad Mowafy

Liver Jaundice

Liver Liver

Liver

rheumatology 15

Liver

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Cardiology Dr. Ahmad Mowafy

Cardiology
Neuro cardiology

cardiology

cardiology

rheumatology rheumatology

cardiology

cardiology cardiology

cardiology

cardiology

60 %

cardiology cardiology

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Cardiology Dr. Ahmad Mowafy chest blood Infection rheumatology GIT endocrine Neuro

cardiology

cardiology

2007 In capsule series In Capsule Series

arrhythmia rheumatology

attitude cardiology cardiology investigations clinical picture clinical pictures

clinical pictures

cardiology

clinical picture

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Cardiology Dr. Ahmad Mowafy

Manifestations of low cardic output Low cardic output low cardic output

Low cardic output

blurred of vision

headache Syncope syncope

ischemic heart disease

Oliguria S S skin skeletal muscle pale and cold skin claudication fatigue skeletal muscle cardiology fatigue and intermittent claudication

pulse blood pressure pulse blood pressure

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Cardiology Dr. Ahmad Mowafy low cardic output

symptoms and signs signs signs symptoms signs of low cardic output 9: 10 9: 10 signs Syncope Ischemic heart disease Oliguria Pallor fatigue and intermittent claudication Pulse Blood pressure signs signs of low cardic output

symptoms

signs of low cardic output signs

cold pulse cyanosis signs of low cardic output

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Cardiology Dr. Ahmad Mowafy Low cardic output

Manifestation of Pulmonary congestion Lung congestion Lung Pulmonary

Lung congestion Lung Left side left lung congestion lung congestion Lung

dyspnea dyspnea

cardiology

dyspnea left sided heart failure

specific

left sided heart failure Left sided heart failure

specific

specific dyspnea dyspnea Paroxysmal nocturnal dyspnea

Lung congestion

dyspnea

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Cardiology Dr. Ahmad Mowafy

Cough hemoptysis Recurrent chest infection pleural effusion pleura congestion acute congestion pulmonary edema alveoli

alveoli apparatus mechanism of

alveoli

crepitation

systemic congestion systemic congestion

congestion

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Cardiology Dr. Ahmad Mowafy

Insomnia

congested neck vein

Edema lower limb edema lower limb Low cardic output fatigue Lung congestion systemic congestion then ascites

ischemia edema lower limb

Non pitting

pitting

Unilateral Unilateral heart failure P bilateral

edema Pitting bilateral bilateral

Pitting

congested neck vein insomnia edema lower limb then ascites

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Cardiology Dr. Ahmad Mowafy sweating on slight activity systemic congestion

systemic congestion sweating on slight activity Liver round edge smooth soft Enlarged tender Liver GIT dyspepsia

Dyspepsia Heart burn diarrhea dyspepsia dyspepsia related Heart failure systemic congestion Pleural effusion Pleural effusion

systemic congestion

pleura Pulmonary circulation systemic circulation

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visceral Parietal

13

Cardiology Dr. Ahmad Mowafy right Left right Left Pleural effusion systemic congestion Low cardic output cardiology Manifestation of low cardic output Lung congestion

systemic congestion

Pericardial effusion Pericardial effusion Pericardial effusion

Low cardic output systemic congestion Lung congestion chest pain chest pain angina
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Cardiology Dr. Ahmad Mowafy

Palpitation

Palpitation arrhythmia Palpitation

bigger not better

Mediastinum mediastinum pressure manifestation trachea cough dyspnea esophagus dysphagia Nerve left recurrent laryngeal nerve Hoarsness of voice Left recurrent laryngeal nerve right right
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Lung

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Cardiology Dr. Ahmad Mowafy

Low cardic output Lung congestion systemic congestion Chest pain Palpitation Pressure manifestation

stagnation of blood thrombo embolism

cardiology

cardic tamponade

clinical picture of cardiology cardiology

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Cardiology Dr. Ahmad Mowafy clinical picture rheumatology rheumatology

cardiology

Investigation

Investigation
cardiology Investigation

Investigation

ECG ECHO angio cardiology Investigations Investigations Investigations cardiology

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Cardiology Dr. Ahmad Mowafy X-ray ECG ECHO Catheterization

To detect the cause and to detect chamber enlargement Detect the cause detect the chamber enlargement ECHO detect paradoxical movement of the myocardium

paradoxical movement of the myocardium ECG ECG To detect the cause and detect chamber enlargement

ECG

ECG Angina ECG

angina

Myocardial infarction

dry pericarditis
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Cardiology Dr. Ahmad Mowafy arrhythmia ECG arrhythmia

ECG ECG detect the cause and detect chamber enlargement

investigations

myocardium infarction

cardic enzymes

Myocardial infarction cardic enzymes

ECG

Infective endocarditis infective endocarditis culture pulmonary 20 :40

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Cardiology Dr. Ahmad Mowafy

pulmonary embolism

myocardial infarction

infective endocarditis

Pulmonary embolism

Pulmonary embolism

Pulmonary embolism

dissecting aorta

CT angio CT CT dissecting aorta CT

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Cardiology Dr. Ahmad Mowafy

dissecting aorta dissecting aorta CT

constrictive pericarditis CT

Investigations

Investigations Investigations

Investigations Investigations treatment Investigations etiology

Investigations

Heart failure

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Cardiology Dr. Ahmad Mowafy

investigations

cardiology definition etiology clinical pictures differential diagnosis treatment

cardiology

Liver cardiology Liver Liver

angina
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heart failure

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Cardiology Dr. Ahmad Mowafy cardiology endocrine endocrine

Infection

cardiology

cardiology

branch heart failure

cardiology

Heart failure
Heart failure etiology etiology etiology heart failure definition definition

heart failure Hyper tension etiology ischemic heart disease

etiology etiology etiology

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Cardiology Dr. Ahmad Mowafy Pathophysiology cardic reserve etiology clinical pictures cardiology investigation break Investigations Investigations Investigations

treatment

definition of heart failure

Definition
heart failure definition definition of heart failure syndrome in which the heart can't maintain adequate cardic output clinical syndrome in which can't maintain adequate cardic output adequate Normal cardic output high cardic output heart failure High cardic output heart failure Heart failure cardic output

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Cardiology Dr. Ahmad Mowafy

heart failure High cardic output

normal adequate cardic output adequate

syndrome in which the heart can't maintain adequate adequate cardic output definition of heart failure In spite of normal ventricular filling

ventricle shock

Heart failure

In spite of normal venous return

In spite of normal

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Cardiology Dr. Ahmad Mowafy ventricular filling etiology

Etiology
etiology etiology

Heart failure left sided heart failure right Left sided heart failure

Left

etiology the most common causes are

Coronary heart disease Hyper tension etiology etiology clinical pictures clinical picture of the cause Item clinical picture of the cause cause coronary heart disease
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Cardiology Dr. Ahmad Mowafy hyper tension Heart failure

Left side of the heart left ventricle left atrium Left atrium atrium left sided heart failure pressure gradient 70 % left atrium failure

Essential for life

left atrium left atrium

left atrium failure left atrium failure Left atrium failure Mitral stenosis left atrium bigger not better

Left sided heart failure Mitral stenosis valvular heart disease Mitral stenosis related left sided heart failure
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Cardiology Dr. Ahmad Mowafy

Left ventricle

left ventricle

Mitral stenosis

mitral stenosis

left ventricle

female female

female Female

female female female Mitral stenosis Female female

left atrium Myxoma Left atrium benign tumor

left atrium

atrium

left ventricle

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Cardiology Dr. Ahmad Mowafy Left ventricle Left ventricular failure

Myocardial disease myo Myocardial infarction Myocarditis cardiomyopathy myopathy

after load after load pre load Load Load after load Load pre load after load after load systemic hyper tension systemic hyper tension

the most common causes are coronary and systemic hyper tension
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Cardiology Dr. Ahmad Mowafy systemic hyper tension

most common causes

Systemic hyper tension Aortic stenosis

Coarctation of the aorta

Pre load Pre load pre load

venous return venous return after load Pre load

Pre load

Hyper dynamic circulation

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Cardiology Dr. Ahmad Mowafy

Valvular heart disease Mitral stenosis aortic regurge Mitral regurge

pre load aortic regurge valvular heart disease

Mitral regurge

aortic regurge

mitral

left sided heart failure valvular heart disease

congenital heart disease VSD VSD VSD congenital heart disease

left sided heart failure congenital heart disease PDA in left and ASD in right ASD PDA

congenital heart disease

left sided heart failure

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Cardiology Dr. Ahmad Mowafy

coronary heart disease hyper tension

acute heart failure diastolic heart failure

acute diastolic

causes of diastolic heart failure diastolic heart failure systolic heart failure diastolic heart failure

etiology acute heart failure diastolic heart failure

diastolic heart failure

acute heart failure

precipitating factor Precipitating factors

Precipitating factors
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Cardiology Dr. Ahmad Mowafy

Precipitating factors

A Anemia Arrhythmia Heart failure Precipitating factor Heart failure

P pregnancy Physical effort i infection iatrogenic Infective endocarditis calcium channel blocker Infection infection iatrogenic

heart failure endocrine Load

endocrine

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Cardiology Dr. Ahmad Mowafy acute diastolic

cardic reserve cardic reserve

Heart failure

cardic reserve

heart failure cardic output

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Cardiology Dr. Ahmad Mowafy

heart rate

cardic output Stroke volume

stroke volume stroke volume

heart rate Heart rate sympathetic

sympathetic heart rate cardic reserve

cardic reserve heart rate

150 150

tachycardia

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Cardiology Dr. Ahmad Mowafy

tachycardia

Heart rate heart rate

120 70

physiological

Physiological

Heart rate heart rate Beta blocker

heart rate
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cardic output stroke volume

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Cardiology Dr. Ahmad Mowafy

Tachycardia

cardic reserve

Left ventricle left ventricle dilatation Starling law within limit fibers

ventricular dilatation

fibers

after load against resistance

Hypertrophy hypertrophy without blood supply ischemia

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Cardiology Dr. Ahmad Mowafy

cardic reserve adverse effect side effects

PNP ANP Atrial naturtic peptide

ANP ANP failure ANP

ANP

shock dyspnea dyspnea MCQ chest X-ray ECG ECHO ANP

chest

dyspnea

chest

ANP
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Cardiology Dr. Ahmad Mowafy ANP lasix ANP heart failure heart failure

: heart failure Heart failure lasix

lasix Lasix lasix ANP

heart failure heart failure lasix

sympathetic

renin renin RBCs Low cardic output

ANP
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Renin

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Cardiology Dr. Ahmad Mowafy cardic reserve

heart failure

cardic reserve cardic reserve

Heart failure

symptoms heart failure etiology definition Heart failure clinical pictures Investigations

differential diagnosis

treatment

clinical pictures clinical pictures

Clinical pictures

cardiology

clinical pictures

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Cardiology Dr. Ahmad Mowafy

cardiology clinical pictures of cardiology

clinical pictures

left sided heart failure Left sided heart failure Left ventricle

Manifestation of low cardic output Low cardic output manifestations

dizziness tinnitus blurring of vision syncope

ischemic heart disease

manifestions of lung congestion

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Cardiology Dr. Ahmad Mowafy left ventricle left atrium

left atrium Lung Pulmonary veins

pulmonary veins Left atrium left atrium

Pulmonary veins pulmonary veins pulmonary congestion Manifestions of lung congestion Lung congestion

clinical pictures of left sided heart failure

cardiology

Low cardic output

Left sided heart failure Lung congestion Left lung congestion

clinical pictures of the cause

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Cardiology Dr. Ahmad Mowafy

coronary disease systemic hypertension

Pressure manifestations hypertrophy dilatation

source

even

thrombo embolism stagnation of blood Manifestations of thrombo embolism clinical pictures

Cardic signs

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Cardiology Dr. Ahmad Mowafy clinical pictures cardic signs

cardic signs

Manifestations of low cardic output

signs symptoms

signs

symptoms lung congestion

systemic congestion

signs of low cardic output

signs
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symptoms

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Cardiology Dr. Ahmad Mowafy

cardic signs

IQ

IQ

left left ventricular enlargement Left ventricular

Left ventricle

MCQ left ventricular enlargement

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Cardiology Dr. Ahmad Mowafy

MCQ right ventricular enlargement

bilventricular enlargement right ventricle Left ventricle

clinical

right ventricle

left ventricle

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Cardiology Dr. Ahmad Mowafy Most anterior right ventricle most posterior left

right ventricle most anterior Left ventricle

apex clinical

clinical

apex of the heart Left ventricle right ventricle spleen Left ventricle

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Cardiology Dr. Ahmad Mowafy right ventricle spleen left ventricle

left ventricle

apex

Localized Localized diffused diffused right ventricle right ventricle

normal

cardiology chamber According

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Cardiology Dr. Ahmad Mowafy longitudinal axis Longitudinal axis right ventricle

left ventricle

longitudinal axis Left ventricle longitudinal axis apex outward and downward

apex According the longitudinal axis

Longitudinal axis Palpation

right ventricle longitudinal axis Outward

According

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Cardiology Dr. Ahmad Mowafy

During systole apex bulge

systolic bulge contraction rotation

IQ systolic bulge
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Cardiology Dr. Ahmad Mowafy systolic bulge

systolic bulge

due to rotation of the heart

left ventricular enlargement

rheumatology rheumatology rheumatology left ventricular enlargement Localized outward and downward systolic bulge

Left ventricular enlargement

tachycardia tachycardia

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Cardiology Dr. Ahmad Mowafy pulse Pulse pulsus alterns Pulsus alternas Pulse pulse heart failure Pulse pulsus alterns heart tachycardia

Left ventricular failure left ventricle

left ventricle left ventricle Left ventricular failure left ventricle

healthy diseased diseased

fibers fibers healthy diseased

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Cardiology Dr. Ahmad Mowafy

healthy fibers diseased fibers

healthy

diseased

healthy
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fibers

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Cardiology Dr. Ahmad Mowafy

healthy

diseased

healthy Healthy Healthy

stress Pulsus alterns

Normal heart sound S1 and S2 distole second heart sound first heart sound S1 S2 S2 systole ( diastole second heart sound first heart sound clinical S1 S2 S1 S1 S2 systole

second
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first

54

Cardiology Dr. Ahmad Mowafy

carotid diastole systole

timing

tachycardia second first

diastole ventricle atrium

left ventricle left ventricle

Left ventricle

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Cardiology Dr. Ahmad Mowafy

ventricle

Vibration ventricle Heart failure ventricle S3 S3 tachycardia

Heart sound

gallop

Gallop

Left ventricle

valve

left ventricle cuspus

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Cardiology Dr. Ahmad Mowafy regurge apex Pan systolic murmur of mitral regurge

valvular heart disease Mitral regurge

murmur

left ventricle

signs clinical pictures

Low cardic output Lung congestion

cardic signs

cardic signs left ventricular enlargement

pulse

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Cardiology Dr. Ahmad Mowafy

clinical pictures

right Right systemic congestion Left right Lung congestion

right ventricular

Investigations

Investigations
Investigations right Pulsus alterns

Left ventricle

Pulsus alterns Pulse Pulse right ventricle right

pulsus alterns
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Cardiology Dr. Ahmad Mowafy Investigations Investigations

Investigations Investigations Investigations cath ECHO ECG X-ray

key investigations

heart failure X-ray ECG ECHO ECHO ECHO ECHO ECG X- ray to detect the cause, to detect the chamber enlargement ECHO
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Cardiology Dr. Ahmad Mowafy Ejection fraction

EF Ejection fraction EF ejection fraction

100 50 ejection fraction

50 %

50/100 heart failure ejection fraction

stroke volume diastole systole diastole end diastolic volume stroke volume end diastolic volume

70 140 physiology

10 %

Ejection fraction

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Cardiology Dr. Ahmad Mowafy

ejection fraction

Investigations

ANP ANP ICU acute dyspnea

92 90 92

92

treatment
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Investigations

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Cardiology Dr. Ahmad Mowafy treatment of heart failure

Treatment
treatment of the cause precipitating factors

failure failure

Logic

Liver

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Cardiology Dr. Ahmad Mowafy

Liver hypo kalemia Liver hypokalemia

diuretic diuretic diuretics digitalis heart failure

Heart failure digitalis diuretics diuretics

Load vaso dilator after load preload

diuretics thiazide lasix

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Cardiology Dr. Ahmad Mowafy spironolactone

spironolactone

thiazide Lasix Mechanism of action Kidney kidney loop of Henle lasix thiazide Distal tubules D loop thiazide distal absorption 95 % mechanism of action re absorption of H ions

side effects side effects

Hypo Hypokalemia Hypokalemia

Hyper glucose hyper glycemia

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Cardiology Dr. Ahmad Mowafy

hyper glycemia Hyperlipidemia Hyperurecemia Hypercalcemia side effects calcemia urecemia lipidemia Hyperglycemia calcemia Hyper calcemia thiazide Hyper calcemia hyper calcemia Lasix

hypercalcemia Hypocalcemia

thiazide lasix

lasix Ototoxicity lasix 80 160 40

lasix
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Cardiology Dr. Ahmad Mowafy lasix symptomatic treatment lasix load symptomatic treatment congestion congestion Heart failure

Digitalis digitalis action action cardiology

cardiology digitalis action digitalis contractility heart failure

conductivity conductivity A.V. node atrial arrhythmia conductivity ventricle atrium arrhythmia ventricle conductivity Atrial arrhythmias Heart failure
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contractility

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Cardiology Dr. Ahmad Mowafy conductivity atrial arrhythmias

para sympathetic effect

para sympathetic contractility

contractility

para sympathetic

parasympathetic ventricle digitalis digitalis

digitalis excitability digitalis tachycardia Para sympathetic excitability arrhythmia of digitalis digitalis digitalis magic product

digitalis arrhythmia
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digitalis

67

Cardiology Dr. Ahmad Mowafy heart failure arrhythmia digitalis toxicity digitalis arrhythmia

type two second degree heart block

digitalis arrhythmia sinus tachycardia bradycardia sinus tachycardia arrhythmia arrhythmia heart block heart block type two second degree heart block arrhythmia MCQ digitalis digitalis

digitalis contra indication of digitalis digitalis toxicity paroxysmal ventricular tachyarrhythmia arrhythmia
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Cardiology Dr. Ahmad Mowafy V Tac ventricular tachycardia digitalis digitalis

ventricle atrium ventricle

arrhythmia arrhythmia

ventricular tachycardia

excitability digitalis

excitability absolute contraindication digitalis digitalis toxicity ventricular tachycardia

Heart rate A.S. node ectopic focus excitability ventricular tachycardia

arrhythmia

digitalis

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Cardiology Dr. Ahmad Mowafy arrhythmia atrium

atrium ventricular

digitalis

no absolute contra indication

absolute contraindication in very severe heart failure

absolute contraindication ventricular tachycardia severe heart failure absolute contra indication

ventricular tachycardia Absolute contraindication

severe heart failure

Severe contraindication relative contraindication Relative atrial arrhythmia

arrhythmia
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Cardiology Dr. Ahmad Mowafy

peptic ulcer para sympathetic effect

Relative Peptic ulcer peptic ulcer

digitalis digitalis

digitalis toxicity

partial

Partial Peptic ulcer

Partial complete complete heart block

Complete heart block

partial heart block partial Impulses complete Partial impulse digitalis

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Cardiology Dr. Ahmad Mowafy p heart block partial

Partial

digitalis toxicity digitalis toxicity 400 Metabolism digitalis toxicity 400

digitalis toxicity renal failure digitalis digoxin

Digitoxin digitoxin

digoxin Digitoxin

digoxin

Digitoxin

digoxin Digitoxin

kidney Liver

digoxin digoxin

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Cardiology Dr. Ahmad Mowafy Digoxin ( lanoxin ) : excreted mainly by the kidney ( tab = 0.25 mg , amp = 0.5 mg ) Digitoxin : metabolised mainly in the liver ( Digitoxin hepatic ) digoxin renal failure

hypo thyroidism Metabolism Hyper thyroidism tachy arrhythmia Hyper thyroidism arrhythmia arrhythmia digitalis

hyper thyroidism digitalis toxicity Hypokalemia hypercalcemia MCQ digitalis toxicity arrhythmia digitalis toxicity Hypokalemia Hypocalcemia Hypercalcemia Hypo phosphatemia Hyper calcemia Hypo kalemia digitalis toxicity

non cardic cardic Non cardic nasuea Anorexia

vomiting
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Cardiology Dr. Ahmad Mowafy

first symptom digitalis

anorexia

toxicity

digitalis Yellow vision

gynecomastia psychosis cardic

cardic manifestations of digitalis toxicity

paroxysmal supra ventricular tachycardia Ventricular tachycardia Heart block arrhythmia arrhythmia extrasystole arrhythmia
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Cardiology Dr. Ahmad Mowafy

arrhythmia type two second degree heart block

digitalis

Nephrology rheumatology arrhythmia digitalis Type two second degree heart block

www.facebook.com/dr.tafreegh
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Cardiology Dr. Ahmad Mowafy

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