Dyspnea

Question 1

**Medications for Dyspnea **

• Anti-platelet effect (block TX)
• CAD, hypercholesterolemia
• Vasodilation, reverse remodeling of LVH

Answer 1

• Aspirin - anti-platelet effect (block TX)
• Atorvastatin - CAD, hypercholesterolemia
• Ramipril - vasodilation, reverse remodeling of LVH

Question 2

Causes of Dyspnea

• Pulmonary
• Neuro/MSK
• Hematologic
• Toxic/Metabolic
• Cardiac
• Upper airway

Answer 2

• Pulmonary
  
  • COPD or asthma
  • Infection
  • Pneumothorax
  • Contusion, hemorrhage
• Neuro/MSK
  
  • ALS, myasthenia gravis
  • Rib fracture
  • Chest or spine deformity
• Hematologic
  
  • Anemia
  • Pulmonary embolism
• Toxic/Metabolic
  
  • Metabolic acidosis
  • Poisonings (CO, salicylate)
• Cardiac
  
  • Heart failure
  • MI
  • Arrhythmia
  • Valvular disorder
  • Cardiac tamponade
• **Upper airway **
  
  • Angioedema
  • Anaphylaxis
  • Pharyngeal infections
  • Deep neck infections
  • Foreign body

Question 3

**Causes of Heart Failure **

• Preserved EF
• Reduced EF
• Pulmonary/Vascular
• High output failure
• Other primary cardiac causes

Answer 3

• Preserved EF
  
  • HTN
  • Aging
  • Restrictive CM
  • Infiltrative
• Reduced EF
  
  • CAD/MI
  • HTN
  • Toxins
  • Viral
  • Idiopathic
• Pulmonary/Vascular
  
  • Cor pulmonale
  • AV malformation
• High output failure
  
  • Anemia
  • Thyrotoxicosis
• **Other primary cardiac causes **
  
  • Congenital lesions
  • Valvular disease
  • Arrhythmias
  • Idiopathic

Question 4

Causes of Atrial Fibrillation

Answer 4

• Advancing age
• **CV causes & risk factors **
  
  • HTN
  • CAD
  • Rheumatic heart disease
  • Non-rheumatic valvular heart disease
  • Cardiomyopathy
• **Other causes **
  
  • Thyrotoxicosis
  • Obstructive sleep apnea
  • Alcohol
  • Acute stressors

Question 5

Goals of Treatment: Atrial Fibrillation

Answer 5

• Control rate
• Convert to sinus rhythm
• Prevent stroke
• Improve symptoms
• Prevent/improve CHF

Question 6

New Medications

• Rate control of atrial fibrillation, anti-HTN
• Oral anticoagulant
• Treatment of peripheral or pulmonary edema

Answer 6

• Diltiazem - rate control of atrial fibrillation, anti-HTN
• Warfarin - oral anticoagulant
• Furosemide - treatment of peripheral or pulmonary edema

Question 7

3 Cardinal Features of Severe Aortic Stenosis

Answer 7

• Congestive heart failure
• Syncope
• Anginal/exertional chest pain

Question 8

Preferred treatment for severe aortic stenosis

Answer 8

Valvuloplasty (surgical replacement)

Question 9

Clinical Features of PE

Answer 9

• Dyspnea, sudden onset
• Hemoptysis
• Wheezes
• Fever

Question 10

What are the 3 major scoring systems for PE?

Answer 10

• Wells
• Geneva
• PERC rule

Question 11

Which of the following medications is most likely to provide immediate symptom relief of dyspnea?

• IV Nitroprusside
• IV Furosemide
• IV Hydrochlorothiazide
• IV Digitalis
• IV Hydralazine
• IV Captopril

Answer 11

IV Furosemide

• Heart Failure
  
  • Excessive salt & water retention
  • Inappropriate volume expansion of vascular & extravascular space
• Powerful loop diuretic
• Excretion of 25% of filtered Na+ load through inhibition of Na⁺/2Cl^-/K⁺ co-transporter (thick ascending limb of LOH)
• Impairs generation of hypertonic interstitium

Question 12

What is the mechanism of action of diltiazem?

What is the most likely major benefit of diltiazem in a patient with atrial fibrillation?

Answer 12

• Selective blockade of L-type cardiac Ca²⁺ channels
• Decrease in HR

Question 13

Orthostatic hypotension is a common side effect of ______ and ______.

May be a sign of __________.

Answer 13

ß-blockers, vasodilators

hypovolemia