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Conditions causing HF
- coronary heart disease, 62%
- cigarette smoking, 17%
- hypertension, 10%
- overweight, 8%
- diabetes, 3%
- valvular heart disease, 2%.
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Dilated cardiomyopathy 5 causes
- idiopathic (50%)
- myocarditis (9%)
- ischemic (7%)
- peripartum (4%)
- toxic (3%)
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Restrictive cardiomyopathy
- 1. Amyloidosis
- 2. Sarcoidosis
- 3. Hemochromatosis
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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.
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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
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Sarcoidosis
Bilateral hilar lymphadenopathy with or without pulmonary reticular opacities and skin, joint, or eye lesions
arrhythmias, conduction blocks, or heart failure
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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
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HF and preserved ejection fraction
- control heart rate and blood pressure, maintenance of normal sinus rhythm,
- and identification and management of myocardial ischemia.
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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,
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Atrial flutter
Flutter waves in II, III, aVF, V1
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Irregular SVTs
- 1. Atrial fibrillation - no p-waves, irregular baseline
- 2. Multifocal atrial tachycardia - at least three p wave morphologies
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LBBB
- The heart rhythm must be supraventricular in origin
- wide QRS
- V1 QS or rS complex
- V6 RsR'
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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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