By Steven S. Agabegi, Elizabeth D. Agebegi
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Extra resources for Step-Up to Medicine
Severe pulmonary disease), or when more precise assessment of left ventricular function is desired Cardiac catheterization can provide valuable quantitative information regarding diastolic and systolic dysfunction, and can clarify the cause of CHF if noninvasive test results are equivocal. Consider coronary angiography to exclude CAD as an underlying cause of CHF. Stress testing o Identifies ischemia and/or infarction o Quantitates level of conditioning o Can differentiate cardiac vers us pulmonary etiology of dyspnea o Assesses dynamic responses of HR, heart rhythm, and BP The RALES trial showed that spironolactone reduces morbidity and mortality in patients with class III or IV heart failure.
C a l ci um ch an n el bl oc ke rs a re p re f e rr e d . β - bl oc ker s a re an al t er n a ti ve . I f le f t ven t r ic ul a r s ys to li c d ys f un ct i on is p r es e nt , c o ns id e r d ig o xi n o r a m io d ar o ne . o C a r d io ve r si o n t o s in us rh yt h m ( a f te r ra t e c on t r ol i s a ch i e ved ) E l e ct r ic al ca r di o ve rs i on is p re f e r re d o ve r p h a rm ac o lo gi c c a rd io ve r si o n. U s e ph a rm ac ol o gi c ca r d io ve r s io n o nl y i f e l ec t ri cal ca r di o ve rs i on fa i ls o r i s n o t f e as ib le : Pa r e nt e ra l ib u ti li d e, p ro ca i na mi de , fl e ca in i de , s o ta lo l , o r a m io d ar o ne a re c h oi ce s.
C h r o ni c AF i b o R a t e c o nt r ol wi t h a β - b loc ke r o r ca lc i um c h an ne l b l oc ke r o A n t ic o ag ul a ti o n P a t i en ts wi t h " l on e" A Fi b ( i . e. , A Fi b i n t h e a bs en ce o f u nd e r l yin g h ea r t d i se as e o r ot h e r ca r di o va sc u la r ri sk fa c to r s) u nde r a ge 6 0 d o n ot r eq ui r e a n t ic oa g ul a ti on be ca us e t h e y a re at lo w r i s k f o r em b ol i za ti on ( as pi r in m a y be ap p r op r ia t e ). Tr e a t a ll ot h er p at ie n ts wi t h c h ro n ic a n ti co a gu l ati o n ( wa r f a r i n) .