Clinicals Presentation seen in Cardio Anatomy.

Clinical presentation: 

54 year old women present with rumatic heart disease present with mitral stenosis casues enlargement of left  atria  cause impingment of left recurrent larengial nerve invervates intrensic muscles of larynges  causes hoarseness of voice 

Clinical presentation: 

Patient is prescribed metoprolol, a β-blocker, to treat the stable angina resulting from his likely coronary artery disease. Plaque buildup over time narrows the arterial lumen, which produces intermittent ischemia, often resulting in angina. To counteract this decreased coronary artery flow, β-blockers work by decreasing sympathetic tone, reducing the heart rate, increasing the duration of diastole, and allowing increased coronary filling. 

 

Clinical presentation: 

Patient presents with diaphoresis and crushing chest pain radiating down his left arm, elevated heart rate, high blood pressure, and presence of elevated troponin I levels. Together, these indicate a diagnosis of myocardial infarction (MI). The 12-lead ECG shows ST segment elevation in leads II, III and aVF. These leads are called the inferior leads because they represent the inferior surface of the heart. ST segment elevations in these leads suggest an occlusion of the right coronary artery (RCA).

 

The RCA arises from the aortic sinus of the ascending aorta and runs along the right side of the pulmonary trunk in the coronary groove. It gives off a sinoatrial (SA) nodal branch, the acute marginal artery, and an atrioventricular (AV) nodal branch. The right or left arterial dominance is determined by the posterior interventricular branch. The coronary vasculature is called “right dominant” if the posterior interventricular artery is a branch of the RCA, and is called “left dominant” if the posterior interventricular artery is a branch of the left coronary artery. About 85% of people have right-dominant circulation.

Clincal Presentation: 

Patient is a 63-year-old man with a history of rheumatic heart disease who presents with hypoxemic respiratory failure, pulmonary crackles, jugular vein distention, and a diastolic murmur on cardiac examination. He is likely experiencing heart failure due to severe mitral stenosis. 

 

Rheumatic heart disease is more common in developing countries and is the number one cause of mitral stenosis. The incidence of mitral stenosis due to rheumatic heart disease has decreased dramatically since physicians have begun to treat streptococcal pharyngitis aggressively with antibiotics.

 

In rheumatic heart disease, valvular stenosis occurs due to an autoimmune attack on the valve. In rheumatic valvular disease, the mitral valve is always affected, with or without concurrent effects on the aortic valve. As part of the disease, mitral valve leaflets thicken, leading to a “fish-mouth” appearance of the mitral valve and an associated smaller valve opening. As mitral stenosis worsens over time and mitral valve area continues to decrease, the left atrial pressure must increase to try and force more blood through the stenotic valve into the left ventricle. Classically, this results in a pressure gradient between the left atrium and left ventricle during diastole, and the left atrium increases in size to compensate for the increased pressures. The large left atrium predisposes individuals with severe mitral stenosis to atrial fibrillation. The increase in left atrial pressures is also transmitted back to the lung, leading to pulmonary edema, hypoxemia, and occasionally hemoptysis, as seen in this patient.

 Clinical presentation: 

3-year-old boy has a combination of symptoms including fever lasting longer than 5 days, conjunctivitis, mucosal erythema, hand and foot edema, and adenopathy, which are highly indicative of Kawasaki disease. This disease is a self-limiting process that typically affects infants and children <4 years of age; those of Asian ethnicity are at increased risk. Typically, presenting symptoms include conjunctival erythema, oral erythema, edema of the hands and feet, a desquamative rash, and enlarged cervical lymph nodes. The most common histopathologic sign of Kawasaki disease is acute necrotizing vasculitis of medium-sized vessels (which include medium and small arteries). 

 

Cardiac complications from Kawasaki disease can lead to vasculitic changes in the coronary arteries, with subsequent coronary artery aneurysms and possible myocardial infarction. Patients who have had Kawasaki disease require serial echocardiograms to screen for disease progression. In some cases, cardiac catheterization is required.

Clinical Presentation:

Patient presents with exertional dyspnea, vocal hoarseness, and electrocardiographic findings that suggest left atrial enlargement. In addition, his immigration from a developing country (India), history of a childhood illness, and echocardiographic finding of mitral stenosis point to rheumatic heart disease. His hoarseness is due to Ortner syndrome, caused by an enlarged left atrium compressing the left recurrent laryngeal nerve. The most common cause of left atrial enlargement is mitral stenosis from rheumatic heart disease, which is consistent with this patient's medical history of a childhood bacterial illness.

 

Compression of the recurrent laryngeal nerve as seen in this patient manifests as hoarseness, because the recurrent laryngeal nerve innervates all intrinsic muscles of the larynx, with the exception of the cricothyroid, which is innervated by the external laryngeal branch of the vagus nerve. The recurrent laryngeal nerves branch from the vagus nerves. The left recurrent laryngeal loops under the aortic arch, whereas the right recurrent laryngeal travels under the right subclavian artery. The palatoglossus is the only muscle of the tongue that receives its innervation from the vagus nerve. All other intrinsic and extrinsic tongue muscles are innervated by the hypoglossal nerve. The vagus nerve innervates other skeletal muscles, including all muscles of the pharynx (with the exception of the stylopharyngeus [IX]), all muscles of the palate (with the exception of the tensor veli palatini [V3]), and the upper part of the esophagus.