tailieunhanh - Critical care medicine - part 3

Bệnh nhân với một ECG nondiagnostic có một không xác định hoặc có nguy cơ thấp của MI sẽ nhận được aspirin trong khi trải qua các nghiên cứu về enzyme nối tiếp tim và ECG lặp lại. B. Treadmill kiểm tra căng thẳng nên được xem xét cho các bệnh nhân có nghi ngờ thiếu máu cục bộ động mạch vành. | A. Patients with a nondiagnostic ECG who have an indeterminate or a low risk of MI should receive aspirin while undergoing serial cardiac enzyme studies and repeat ECGs. B. Treadmill stress testing should be considered for patients with a suspicion of coronary ischemia. Heart Failure Congestive heart failure CHF is defined as the inability of the heart to meet the metabolic and nutritional demands of the body. Approximately 75 of patients with heart failure are older than 65-70 years of age. Approximately 8 of patients between the ages of 75 and 86 have heart failure. I. Etiology A. The most common causes of CHF are coronary artery disease hypertension and alcoholic cardiomyopathy. Valvular diseases such as aortic stenosis and mitral regurgitation are also common. B. Coronary artery disease is the etiology of heart failure in two-thirds of patients with left ventricular dysfunction. Heart failure should be presumed to be of ischemic origin until proven otherwise. II. Clinical presentation A. Left heart failure produces dyspnea and fatigue. Right heart failure leads to lower extremity edema ascites congestive hepatomegaly and jugular venous distension. Symptoms of pulmonary congestion include dyspnea orthopnea and paroxysmal nocturnal dyspnea. Clinical impairment is caused by left ventricular systolic dysfunction ejection fraction of less than 40 in 80-90 of patients with CHF. B. Patients should be evaluated for coronary artery disease hypertension and valvular dysfunction. Use of alcohol chemotherapeutic agents daunorubicin negative inotropic agents and symptoms of a recent viral syndrome should be assessed. C. CHF can present with shortness of breath dyspnea on exertion paroxysmal nocturnal dyspnea orthopnea nocturia and cough. Exertional dyspnea is extremely common in patients with heart failure. Myocardial ischemia or infarction Atrial fibrillation Worsening valvular disease Pulmonary embolism Hypoxia Severe uncontrolled hypertension Thyroid disease Pregnancy .