Overview
Scleroderma Renal Crisis
- Diagnosis: New-onset accelerated HTN or oliguric kidney failure in systemic sclerosis.
- Labs: Worsening proteinuria, elevated creatinine.
- Treatment: High-dose ACE inhibitors (e.g., captopril) even with elevated creatinine. ICU admission if end-organ damage.
Constrictive Pericarditis
- Signs: Right-sided heart failure (elevated JVP, ascites, hepatomegaly), Kussmaul sign, history of chest radiation.
- Treatment: Diuretics initially, pericardiectomy for refractory cases.
Heart Failure with Reduced Ejection Fraction (HFrEF)
- Key Medications (GDMT):
- ARNIs > ACE/ARBs
- Beta-blockers
- Mineralocorticoid receptor antagonists (e.g., spironolactone)
- SGLT2 inhibitors.
- Add-on: Hydralazine + nitrate if ARNI/ACE/ARB is contraindicated.
Cardiac Tamponade
- Signs: Hypotension, elevated JVP, muffled heart sounds.
- Next Step: Echocardiogram for diagnosis; treat with IV fluids and pericardiocentesis.
Acute Pericarditis
- EKG Findings: Diffuse ST elevation (concave), PR depression.
- Treatment: NSAIDs + colchicine (preferred over monotherapy). Steroids only for severe/refractory cases.
Pulmonary Embolism with Hemodynamic Instability
- Definition: SBP < 90 for >15 min or shock.
- Treatment: Thrombolytics, followed by anticoagulation.
Post-Cardiac Injury Syndrome (Dressler’s)
- Signs: Chest pain, fever post-MI or surgery.
- Treatment: High-dose aspirin + colchicine.
Coarctation of Aorta
- Signs: BP discrepancy (high in arms, low in legs), pulse differences.
- Workup: BP in 4 extremities; genetic testing for Turner syndrome.
Antibiotic Prophylaxis for Dental Work
- Indications:
- Prosthetic valves.
- History of infective endocarditis.
- Repaired congenital heart disease with residual shunt.
- Cardiac transplant with valve abnormalities.
- Drug: Amoxicillin 2 g (or azithromycin for penicillin allergy).
Targeted Temperature Management (TTM)
- Post-VF/VT Arrest: Maintain normothermia or hypothermia (no significant difference per recent studies).