Internal Medicine Eor Review.| Verified Solution

INTERNAL MEDICINE EOR REVIEW. Cardiovascular (20) Congestive Heart Failure: ▪ Info: Acute decompensated heart failure with worsening of baseline symptoms characterized by pulmonary congestion (worsening of dyspnea, rales, pink frothy sputum, etc); sympathetic activation or CXR findings of congestion ▪ Dx: CXR: Cephalization of Flow- Increased vascular flow to the apices as a result of increased pulmonary venous pressure; Kerley B Lines- short linear markings at the lung periphery of lower lung fields ▪ Tx: LMNOP: L-Lasix, M-Morphine, N-Nitrates, O-Oxygen, P-Position (place upright to decrease venous return) Hypertension: ▪ Primary (Essential): (95%) Hypertension due to idiopathic etiology ▪ Secondary: Hypertension due to an underlying, identifiable, and often correctable cause, suspect secondary HTN if patient is refractory to antihypertensives or severe BP ▪ Pathogenesis: Increased sympathetic activity, increased angiotensin II activity and mineralocorticoid excess, increased mineralocorticoid activity (Na and water retention) ▪ Tx: Goal 140/90 mmHg; if diabetic or chronic renal disease, goal is 130/80 mmHg • -Diuretics: Indications- Treatment of choice as initial therapy in uncomplicated HTN; CI- Renal failure/hyponatremia • -ACE-Inhibitors: Indications- HTN (especially if DM, nephropathy, CHF, or MI); CI-pregnancy • -Angiotensin II Receptor Blockers (ARBs): Indications- Consider in patients not able to tolerate beta- blockers/ACE-I or use in addition to ACE-I; CI-pregnancy • -CCB’s: Indications- HTN, angina, or Raynaud’s; CI- Patients taking Beta-Blockers, CHF, 2nd/3rd degree heart blocks • -Beta-Blockers: Indications: HTN (especially if history of MI/tachycardia), angina (stable and unstable), acute MI, HF (systolic or diastolic), pheochromocytoma, migraines, essential tremor; CI- 2nd/3rd heart block, decompensated heart failure, asthma/COPD, may worsen peripheral vascular disease/Raynaud’s phenomenon • -Alpha-1 Blockers: Indications- Drug of choice in patients with HTN and BPH