Heart failure

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Author:
desaix
ID:
200424
Filename:
Heart failure
Updated:
2013-02-18 17:05:45
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Heart failure
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Description:
Heart failure
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  1. Conditions causing HF
    • coronary heart disease, 62%
    • cigarette smoking, 17%
    • hypertension, 10%
    • overweight, 8%
    • diabetes, 3%
    • valvular heart disease, 2%.
  2. Dilated cardiomyopathy 5 causes
    • idiopathic (50%)
    • myocarditis (9%)
    • ischemic (7%)
    • peripartum (4%)
    • toxic (3%)
  3. Restrictive cardiomyopathy
    • 1. Amyloidosis
    • 2. Sarcoidosis
    • 3. Hemochromatosis
  4. Restrictive cardiomyopathy symptoms
    fatigue, weakness, anorexia, and edema

    • O/E:
    • peripheral edema, jugular venous distention, hepatojugular reflux, and Kussmaul sign (an increase in jugular venous distention during inspiration).
    • The apical impulse may be forceful, a loud S3 usually is present, and regurgitant murmurs are common.
  5. Amyloidosis
    • triad: neuropathy, proteinuria, hepatomegaly
    • echo:  increased ventricular wall thickness, thickened atrioventricular valves, a thickened atrial septum, and pericardial effusion

    The combination of low voltage on ECG and thick ventricular walls on echocardiogram suggests amyloidosis
  6. Sarcoidosis
    Bilateral hilar lymphadenopathy with or without pulmonary reticular opacities and skin, joint, or eye lesions

    arrhythmias, conduction blocks, or heart failure
  7. Heart failure meds
    • 1. ACE inhibitor therapy reduces mortality by about 20%, risk for MI by about 20%, and risk for hospitalization for heart failure by 30% to 40%. ARBs can be used in place of ACE with cough, but together -> kidney failure, hyperkalemia, hypotension
    • 1. B-blockers - metoprolol, carvedilol
    • 2. Diuretics - spironolactone (mortality benefit)
    • -isosorbide dinitrate + hydralazine (blacks)
    • -loops - for volume only
    • 3. Calcium channel blockers
    • 1st gen (nifed) - inc decomp and hospitalization
    • 2nd gen - amlodipine, felodipine (neutral)
    • Peripartum - hold ACE/ARB; use beta, digoxin, diuretic
  8. HF and preserved ejection fraction
    • control heart rate and blood pressure, maintenance of normal sinus rhythm,
    • and identification and management of myocardial ischemia.
  9. Regular Supraventricular Tachycardia
    • 1. Sinus tachycardia
    • 2. AVNRT - P wave after QRS, buried in QRS
    • 3. AVRT - WPW - short PR, delta wave
    • 4. Atrial tachycardia - abn p waves, CAD, cor pulmonale,
  10. Atrial flutter
    Flutter waves in II, III, aVF, V1
  11. Irregular SVTs
    • 1. Atrial fibrillation - no p-waves, irregular baseline
    • 2. Multifocal atrial tachycardia - at least three p wave morphologies
  12. LBBB
    • The heart rhythm must be supraventricular in origin
    • wide QRS
    • V1 QS or rS complex 
    • V6 RsR'
  13. RBBB
    • QRS duration must be more than 100 ms (incomplete block) or more than 120 ms (complete block)
    • There should be a terminal R wave in lead V1 (e.g. R, rR', rsR', rSR' or qR)
    • There should be a slurred S wave in leads I and V6.

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