Intern Report 10/6 – New Onset Heart Failure

Teaching Pearls:

  • MKSAP Board Review Question – Thrombotic Thrombocytopenic Purpura (TTP) pentad: thrombocytopenia, microangiopathic hemolytic anemia (presence of schistocytes), renal failure, fever, neurological deficits.
    • Need only thrombocytopenia and MAHA (presence of schistocytes) for diagnosis.
    • Hematologic emergency. Treatment with plasmapheresis.
  • Left ventricular thrombus occurs in up to 10% of patients with post-MI and EF<30%.
    • Due to combination effects of blood stasis and replacement of endothelium with fibrotic tissue.
    • Diagnosis: Echocardiogram with Definity study
    • Treatment involves anticoagulation for 3-6 months
  • Etiologies of Heart Failure
    • Ischemic
    • Hypertensive heart disease
    • Valvular disease
    • Toxin/drug-induced
    • Medication-induced
    • Infiltrative disease
    • Infectious etiologies
    • Stress cardiomyopathy
    • Idiopathic
  • Presence of low voltage on EKG suggestive of tissue, air, or fluid surrounding the heart. Ex: obesity, pericardial effusion, etc.
  • Isolated Q wave can be present in lead III in a normal heart.
  • NT pro-BNP is primarily used as a helpful adjunct in distinguishing between heart failure and other etiologies of dyspnea. However if your patient clearly is coming in with symptoms of heart failure, it is not necessary to order it.
  • FREEDOM Trial
    • In patients with 3V disease, left main disease, and 2V disease with DM, CABG has demonstrated better clinical outcomes in CV mortality and MI compared to PCI.
    • Increased risk of stroke seen with CABG vs PCI.

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