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Hydralazine nitroprusside cyanide toxicity

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Unformatted text preview: terase Ventilation vs. CPAP (continuous positive airway press) CPAP PA catheter to monitor LA pressure monitor press Intra aortic balloon pump L or R ventricular assist device ventricular Transplant Drugs rest life = anti-rejection Drugs Long Term Management Long Term Management Conservative Bed rest, elevation of head of bed elevation head Fluid restriction Salt and water restriction water DM control Quit smoking Decrease alcohol Long Term Management Long Vasodilators Beta blockers Aldosterone antagonists Diuretics spironolactone Inotropes Anti-arrhythmic drugs Anticoagulants Vasodilators Vasodilators ACE inhibitors Angiotensin 11 receptor blockers SOLVD, CONSENSUS, SAVE trials SOLVD, trials All symptomatic patients, post MI All symptomatic post All patients with EF<35% All EF<35% ELITE11, CHARM, Val-HeFT Second line Hydralazine and nitrates nitrates VeHeFT 1 trial VeHeFT trial Second line to ACEI Beta Blockers Beta Standard of care Slows progression Up to 30% survival benefit Up 30 survival US-Carvedilol, COPERNICUS, MERIT trials US-Carvedilol, trials Class 1-3hyperkalemia Cautious in Class 4 Aldosterone Antagonists Aldosterone Mortality benefit in severe CHF Mortality severe RALES Class 3 and 4 CHF on ACEI and loop diuretic Class CHF ACEI loop Hyperkalemia and renal impairment are side renal effects effects Diuretics Diuretics Manage fluid overload Furosemide Metalozone Spironolactone Inotropes Inotropes Digoxin Improved contractility Improves symptoms Reduces rehospitalizations DIG trial-does not improve survival DIG trial-does not CHF and atrial fibrillation atrial Procedures Procedures Resynchronization therapy- Biventricular Biventricular pacing to improve synchronicity of contraction pacing improve contraction (MIRACLE) (MIRACLE) ICD Intra-Cardiac Defibrillation Intra-Cardiac Primary and secondary prevention of sudden secondary ion death (MADIT-1, MUST, MADIT-2) death Left LVAD Left ventricular assist device Cardiac Transplantation Cardiac Transplantation Summary Summary Cardiac failure is an increasingly diagnosed disorder Cardiac with a high mortality rate with Syndrome with varied causes and precipitants Neurohumoral and Frank-Starling mechanism can Frank-Starling explain pathophysiology pathophysiology Diagnosis is based on history, exam and investigation Treatment is multifaceted Treatment ACEI, Beta blockers, spironolactone and hydralazine/nitrates improve survival hydralazine/nitrates improve Bibliography Bibliography Braunwald’s Textbook Harrison’s textbook Toronto Notes 2005 ACC/AHA Guidelines ACC/AHA...
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