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Ayokunle Olubaniyi (talk | contribs)
Ayokunle Olubaniyi (talk | contribs)
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❑ [[Right heart catheterization|Pulmonary artery catheterization]] - in  [[respiratory distress]] or [[shock]]</div>}}
❑ [[Right heart catheterization|Pulmonary artery catheterization]] - in  [[respiratory distress]] or [[shock]]</div>}}
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Revision as of 00:04, 21 February 2014

Management

 
 
 
 
 
 
 
Characterize the symptoms:

Cardiac

Chest pain
Cough
Dyspnea at rest
Exertional dyspnea
Orthopnea
Palpitation
Paroxysmal nocturnal dyspnea
Peripheral edema

Extracardiac

Anorexia
Bloating
Fatigue
Nausea
Oliguria
Weight loss

Obtain a detailed history:
Medications:

Alcohol
Beta blockers
Calcium channel blockers
Chemotherapy drugs - anthracyclines
NSAIDs
Thiazolidinedione

Past medical history

Arrhythmias
Cardiomyopathy
Diabetes mellitus
Hypertension
Obesity
❑ Previous myocardial infarction
Sleep disorders
Thyroid disease
Valvular heart disease

Family history

❑ History of dilated cardiomyopathy
Radiation to the chest
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:

❑ General examination:

Pulse rate - ↑
Blood pressure - ↑ or ↓
Respiratory rate - ↑
Weight

❑ Head/neck examination:

❑ ↑ JVP

❑ Cardiovascular examination:

Wheeze (cardiac asthma)
❑ S3 or S4 or both
❑ New or changed murmur

❑ Respiratory examination

❑ Crackles

❑ Abdominal examination:

Hepatomegaly
Ascites

❑ Neurological examination:

Altered mental status

❑ Extremity examination:

Pedal edema

❑ Assess severity - NYHA or ACC/AHA scales


Consider close differential diagnoses:
❑ Acute asthma
Acute respiratory distress syndrome
Cardiac tamponade
Pneumonia

Pulmonary embolism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Initial stabilization:

❑ Assess airway, pulse oximetry
❑ Nurse 45 degrees upright
❑ Give oxygen, if Sa02 ↓90%
by non-rebreather face masks
❑ Continuous cardiac monitoring
❑ Intravenous access
❑ Monitor vitals - Pulse, BP
❑ Monitor urine output
Order

chest x ray
Cardiomegaly
Pulmonary edema
Kerley B lines
EKG
❑ Evidence of ischemia
Infarction
Arrythmia
Left ventricular hypertrophy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order laboratory tests:

CBC
Troponin
Electrolytes - ↓Na
serum calcium
serum magnesium
BUN, creatinine - ↑
Arterial blood gas
❑ Fasting blood sugar
Liver function tests ❑ BNP or NT-pro BNP (if diagnosis is uncertain)


Other additional laboratory tests:
TSH
Urinalysis
ANA, rheumatoid factor
❑ Diagnostic tests for hemochromatosis, pheochromocytoma
Radionuclide ventriculography or MRI
Coronary angiography
Endomyocardial biopsy

Pulmonary artery catheterization - in respiratory distress or shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indication for admission
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute treatment
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Persistent respiratory distress
 
Cardiogenic shock
 
Treat precipitating causes/co-morbidities
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Assess hemodynamic and volume status
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wet & Cold
 
Dry & Cold
 
 
 
Wet & Warm
 
Dry & Warm
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Monitoring
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Discharge and follow-up
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References