Cardiopulm diseases

Question 1

Overview of Cardiopul diseases

Answer 1

Question 2

Hypertrophic cardiomyopathy

Answer 2

Findings:
Hypertrophied ventricles- not dilated
Mitral regurg, LVOutflow Obstruction, A/Mitral valve dysfunction, impaired diastolic function
*Goals tx:
1. Decreased inotropy
2. Improve diastolic fxn
3. less outflow obstruction
TX:
INOTROP1. BB- initial therapy-> for dyspnea, angina, and arrhythmias
INOTROP2. Calcium channel blockers (Verapamil)-> rate slowing, improved diastolic dysfunction

AVOID- BETA AGONISTS, DIGOXIN, EXCESSIVE DIURESIS

Question 3

Restrictive Cardiomyopathy

Answer 3

Findings: (disease of myocardium-> restricted vent filling)
Stiff ventricles w/ diastolic > systolic
fatigue, dyspnea, peripheral edema, 2ndary to other diseases
(Amyloidosis common, sarcoidosis, glycogen storage diseases, hemochromatosis)
TX:
**1. Diuretics-> pulmonary + systemic congestion-> must balance w/ decreased preload and decreased CO (FOR SWELLING)
**2. Beta blockers- slow HR-> increase diastolic filling time-> improve filling
**3. Calcium channel blocker-> improves myocardial relax and increase diastolic filling time
anticoag not rec

Question 4

Dilated cardiomyopathy

Answer 4

Typical findings: STRETCHED OUT VENTRICLES
very similar to Heart Failure
TX: Control BP and contributing factors
ALL PTS SHOULD BE ON BETA BLOCKER AND ACE INHIBITOR
if no improvement: + Aldosterone antagonists and/or ARNI
hydralazine/nitrate for AA due to question of NO utilization
CCB only if needed for rate control -> Afib or flutter

Question 5

Inflammatory Pericarditis

Answer 5

Typical finding: ** pericardial chest pain, pericardial friction rub
new widespread STElevation or PR depression, pericardial effusion
Diagnostics: EKG = ST elevation then return to baseline, PR depression
TX:
1. tx any infectious causes - tb or bacterial
**2. Aspirin or ibuprofen= for inflammation + Gastroprotection (PPI)
**3. Add colchicine if refractory to tx or recurrent disease

Athletes-> restrict exercise until resolution of symptoms and normal labs
immunosuppression for refractory/recurrent

Dressler syndrome= post MI pericarditis-> aspirin and colcicine

Question 6

Constrictive pericarditis

Answer 6

Scarring and loos of elasticity of pericardial sac
RF: purulent bacterial pericarditis (highest), **radiation therapy, immune or neoplastic pericarditis, post cardiac surgery, viral or idiopathic
Typical findings: **slowly progressive dyspnea, fatigue, weakness, chronic edema, hepatic congestion, ascites **
TX: tx underlying etiology initially
Aggressive diuresis (flush water)
**1. Loop diuretics (oral torsemide or butanide)
**2. Thiazides
**3. Aldosterone antagonists

Question 7

Constrictive vs restrictive

Answer 7

Question 8

Pulmonary Hypertension overview

Answer 8

Definition: MAP of 25 or more with a Pulmonary capillary wedge pressure of less than 16
Typical findings:
Early sxs: exertional dyspnea, chest pain, fatigue, lightheaded
Delayed sxs: syncope, abdominal distention, ascites, periph edema, enlarged pulm arteries on cxray, ECHO can b diagnostic
Patho:
Increased production of VConstric compounds + decreased production of VD compounds

Question 9

Pulmonary hypertension groups and tx

Answer 9

Group 1- Pulmonary arterial htn related to pum vasculopathy:
idiopathic, genetics, drugs/toxins= meth/amphetamines, cocaine, Connective tissue diseases: scleroderma, HIV, cirrhosis, congen heart disease-»» Calcium channel blockers
Group 2- Left heart disease (systolic or diastolic dysfunction)
Group 3- parenchymal disease, impaired control of breathing or high altitudes= COPD, interstitial lung disease, sleep apnea
Group 4- Chronic thromboembolic diseases
Group 5- Multifactorial cases
hematologic- myeloproliferative, splenectomy
systemic: sarcoidosis, pulm langerhaan cell histiocytosis
Metabolic: glycogen storage disease, thyroid disorders

Question 10

Pulmonary htn agents

Answer 10

1. Monotherapies-> Vasodilation -> Ambrisentan (Letairis) and Riociquat (Adempas)
2. Diuretics-> RSHF-» Loop diuretics- torsemide plus pironolactone DONT OVER DIURESE
3. Oxygen-> to maintain O2 above 90%

Question 11

Pulmonary htn agents

Answer 11

1. Monotherapies-> Vasodilation -> Ambrisentan (Letairis) and Riociquat (Adempas)
2. Diuretics-> RSHF-» Loop diuretics- torsemide plus pironolactone DONT OVER DIURESE
3. Oxygen-> to maintain O2 above 90%

Question 12

Pulm htn tx- Riociguat (Adempas)

Answer 12

Indications: ** Group 1 or Group 4- thromboembolic pulm htn**
MOA: thru messenger (cGMP) to increase NO effectiveness_> VASODILATION
Contraindication: Pregnancy
Monitoring: hypovolemic or hypotensive
AE: Bleeding, pulm edema, many drug interactions

Question 13

Pulm htn- Ambrisentan (Letairis)

Answer 13

Indications: Group 1 pulm arterial htn
MOA: **Blocks endothelin receptors (vasoconstriction)
contraindications: pregnancy
Monitoring: prego test b4, monthly during tx, and 1 month after tx
hemoglobin and hematocrit @ baseline, 1 month, and periodically
AE: peripheral edema, headache, anemia, nasal congestion, flushing, sinusitis

Question 14

Cor Pulmonale

Answer 14

Overview: RV systolic and diastolic failure from pulm disease and hypoxia or vas disease= mc is pulm htn

Findings: Chronic productive cough, exertional dyspnea, wheezing respirations, easily fatigued, dependent edema RUQ pain, cyanosis, clubbing, distended neck veins

Diagnostic studies:
EKG: peaked P waves, RVH w/ RAD
CXR: RVH, increased pulm artery opacity

TX:
**1. Oxygen
2. Salt and fluid restriction
3. Combo diuretic therapy **