HIGHERST RISK FOR HF and Complications o Treatment emergent PCI antithrombotic

Higherst risk for hf and complications o treatment

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HIGHERST RISK FOR HF and Complications o Treatment- emergent PCI antithrombotic Concept of myocardial remodeling and how this impacts recovery treatment o ECG changes with: Ischemia, Injury, Infarction Area of Ischemia: T wave inversion ST segment depression Area of Injury ST segment elevation Increase cardiac biomarkers- Toponin, CK- MB Area of necrosis (infarction) Deep (abnorm) Q waves after 24 H o Prophylaxis of CAD
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LDL vs. HDL cholesterol Know appropriate ranges for each and for total cholesterol Methods of control, including pharmacological Heart Wall Disorders- 6 questions o Pericardium: (Epicardium) – double walled heart sac, out most layer, fibrous and serous, pericardium cavity Acute Pericarditis Acute Inflammation of pericardial membranes, fibrotic process (roughened) Causes: Multiple, idiopathic, infection (bacterial, viral, HIV, TB), trauma, MI, uremia, SLE/ RA Symptoms: o Precipitating fever, sudden onset and severe, retrosternal CP, worsens w/ breathing & lying down, tachycardia, cardiac friction rub @ apex and L. sternal border, ECH changes (PR depression, ST elevation) Diagnosis: o US< CT, MRI Treatment: o Treat underlying cause, anti-inflammatory meds (Salicylates/ NSAIDs) colchine Complication: o Pericardial Effusion, tamponade, constrictive pericarditis Pericardial effusion: Accumulation of fluid in pericardial sac (cavity) can occur w/ pericarditis: o Exudate (inflammatory), acute pericarditis, autoimmune disorder, infection o Transudate (serous): HF, hypoproteinemia, overhydration o Serosangulneous/ Sangulneous: trauma, ruptured myocardium, coag defects Causes: o 20% idiopathic, neoplasm, infection Symptoms: o DOE, dull chest pain Signs: o Muffled hear sounds, X ray (looks like a water bottle)
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DX: Echocardiogram can detect 20 mL Treatment: o pericardiocentesis (needle aspiration to remove fluid), pericardial window (drain), analgesics, anti- inflammatory, steroid Complication: fluid increases rapidly (50-100mL), tamponade preceded by pulsus paradoxus (BP during expiration exceeds by 10) Tamponade: Pressure exerted by pericardial fluid, equals or exceeds diastolic pressure w/in the heart Interferes w/ atrial filling, increases venous pressure/ congestion, S&S of RHF, decreased ventricular filling (decreased SV, reduced CO) Leads to circulatory collapse Constrictive Pericarditis: Fibrotic scarring/ calcification or pericardium that causes the pericardial layers to adhere resulting in compression of the heart (like tamponade) and reduces CO but develop gradually Causes: o TB!, idiopathic, viral infection, uremia, sarcoidosis, neoplasm, post-surgical scarring Symptoms: Exercise intolerance, DOE, fatigue, anorexia Signs: Edema, JVD, hepatic congestion, hypotension Dx: Chest x-ray (calcification of pericardium), ECG changes, TEE (Trans Effofacial Ecocardial Gram), CT, MRI Tx: Restrict Na intake, diuretics, some need surgery, treat underlying cause, anti-inflammatory, (pericardial decortication) Complication : Tamponade o Myocardium: Cardiac muscle layer, thickest layer Cardiomyopathies: Cause: Most – idiopathic, underlying HD; HTN, ischemia,
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