1- Congestive Heart Failure and Hypertension

failure of the diseased myocardium to deliver cardiac output where demanded by the body or when excessive demands may be placed upon a normal myocardium. The end result is backup of blood into the pulmonary, hepatic, and mesenteric vascular beds

congestive heart failure

5 causes of congestive heart failure

1. hypertension

2. coronary artery disease

3. cardiomyopathy

4. valvular disease

5. congenital heart disease

symptoms of congestive heart failure

fatigue

dyspnea

ortopenea

difficulty breathing after lying down

edema in lungs and feet

weight gain due to fluid retention

distended abdomen (fluid buildup due to backup in hepatic portal)_

difficulty breathing

dyspnea

difficulty breathing lying down

orthopnea

if a patient has congestive heart failure do we need to ocnsult a physician

yes to optimize heart function

if a patient has congestive heart failure we should use the _____ protocol and administer supplemental _____

anxiety

O2

if a patient has congestive heart failure we want to aviod the ____ position

supine

for patients with congestive heart failure we want to limit epi to ____mg

0.04

how do ACE inhibitors help with congestive heart failure

vasodilation and decrease BP

how do ARBs help with congestive heart failure

vasodilation and decreased BP

beta blockers work to ____ HR and ___ BP of patients with congestive heart failure

decrease x2

how does digoxin helo for patients with congestive heart failure

increases heart contractility and slows conduction through AV node

diuretics work to ______ intravascular volume, ____ BP and fluid retention in patients with congestive heart failure

decrease

decrease

how does diet help for patients with CHF

salt restriction, decreases water retention which decreases BP

hypertension is classified as sustain systolic BP > ____ or sustained diastolic BP > ___mghg or both systolic and diastolic measured on at least 2 separate occasions

130

80

range of BP in a normal healthy individual is between ____/___ and ____/____

90/60 and 120/80

below 90/60 is ____ and above 120/80 is ____

hypotension

hypertension

what is the hypertensive crisis BP

systolic >180 or diastolic >120 mghg

If 2 numbers add up to 300 that is bad

hypertensive ____ presents without acute organ damage

urgency

hypertensive _____ involves life threatening complications involving complications such as stroke, acute kidney damage, or aortic dissection - requires early diagnosis and immediate medical management

emergency

severe hypertension may be asymptomatic but some patients experience

headaches

chestpain

irregular heart rhythm

shortness of breath

vision changes

neurological symptoms - confusion, seizures, muscle weakness

normal blood pressure

<120 and <80

elevated blood pressure

120-129

and

<80

high blood pressure/ Stage 1

130-139

or 80-90

high blood pressure/Stage 2

>=140

or >=90

for preoperatuve management of hypertensive patients we need to determine adequacy of ______ and need to review _____

control

medications

are patients supposed to stop or continue hypertensive meds before and after tx

continue

recommend urgent evalulation if >180/120

is mild to moderate hypertension considered a contraindication to oral surgery procedures under local anesthesia

no

what do you need to do for patients with sever hypertension prior to elective surgey

consult their physician

for patients with hypertension we need to avoid IV solutions containing __

Na

it wil increase BP

what should we limit epi to for patients with hypertension

0.04mg

for patients with a Coronary Artery Bypass Gradft (CABG) do we need to delay elective surgery?

yes - delay 1 month -similar to post MI patients

if emergent surgery is need for a patient with a CABG what should be done

consult physician

is antibiotic prophylaxis necessary for patients with CABG

no