PESA PULM AND CARDIO DIAGNOSIS DISCUSSION

Asthma in Adults and Adolescents

1. Diagnosis Overview & Risk Factors:
Asthma is a chronic inflammatory airway disease characterized by reversible airflow obstruction and bronchial hyperreactivity. Risk factors include family history of atopy, allergens, obesity, and occupational irritants.

2. Patient Presentation:
Symptoms include episodic wheezing, dyspnea, chest tightness, and cough, often worse at night or early morning. Physical exam shows wheezing on expiration and prolonged expiratory phase.

3. Diagnosis & Workup:
Diagnosis is clinical and supported by spirometry showing reversible obstruction (↑FEV₁ >12% post-bronchodilator). Peak flow monitoring helps assess control. Methacholine challenge may confirm diagnosis.

4. Management:
Stepwise approach: Non-pharmacologic: Avoid triggers, smoking cessation. Pharmacologic: Inhaled corticosteroids (ICS) first-line; add LABA or LTRA as needed. Acute: SABA for rescue. OMM: Rib raising, lymphatic techniques to improve respiratory mechanics.

5. Complications:
Status asthmaticus, airway remodeling, and medication side effects (e.g., oral thrush from ICS).

Acute Respiratory Distress Syndrome (ARDS)

1. Diagnosis Overview & Risk Factors:
ARDS is a life-threatening inflammatory lung injury leading to non-cardiogenic pulmonary edema and hypoxemia. Common causes include sepsis, aspiration, trauma, or pneumonia.

2. Patient Presentation:
Patients present with severe dyspnea, tachypnea, hypoxemia refractory to oxygen, and diffuse crackles. Often occurs within a week of a precipitating event.

3. Diagnosis & Workup:
Diagnosis per Berlin criteria: acute onset, bilateral infiltrates on chest X-ray, PaO₂/FiO₂ ratio <300, and no evidence of left heart failure. ABG shows hypoxemia with respiratory alkalosis.

4. Management:
Mechanical ventilation with low tidal volumes and adequate PEEP. Treat underlying cause (e.g., antibiotics for sepsis). Conservative fluid management; prone positioning improves oxygenation.

5. Complications:
Respiratory failure, barotrauma, multi-organ dysfunction, and pulmonary fibrosis.

Heart Failure with Reduced Ejection Fraction (HFrEF)

1. Diagnosis Overview & Risk Factors:
HFrEF results from impaired myocardial contractility with LVEF ≤40%. Common causes include ischemic heart disease, hypertension, and dilated cardiomyopathy.

2. Patient Presentation:
Symptoms include dyspnea, orthopnea, fatigue, and lower extremity edema. Exam may reveal S3 gallop, elevated JVP, crackles, and peripheral edema.

3. Diagnosis & Workup:
Echocardiogram confirms reduced ejection fraction. BNP or NT-proBNP levels aid diagnosis. ECG and chest X-ray may show LV hypertrophy or pulmonary congestion.

4. Management:
Non-pharmacologic: Sodium restriction, daily weights, exercise. Pharmacologic: ACE inhibitors/ARBs/ARNI, beta-blockers, mineralocorticoid antagonists, SGLT2 inhibitors. Procedural: ICD or CRT for select patients. OMM: Improve thoracic cage motion and lymphatic drainage.

5. Complications:
Arrhythmias, cardiogenic shock, renal dysfunction, and recurrent hospitalizations.

Infective Endocarditis

1. Diagnosis Overview & Risk Factors:
Infective endocarditis is infection of the endocardial surface, often involving heart valves. Common pathogens: Staphylococcus aureus, Streptococcus viridans, Enterococcus. Risk factors include prosthetic valves, IV drug use, and prior valvular disease.

2. Patient Presentation:
Fever, fatigue, and new or changing murmur. May have petechiae, Janeway lesions, Osler nodes, or splinter hemorrhages.

3. Diagnosis & Workup:
Use modified Duke criteria (positive blood cultures, echocardiographic evidence). Transthoracic or transesophageal echo identifies vegetations.

4. Management:
IV antibiotics tailored to organism. Surgery for heart failure, abscess, or prosthetic valve infection. Preventive antibiotics before dental procedures in high-risk patients.

5. Complications:
Embolic events (stroke, splenic infarct), valvular insufficiency, heart failure, and abscess formation