Heart failure

• coronary heart disease, 62%
• cigarette smoking, 17%
• hypertension, 10%
• overweight, 8%
• diabetes, 3%
• valvular heart disease, 2%.

• idiopathic (50%)
• myocarditis (9%)
• ischemic (7%)
• peripartum (4%)
• toxic (3%)

• 1. Amyloidosis
• 2. Sarcoidosis
• 3. Hemochromatosis

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.

• 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

Bilateral hilar lymphadenopathy with or without pulmonary reticular opacities and skin, joint, or eye lesions

arrhythmias, conduction blocks, or heart failure

• 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

• control heart rate and blood pressure, maintenance of normal sinus rhythm,
• and identification and management of myocardial ischemia.

• 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,

Flutter waves in II, III, aVF, V1

• 1. Atrial fibrillation - no p-waves, irregular baseline
• 2. Multifocal atrial tachycardia - at least three p wave morphologies

• The heart rhythm must be supraventricular in origin
• wide QRS
• V1 QS or rS complex 
• V6 RsR'

• 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.