Pregnant precipitants precipitants htn endocarditis

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Unformatted text preview: g problems (COPD, pneumonia, PE) pneumonia PE Dietary indiscretions Symptoms Symptoms Low Cardiac Output ardiac Fatigue, tiredness, mental cloudiness tired Venous congestion 4 pillow Dyspnea, orthopnea, PND, Cough Hemoptysis Peripheral oedema Tender liver Paroxysmal nocturnal dyspnoea Dyspnea Dyspnea Due to pulmonary congestion due to poor LV Due pulmonary congestion poor systolic function, increased LV filling pressure, systolic func LV pressure, increased LA pressure and subsequent pulmonary increased LA pressure pulmonary venous hypertension and pulmonary oedema venous pulmonary Orthopnea Increased venous return when recumbent Increased venous recumbent Pulmonary congestion due to poor forward flow onary congestion poor SOB when lying supine lying Relieved with the use of pillows with pillows Paroxysmal nocturnal dyspnea Exacerbations of SOB at night, waking from sleep and SOB night, waking sleep requiring sitting out of bed sitting bed Classification of Symptoms Classification Symptoms better New York Heart Association ew ork Heart Association Class 1-symptoms of heart failure with severe Class heart exertion exertion Class 2- symptoms of heart failure with moderate Class symptoms exertion exertion worse Class 3-symptoms with mild exertion Class -symptoms mild Class 4-symptoms at rest Class -symptoms at Signs Signs Cardiomegaly S3 Murmurs Basal crackles/rales in lung lung Anasarca Leg oedema Anasarca – severe oedema up to trunk + odema pitting Elevated JVP Tender hepatomegaly and ascites ascites Soft S1 + S2 Investigations Investigations Identify and treat precipitating causes Identify precipitating Urea + electrolytes Brain Naturietic Peptide Blood work-U&E, CBC, Thyroid test, BNP, (elevated) CBC Thyroid test BNP cardiac enzymes, ferritin WBC ↑ in infection cardiac enzymes ferritin WBC in Brady ECG Brady + tachycardia heart failure CXR Echocardiogram Nuclear imaging tests Treatment Treatment Acute Bed rest Oxygen administration Fluid restriction Semi-Fowler’s position with head elevated position head Diuretic administration-furosemide Morphine-for vasodilation and anxiety -for vasodilation anxiety Nitroglycerin-reduces preload and afterload -reduces preload afterload Treatment Treatment Vasodilators Nitroprusside, hydralazine, Nitroprusside cyanide toxicity Nitroprusside Inotropes Acute Dobutamine- selective Beta 1 agonist and alpha 1 antagonist selective alpha afterload Dopamine ↑ afterload at high conc PDE inhibitors Phospho Di-Es...
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