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Common Congenital Heart Lesions - page 92 / 126

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92 / 126

92 of 126

together) or cardiac transplant (indicated for patients with severe LV dysfunction whose condition is refractory to medical treatment)

Acute Pulmonary Edema

Etiology: Acute, left sided failure results from an MI or from a precipitating event in a patient with chronic compensated congestive heart failure

Pathophysiology: Acute, severe left sided heart failure causes elevated capillary hydrostatic pressure, rapid accumulation of fluid in the lungs

Clinical Presentation: Severe dyspnea and anxiety

Physical Findings: hypoxemia, cold, clammy skin, tachypnea, coughing up “frothy” sputum, rales, wheezing

Treatment: eliminate underlying cause and think “LMNOP”

L: Lasix (furosemide): fast-acting diuretic preload and pulm capillary pressure M: Morphine: reduces anxiety and venous dilation (pooling of blood in periphery) N: Nitrates: reduces preload O: Oxygen: via face-mask P: Position: patient should be seated upright to allow pooling of blood in lower body,

decreasing venous return to the heart

Objectives:

  • 1.

    Identify the pathophysiologic mechanisms of clinical symptoms in heart failure (pages 3-8)

  • 2.

    Develop a rationale initial medical regimen for a patient with heart failure based on underlying pathophysiology (pages 9-10)

  • 3.

    Recognize clinical indications for device therapy and surgical intervention (bottom of page 11, top of page 12)

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