ccs case........chf with mitral regurgitation, how - amidoc78

[ArchivalUser]

please advise

[ArchivalUser]

try to figure out CHF is due to MR or vice versa

[ArchivalUser]

Again stable or unstable
where is the pt outpt or er
Symptom acute or chronic or subacute
young or elderly
stable can do all workup as outpt
unstable wards or ICU
young for mitral repair
ef for AICD placement
next time take your time give all the information will go from there

[ArchivalUser]

Hey FOKNANPOINT as far as i remember the case was in ER with a 60 year old women coming with SOB and on examination u see the findings of CHF.
Can u explain from this point how will u proceed for a case of CHF n MR.
and will it be any different approach if a same case comes with some young patient in 30s or 40s.
Thanks

[ArchivalUser]

hey foknanpoint r u there

[ArchivalUser]

can anyone give their input on this case.
i mean what all steps need to be taken

[ArchivalUser]

sorry i left for a while. chronic acute it's matter, age matter as i told you before. usually acute onset chf is uncommun unless MI or Afib otherwise is New onset sx when you echo it s already ef 35-40 regardless. pt was in ED with sob with stable vs or unstable vs. if unstable you have to do abc first before physical so your order will be IV access, cardiac monitor/check, pulse oxymeter and oxygen/ chest pain or not with stable bp or high BP give nitroglycerin don't give ASA you don'y know if it s chf yet can be pneumonia, pneumothorax, pe, etc... now you do your physical then you find out is CHF now you can give morphinedoes pt need to go ICU remember that for CHF BADHANDS beta blocker, ACE, duiretic, hydralazine, nitrate, digoxin, spironolactone base on which class of CHF, but in CCS avoid Digoxin just in case you have pulmonary edemais contraindicated now your chest x ray lab, cbc, basic or comp, ekg, cardiac enzyme Q8, BNP, echo, if pulmonary edema ICU. if stable wards. remember your inpt order bed rest, input output, telebed, npo or low salt, low fat, diabetic diet, pneumatic compression/ or dvt prophylaxis, plus all you med you treat the underlying disease in this MR cardiology consult for repair if low EF you consult EPS for AICD placement you will not have time to do all time make sure you do you basic that's why age its inportant. for what king of valve if it is porcine or prosthet....
I will be available in January in you want we can go over CCS magaliemilord78

[ArchivalUser]

thank u very much foknanpoint.
that was a great help.
thanks again for the January thing but i will b through till that time