0071643192.pdf

TREATMENT

■ Lifestyle modification
■ Treat underlying etiology when possible.
■ Aggressive blood pressure and heart rate control (key component in isolated
diastolic dysfunction)
■ ACE inhibitors
■ ↓Mortality and hospitalizations
■ Beneficial effects on LV remodeling
■ Complications include cough, angioedema, and renal failure.
■ Angiotensin receptor blockers
■ If ACE inhibitor not tolerated
■ Hydralazine with nitrates
■ If ACE inhibitors not tolerated
■ -Blockers
■ ↓Mortality and improves symptoms
■ Allows for filling time in diastolic dysfunction
■ Donotstart during acute decompensation of systolic function.
■ Diuretics
■ For patients with evidence of fluid retention
■ Digoxin
■ For refractory cases of systolic dysfunction
■ If class IV symptoms:
■ Spironolactone
■ Mechanical assist device
■ Heart transplant
■ Inotrope infusion

PERICARDIAL DISEASE

Pericarditis

The pericardium may become inflamed for a variety of reasons. The resulting
clinical presentation is sometimes confused with acute myocardial infarction.
Thevast majorityof cases are idiopathic. Identified causes include:

■ Infectious
■ Viral (eg, coxsackie, adenovirus)
■ Bacterial: Less common
■ TB
■ Fungal
■ Parasitic
■ Rickettsia

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CARDIOVASCULAR

EMERGENCIES

TABLE 2.12. NYHA Functional Classification for Chronic Heart Failure

CLASS FUNCTIONALABILITY

Class I (Mild) No limitation of ordinary physical activity

Class II (Mild) Mild dyspnea, fatigue, or palpitations with ordinary physical activity

Class III (Moderate) Symptoms with less than ordinary physical activity

Class IV (Severe) Marked symptoms at rest