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Short-acting, sublingual nitrates can be used in patients with mild, stable CAD for immediate relief on an as needed basis97.Drugs contraindicated in patients with angina-Beta blockers are contraindicated for patients with severe, uncontrolled reactive airway diseases and vasospastic angina98.Patho of heart failure-Heart tries to compensate for not pumping an adequate amt of blood-Increased heart rate-Blood vessels dilate-Heart hypertrophy-Right side triggered by MI or lung dx -Vascular resistance-Greater O2 demand-Cells become hypoxic99.HF Stage A-High risk for development of HF; no underlying structural cardiac disease (HTN, DM, hyperlipidemia, etc) -ACE inhibitors-Treat HTN + lipids-Lifestyle changes100.HF Stage B-Structural heart disease but asymptomatic.-ACE inhibitorsDownloaded by: nataliamontenegro1114 | [email protected]Distribution of this document is illegal
Stuvia.com - The Marketplace to Buy and Sell your Study Material-Beta-blockers101.HF Stage C-Structural heart disease with past or current symptoms of HF -ACE inhibitors and beta-blockers -Diuretics-Digitalis-Dietary salt restriction102.HF Stage D-End-stage disease. Requires specialized treatment strategies such as mechanical circ support, continuous inotropic infusions, cardiac transplantation, or hospice care.103.Systolic Dysfunction-Left ventricular dysfunction (systolic heart failure) begins with injury to the myocardium and is usually a progressive process, even in the absence of additional myocardial insults.The principal mechanism relates to remodeling, which occurs as a homeostatic mechanism to decrease wall stress through increases in wall thickness.104.Diastolic Dysfunction-Diastolic dysfunction, also known as heart failure with preserved ejection fraction (HF-pEF), results from inadequate relaxation and loss of muscle fiber elasticity, resulting in a slower filling rate and elevated diastolic pressures. Although cardiac output is reduced, ejection fractions remain within normal limits105.Diastolic Dysfunction Causes-Valvular dysfunction, hypertrophic and ischemic cardiomyopathy, uncontrolled HTN, hypothyroidism.106.Systolic Dysfunction Causes-Injury to the myocardium107.Diagnostic testing for HF-2D ECG with Doppler flow studies - most useful!-Chest xray, CBC, urinalysis, serum electrolytes, BUN, creatinine, HbA2c, liver fxn studies, fasting lipid profiles, and thyroid-stim hormone.-Brain natriuretic peptide (BNP) to id patient with elevated left-ventricular filling pressures.108.Limited role of digoxin in treatment of HF-Although digoxin increases the force of contraction and modulates the RAAS, thereby improving functioning and symptoms and reducing hospitalizations, it has little if any effect on mortality. Published data suggest that digoxin does not improve quality of life, symptoms, or mortality ratesDownloaded by: nataliamontenegro1114 | [email protected]Distribution of this document is illegal
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