PAEA Internal Medicine Inpatient EOR Topics VERIFIED 100% SOLUTION

PAEA Internal Medicine Inpatient EOR Topics VERIFIED 100% SOLUTION what is the most common cause of heart failure? specifically left sided? right sided? -MC is CAD (coronary artery disease) -L sided: CAD & HTN -R sided: L sided HF & pulmonary dz decreased ejection fraction, thin ventricular walls, dilated LV chamber, and an S3 gallop (filling of dilated ventricle) is associated with systolic or diastolic heart failure? systolic (MC form of CHF) *(the sound is actually heard in the diastole though) -memory trick: "sys-to-lic" 3 consonants = S3 normal ejection fraction, thick ventricular walls, narrowed LV chamber, and an S4 gallop (atrial contraction into a stiff ventricle) is associated with systolic or diastolic heart failure? diastolic -memory trick: "di-a-sto-lic" 4 consonants = S4 what are the causes of systolic vs diastolic heart failure? -systolic: post MI, dilated cardiomyopathy, myocarditis -diastolic: HTN, LVH, elderly, valvular heart dz, hypertrophic or restrictive cardiomyopathy, constrictive pericarditis when the metabolic demands of the body exceed normal cardiac function (d/t thyrotoxicosis, wet beriberi, severe anemia, AV shunting, Paget's disease of the bone) this is termed ________ heart failure high-output *fairly uncommon -low-output HF is just d/t problem w/ myocardial contraction, ischemia, or chronic HTN what are some causes of acute vs chronic heart failure? -acute: largely systolic; hypertensive crisis, acute MI, papillary muscle rupture -chronic: dilated cardiomyopathy (systolic), valvular dz (diastolic) explain class I-IV New York Heart Association functional classes -class I: no sx's, no limitation during ordinary physical activity -class II: mild sx's (dyspnea or angina), slight limitation during ordinary activity -class III: comfortable only at rest (sx's caused maked limitation in activity even with minimal exertion -class IV: sx's even while at rest, severe limitations, inability to carry out physical activity what compensations does the body make when heart failure (can be due to something that causes either inc pre/afterload or dec contractility) begins? 1. sympathetic nervous system activation 2. myocyte hypertrophy/remodeling 3. RAAS activation: fluid overload the following are signs/sx's of what sided heart failure? inc pulmonary venous pressure, dyspnea, orthopnea, rales/rhonchi, chronic nonproductive cough with pink frothy sputum, HTN, Cheyne-Stokes breathing, S3 or S4, pale skin/cool extremities, sinus tachy, fatigue L-sided HF the following are signs/sx's of what sided heart failure? inc systemic venous pressure, peripheral edema, JVD, anorexia, N/V, hepatosplenomegaly, RUQ tenderness, hepatojugular reflex (inc JVP with liver palpation) R-sided HF -CXR showing Kerley B lines (alternate flow tracts), cardiomegaly, pleural effusion, pulmonary edema -echo with dec EF -inc BNP on labs are all signs of? heart failure *BNP released from atrium with preload too high (volume overload) what drugs have shown to decrease mortality rates in pts with heart failure? ACE inhibitors (-prils), ARBs, beta-blockers (-lols), hydralazine + nitrates, spironolactone in pts who experience the following common side effects of an ACE inhibitor to treat heart failure, what is the alternative medication? -1st dose hypotension, renal insufficiency, hyperkalemia, cough, angioedema ARBs (-sartans) what vasodilators are often used to treat heart failure?