Essential Facts on the Go: Internal Medicine by Lauren Stern, Vijay Lapsia Page B

hypertension
– With pulmonary hypertension
Slitlike
Extracardiac Sounds Simulating Systolic Heart Murmurs
• Subclavian (supraclavicular/brachiocephalic) murmur
• Internal mammary soufflé
• Cartoid artery bruits
• Coarctation of the aorta
• Murmurs emanating from a dilated aortic or pulmonary artery root
• Patent ductus arteriosus with pulmonary hypertension

1_5_b Heart Murmurs

    Diastolic Murmurs
Aortic Regurgitation
Pulmonary Valve Regurgitation
Mitral Rumble
• Obstruction to flow
Mitral stenosis (rheumatic, congenital)
Left atrial myxoma
Cor triatriatum
Localized pericardial constriction
• Increased flow
Mitral regurgitation
Ventricular septal defect
Patent ductus arteriosus
Complete heart block
Tricuspid Rumble
• Obstruction to flow
Tricuspid stenosis (rheumatic, Ebstein’s anomaly, carinoid)
Right atrial myxoma
Localized pericardial constriction
• Increased flow
Atrial septal defect
Tricuspid regurgitation

I_6_a Ischemic Heart Disease
    Classification
    New York Heart Association Functional Classification
I Patients have cardiac disease but without the resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.
II Patients have cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.
III Patients have cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.
IV Patients have cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.
    Algorithm for Risk Stratification and Treatment

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_6_b Ischemic Heart Disease
    The TIMI Risk Score for Unstable Angina/NSTEMI*

    LDL Cholesterol Goals and Cutpoints for Therapeutic Lifestyle Changes (TLC) and Drug Therapy in Different Risk Categories

    * Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_7_a Ischemic Heart Disease: Evaluation

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_7_b Ischemic Heart Disease: Management

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed. McGraw-Hill, 2012.

I_8_a Heart Failure
    Common Types of Heart Failure

I_8_b Heart Failure
Diagnostic Criteria of Heart Failure in the Framingham Heart Study

Causes and Risk Factors for Heart Failure

AHA/ACC Stages of Heart Faiure

I_9_a Treatment of Heart Failure

    Approach to Patients with Acutely Decompensated Heart Failure

I_9_b Treatment of Heart Failure
    Diuretics Used in the Management of Heart Failure

    Angiotensin-Converting Enzyme Inhibitors in Heart Failure

    Indications for Digoxin in Heart Failure
• Symptomatic patients on an ACE inhibitor (or ARB), β-blocker, and diuretic.
• Recurrent hospitalization with decompensation.

I_10_a Hypertension
    Classification and Management of Blood Pressure for Adults

    DBP, diastolic blood pressure; SBP, systolic blood pressure.
Drug abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor blocker; BB, beta-blocker; CCB, calcium channel blocker.
    Cardiovascular Risk Factors

I_10_b Hypertension
    Etiology of Hypertension

    Guideline for Compelling Indications for Individual Drug Classes

PULMONARY

II_1_a Diagnostic Algorithm of Pleural Effusion

    Reproduced with permission from Longo DL, et al. Harrison’s Principles of Internal Medicine , 18th ed.