I read a case a while ago about a patient with Fever of Unknown Origin (FUO). He was treated with anti-TB drugs and developed jaundice. The patient was later found to suffer from Hodgkin's lymphoma with liver metastasis.

An uncommon side effect of rifampicin is hepatitis as it's entirely metabolized in the liver. It's especially likely if the patient suffers from liver disease, as in our FUO patient.

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Most common causes of FUO:

• Infection, most commoly TB
• Malignancy
• Connective tissue disorders
• Miscellaneous
• Unidentified causes/spontaneous remission

TB is the most common cause of FUO worldwide, particularly in the  developing world and immigrants from those countries.

The first step in the evaluation of a patient with FUO for the physician, who has not seen the case previously, is to elicit the history carefully and to repeat the physical examination and investigations if necessary.

Heart failure (HF) is a disease with neurohormonal components; the sympathetic nervous system & the RAAS system try to compensate for the fall in cardiac output. But they make matters worse anyways.

Hemodynamic stability is determined by blood pressure & the presence or absence of pulmonary edema.

MI patients are classified based on their hemodynamic status:

1. Hemodynamically stable (mild). Treated with anti-ischemic drugs.
2. Hypotension without pulmonary edema. Treated with anti-ischemic + normal saline.
3. Pulmonary edema without hypotension. Treated with anti-ischemic + diuretics.
4. Pulmonary edema & hypotension (cardiogenic shock, severe). Treated with anti-ischemic + positive inotropic agents + ACEi + diuretics (even if the patient is severely hypotensive, we should give them diuretics).

An ischemic heart wall is hypokinetic. If it goes through MI, the infarcted segment of the heart becomes akinetic, then dyskinetic (moves in the opposite direction of the normal heart wall; if the normal wall contracts, the infarcted wall bulges out), leading finally to the formation of an aneurysm.

Aneurysm complications:
• Thrombus/embolus formation.
• Arrhythmia.
• Persistent ST-elevation.
• Cardiac wall rupture.

Heart failure (HF) can be a complication of MI because of cardiac remodelling.

The artery most commonly occluded in MI is the LAD (Left Anterior Descending). It leads to anterior MI.

Occlusion of the RCA (Right Coronary Artery) leads to inferior MI.

Occlusion of the PDA (Posterior Descending Artery) leads to posterior MI.

Occlusion of the circumflex artery leads to lateral MI.

Lifestyle factors are common contributors to resistant hypertension:

• Elderly patients, black patients, and those with CKD tend to be particularly salt sensitive.
• In an estimated 10% of adults with hypertension in the United States, the hypertension is due primarily to alcohol consump-tion.
• For every 10% increase in body weight, systolic BP increases by 6.5 mm Hg.

What's your dx?
@contactzero_bot

ها صدك

The patient is an old, thin woman with abdominal pain