Endomyocardial Fibrosis

Endomyocardial fibrosis (EMF) is a rare but serious form of restrictive cardiomyopathy that primarily affects the endocardium and the innermost layer of the myocardium. It is characterised by progressive fibrosis—an excessive deposition of connective tissue—in one or both ventricles of the heart. This leads to a stiffening of the ventricular walls, impaired ventricular filling during diastole, and eventually congestive heart failure. Endomyocardial fibrosis predominantly occurs in tropical and subtropical regions, particularly in parts of sub-Saharan Africa, South Asia, and South America. Most commonly, it affects children and young adults, often resulting in chronic cardiac morbidity. While uncommon in developed countries, EMF continues to impose a considerable public health burden in endemic areas due to limitations in diagnostic infrastructure, low awareness, and insufficient access to therapeutic interventions.

Image source Google

Endocardial Fibroelastosis

Endocardial fibroelastosis (EFE) is an uncommon but potentially life-threatening cardiac condition that predominantly affects neonates and infants. It is defined by abnormal proliferation of fibrous and elastic connective tissue within the endocardium, primarily of the left ventricle, resulting in a thickened, less compliant myocardial lining. This histological alteration adversely impacts myocardial relaxation and contraction, culminating in compromised systolic and diastolic function. EFE may exist as an isolated idiopathic disorder or as a sequela of congenital cardiac anomalies. Prompt recognition and management are imperative to mitigate the risk of irreversible heart failure and mortality. This article presents a detailed exposition of EFE, encompassing its aetiology, pathophysiology, clinical manifestations, diagnostic modalities, therapeutic approaches across medical systems, epidemiological patterns, recent research developments, and illustrative case reports.

Image source Google

Cardiac Amyloidosis

Cardiac Amyloidosis: An In-Depth Analysis

Cardiac amyloidosis is a progressive and life-threatening disorder characterised by the deposition of misfolded amyloid fibrils within the myocardium. This pathological protein accumulation results in increased myocardial stiffness, diastolic dysfunction, and, ultimately, heart failure. Due to its nonspecific clinical manifestations, cardiac amyloidosis often remains undiagnosed until advanced stages, highlighting the necessity for heightened clinical awareness and improved diagnostic methodologies.

Image source Google

Dilated Cardiomyopathy

Idiopathic Dilated or Congestive Cardiomyopathy: A Comprehensive Guide

Idiopathic dilated or congestive cardiomyopathy is a heart condition that weakens and enlarges the heart muscle, impairing its ability to pump blood effectively. In simple terms, it’s like the heart becoming overstretched and losing its strength, making it harder for the body to receive the oxygen-rich blood it needs. Globally, idiopathic dilated or congestive cardiomyopathy affects millions, with estimates suggesting it accounts for approximately 25% of all cases of heart failure. Its significance lies in its profound impact on life expectancy and quality of life. Patients with idiopathic dilated or congestive cardiomyopathy often face challenges such as fatigue, shortness of breath, and even sudden cardiac arrest if left untreated. Understanding this disease is crucial for early detection and effective management.

Image source Google

Image source Google

Inflammation

Inflammation: Etiology, Pathophysiology, Clinical Manifestations, and Evidence-Based Interventions

Inflammation constitutes a complex biological response to noxious stimuli, encompassing infection, tissue injury, and immune dysregulation. While acute inflammation is integral to tissue homeostasis and repair, persistent or dysregulated inflammation has been implicated in the pathogenesis of numerous chronic diseases, including cardiovascular disease, metabolic disorders, and autoimmune conditions. This article elucidates the multifactorial causes of inflammation, delineates its clinical presentation, and examines both natural and medical modalities for mitigating its adverse sequelae.

Image source Google

Encephalitis

Synonyms

• Brain Inflammation
• Acute Viral Encephalitis
• Infectious Encephalitis
• Autoimmune Encephalitis
• Cerebral Infection
• Neuroinflammation

Introduction and Definition

Encephalitis is a severe, often life-threatening, inflammatory condition of the brain, typically resulting from viral infections, autoimmune reactions, or, in rarer cases, bacterial and fungal pathogens. The pathological hallmark of encephalitis is extensive neuroinflammation leading to neuronal dysfunction, cerebral edema, and, in severe cases, irreversible neurological sequelae. Given the heterogeneity in etiology and clinical presentation, accurate and timely diagnosis is imperative to optimize therapeutic interventions and reduce morbidity and mortality.

Hyperbilirubinemia

Jaundice

Also known as Icterus, Hyperbilirubinemia, Yellow discoloration syndrome, Bilirubin metabolic disorder, Peeliya (local term)

Introduction

Jaundice is a complex clinical syndrome characterized by the yellow discoloration of the skin, sclerae, and mucous membranes due to elevated serum bilirubin levels exceeding 2 to 3 mg/dL. Bilirubin, a tetrapyrrolic bile pigment, is formed during the catabolism of heme derived from senescent erythrocytes. The condition signals an underlying disorder in bilirubin metabolism, transport, or excretion, often linked to pre-hepatic, hepatic, or post-hepatic etiologies.

Stomach inflammation

Gastritis

Also known as Stomach inflammation, Gastric mucosal inflammation, Gastric irritation. Gastritis refers to the inflammation, irritation, or erosion of the gastric mucosa (the lining of the stomach). It can occur suddenly (acute gastritis) or gradually over time (chronic gastritis). The condition may be caused by various factors, including infections, medications, or autoimmune disorders.

Sweet syndrome

 

Sweet Syndrome (Acute Febrile Neutrophilic Dermatosis)

What is Sweet Syndrome?

Sweet Syndrome is a skin condition that causes painful, red or purple bumps and patches. It usually appears on the face, neck, and arms, and is often accompanied by fever and high levels of neutrophils in the blood.

 

Dengue Fever

 DENGUE FEVER

 

Contents:

1. Introduction
2.  Clinical presentation
3. Diagnosis
4. Treatment
5. Diet
   

 Introduction:

• Dengue fever is a viral infection caused by dengue virus.
• Dengue virus is an RNA virus of genus flavi virus.
• —There are four serotypes dengue virus that is DENV-1, DENV-2, DENV-3, DENV-4
• —Dengue virus transmitted by Aedes aegypti mosquito
  

 

Aedes aegypti mosquito

 

Aedes aegypti mosquito known to transmit Dengue virus, Yellow fever virus, Chikungunya virus, and Zika virus and it also suggest as a potential vector of Venezuelan Equine Encephalitis  virus and studies shown it is capable to transmit West Nile virus as well.

Clinical Presentation:

Divides into 4 categories : 

1. Dengue without warning sign 
2. Dengue with warning sign 
3. Severe dengue / dengue hemorrhagic fever
4. Dengue shock syndrome

 

Remember Note:

• Not all patient goes in all these phases.— 
• Majority of patient develops dengue without warning sign and they cure self or general treatment.
•  But few patients who are not manage properly or the patient who are immunocompromised and who have weak immune system, they can progress from dengue without warning sign to dengue shock syndrome.

 Dengue without warning sign:

• Incubation period 4-10 days (2-14 days)
•  —High grade fever 40˚C (104˚f)       

                               +

  Following any of two are present

•  Severe headache
•  Retro orbital pain
•  Myalgia, arthralgia (break bone fever)
•  Maculopapular widespread rashes.
•  Generalised lymphadenopathy.

 

Dengue with warning sign

 Critical period begins - —  

3-7 days after symptoms onset  

Warning signs appear after fever subsides

  

Population who are at risk –

•  —Pt. with severe comorbidities
•  —Infants less than 1 year of age
•  —History of previous or recurrent dengue infection.

  

Warning Signs Include:

1.  Abdominal pain with or without tenderness. 
2. Persistent vomiting (>3 times in 24 hours) 
3. —Bleeding from nose or gums. 
4. —Blood in vomiting or blood in stool or blood in urine. 
5. —Lethargy, restlessness, irritable. 
6. —Enlarge liver > 2 cm

 

Severe Dengue / Dengue haemorrhagic fever

 Re-infected with different serotype

 This phase begins after fever subside

 —Temperature (hypothermia to second fever spike)

—Plasma leak resulting in pleural effusion, ascites, haematocrit drops

 —Hemorrhagic manifestations such as gingival bleed, epistaxis, petechiae, ecchymosis, purpura, thrombocytopenia,

 —Severe organ involvement like hepatomegaly, liver failure

 —Changes in mental status - confusion

 

Petechiae and Purpura

 

 

Ecchymosis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gingival Bleeding

 

  Dengue Shock Syndrome

Severe hemorrhagic dengue

                   +

Shock (circulatory collapse)

—Severe hemorrhagic fever with circulatory collapse is called dengue shock syndrome

—It is fatal if not manage properly

 

Diagnosis

 Serologic test to detect IgM (Initial 3-4 days the antibodies will be negative but patient having infection.

 —NAAT to detect viral RNA

 —NS-1 antigen to detect dengue non structural protein 1 (NS 1 antigen can be detected directly after onset  of symptoms, before even IgM production begins)

 —Positive capillary fragility test.  

 

When test become positive

 

TOURNIQUET FRAGILITY TEST –

Tourniquet applied to arm.  Inflated to a point b/w systolic and diastolic pressure for 5 minutes.

Positive test : If 10 or more petechiae appear per square inch on forearm.

 

Treatment Approache

Don’t do this

—Don’t use corticosteroids due to increase risk of GI bleeding, hyperglycemia.

—Do not give platelet transfusion for low platelet count b/c it leads to fluid overload.

—Do not assume that IV fluid are necessary, use minimum amount of IV fluid to keep patient profused.

—Do not give ½ NS b/c it leads to ascites, pleural effusion etc.

You can do this

—Do recognize the clinical period

—Monitor fluid intake output, vital sign HCT level etc.

—Do administer colloids such as albumin for refractory shock who do not responds 2-3 boluses of isotonic saline.

—Do give PRBCs or whole blood for significant bleeding.

 

Dengue without warning sign Treatment approach 

—Paracetamol, cold sponging for fever (don’t give aspirin, ibuprofen)

—Prevent dehydration (oral fluid – ORS)

 

Dengue with warning sign treatment approache

—Admit in hospital

—Check hematocrit value

—If oral fluid intake inadequate give isotonic crystalloid (normal saline, RL)

—Stepwise manner, 5-7ml/kg/hour for 1-2 hours followed by 3-5ml/kg/hour for 2-4 hours (increase rate if vital signs worsening.

—Control fever with paracetamol and cold sponging.

—Continue monitor – Haematocrit, fluid intake urine output, vital signs

 

Severe Dengue / Dengue haemorrhagic fever

—Admit patient for emergency management.

—Monitor fluid intake/output

—Give controlled fluid 5-7ml/kg/hr for 1-2 hours, 3-5ml/kg/hr for next 2-4 hours, 2-3ml/kg for next 2-4 hours.

 

Check haematocrit level

DECREASING

—Transfusion 5-10ml/kg PRBCs.

         Or

—10-20ml/kg whole blood immediately

 

INCREASING

 —Give controlled crystalloid (NS, RL) 10-20 ml/kg bolous over 1 hour  

 

Dengue Shock Syndrome

—If patient have hypotensive shock: Give isotonic crystalloid or colloid bolus 20ml/kg within 15 min.

—If  condition improve than continue crystalloid and colloid and slowly taper.

—If condition not improve than check haematocrit.

—If hematocrit decrease than transfuse 5-10ml/ kg PRBCs or 10-20ml/kg whole blood.

If hematocrit increase than give colloid 10-20ml/kg bolus over 30 min – 1 hour 

 

What can we do at home

—Cold sponging to control fever.

—ORS to maintain hydration.

—Papaya leaf juice/papaya to maintain or increase platelet count. Papaya leaf extract is good for digestion which contain papain and chympapain.

—Avoid heavy work or routine work.

 —Increase fruits (specially citrus fruits) in diet.

 

What should eat

—Vitamin-C : It has antiviral and anti-oxidative properties and it boost immunity and it help to absorb another helpful nutrients such iron from intestine. Sources – Orange, lemon, papaya, pineaple etc.

—

—Vitamin-K : Sprouts, broccoli, and green leafy vegetables.

—

—High-calorie foods: Milk, rice, potato etc.

—

Water 

 

What should avoid to eat

—Red or brown colored : Drink or food like chocolate, violet colored juices b/c it misleads the disease progression.

—

—Caffeine : Energy drinks, coffee, tea b/c these act as diuretics which make difficult to maintain hydration.

—

—Spicy foods : Avoid spicy foods b/c it stimulates the stomach for more acid production which may cause stomach or intestinal bleeding.

—

—Fatty foods : Cheese, cuts, butter, deep fried food and avocado etc. Dengue fever  reduces the capacity of digestion and which make difficult to digest for the stomach.