numero cinqo

numero cinqo

1. Management

   • Pharmacological
     • B-blockers
       • bisoprolol
       • metoprolol
     • vasodilators
       • ACEI
       • nitrates
     • digoxin
       • inhibits sodium potassium pump
     • phosphodiesterase inhibitors
       • Inamrinone (Inocor)
       • Milrinone IV (Primacor)
     • Adrenergics/Sympathomimetics
       • Used in acute severe heart failure
   • Non pharmacological
     • dietary changes
     • moderate exercise
     • weight management

2. Investigations

   • physical exam
   • blood tests
     • BNP
     • kidney and liver function tests
   • chest x -ray
   • ECG

3. Signs and Symptoms

   • dyspnea
     • defined as shortness of breath
     • causes
       • cardiovascular
         • congestive heart failure
         • coronary artery disease
       • pulmonary
         • obstructive pulmonary diseases
       • mixed cardio-pulmonary
         • traumatic causes
       • non cardio-pulmonary
         • panic attack
         • metabolic acidosis
   • orthopnea
     • shortness of breath while in the supine position
   • swelling in the abdomen
   • persistent cough w/ sputum
   • peripheral edema
     • mechanisms of edema
       • increased capillary hydrostatic pressure
         • usually the case in heart failure
       • decreased plasma oncotic pressure
       • increased capillary permeability
       • lymphatic obstruction
       • sodium and water retention

4. Causes

   • coronary artery disease
     • most common cause
     • cardiac muscle isnt receiving enough oxygen to pump
   • chronic hypertension
     • heart exerts more force to pump blood
       • dilated cardiomyopathy
         • leads to failure
   • myocardial infarction
     • irreversible damage to cardiac muscle
   • cardiomyopathy
     • caused by infections, genetics, alcohol abuse
   • valvular heart disease
     • stenosis or regurgitation
   • diabetes
     • hyperglycemia damages heart muscle and coronary vessels
   • chronic kidney disease
     • leads to fluid overload and increased BP
   • congenital heart defects
     • structural heart problems

5. Types of HF

   • right sided
     • right ventricle cant pump blood to the lungs
       • leads to
         • elevated JVP
   • left sided
     • systolic heart failure
       • The left ventricle loses its ability to contract normally,
     • diastolic heart failure
       • because the muscle has become stiff.
   • biventricular
     • Involves both the left and right ventricles
   • congestive
     • the stage where fluid builds up around the heart and causes it to pump inefficiently

6. Complications

   • arrhythmias
     • most commonly
       • atrial fibrillation
   • liver damage
     • congested of blood in liver
       • known as
         • congestive hepatopathy
   • pulmonary edema
     • causes shortness of breath
   • anemia
     • not enough red blood cells are carrying O2
   • stroke
     • because of mural thrombi causing brain embolus

7. Prognosis

   • depends on
     • severity
       • NYHA Functional Classification
         • Class I has the best prognosis
         • Class IV has the worst
       • ACC/AHA Stages
         • early stages (A or B) generally have a better prognosis than late stages (C or D)
     • ejection fraction
       • EF < 40%
         • worse prognosis
     • underlying causes
       • ischemic heart disease
         • worse prognosis
       • myocardial infarction
         • worse prognosis