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Healthy Hearts: Promoting Potency, Preventing Predicaments, Perplexing Presenting Problems

Healthy Hearts: Promoting Potency, Preventing Predicaments, Perplexing Presenting Problems. 32 nd Annual Nicholas J. Thompson Women ’ s Health Conference April 18, 2012. Richard Pretorius, MD, MPH Professor of Family Medicine Professor of Geriatrics Assistant Dean for Quality & Primary Care

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Healthy Hearts: Promoting Potency, Preventing Predicaments, Perplexing Presenting Problems

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  1. Healthy Hearts: Promoting Potency, Preventing Predicaments, Perplexing Presenting Problems 32nd Annual Nicholas J. Thompson Women’s Health ConferenceApril 18, 2012 Richard Pretorius, MD, MPH Professor of Family Medicine Professor of Geriatrics Assistant Dean for Quality & Primary Care Research

  2. The heart is a dynamic organ that is always in motion. There are four components of the heart that must work in synergy: a) the pump b) the plumbing c) the wiring d) the gates We will explore how healthy physiology in women can prevent undesired pathology.

  3. Outline • Introduction • A case based approach • Principles of cardiovascular health • Summary

  4. Learning Objectives • To understand the relationship between the 4 components of the heart. • To distinguish accurately between normal physiology and acute and chronic dysfunction. • To understand the interaction of the CV system with other systems (renal, hepatic, etc). • To appreciate the heart as a dynamic organ that is always changing. • To use sound clinical reasoning to solve clinical dilemmas.

  5. Case-Based Learning • Real cases will be used to illustrate important learning principles. • While not all cases may occur in the daily practice of the participants, the learning principles will apply.

  6. Note to participant • Review the following 5 cases and think about the answers to the questions. • At the symposium they will be used to generate discussion, followed by a review of the literature, and a summary of key principles. • A more detailed PowerPoint will be made available at the symposium.

  7. CASE #1 • A 20 yo primip at 32 wks gestation has a BMI 55 has gained 15 lbs in the past 4 wks and 50 lbs for the pregnancy. You admit her with a P.O. 88% on RA that improves to 95% on 4 l/min NC. CxR shows pul edema with small b/l pleural effusions. Labs show uric acid 5.2, BUN/creat 20/0.8, 350 mg protein in 24 hr urine.

  8. CASE #1: question In this pt, a diuretic: • Would improve the pt’s clinical status. • Would worsen the patient’s clinical status. • Is not relevant to the optimum therapeutic choices.

  9. CASE #1: another question In this pt: A. The intravascular space is contracted. B. The intravascular space is expanded. C. The renal endothelium has been injured. D. Two of the above. E. None of the above.

  10. CASE #2 • A 64 yo female with h/o metabolic syndrome and a coronary stent x 1 placed a yr early had c/o fatigue & diaphoresis for 30 min after planting rose bushes for an hr. • There was no CP, SOB, nausea. • A routine exercise stress test 6 days earlier was neg.

  11. CASE #2: questions • What do you think is going on? • What is your plan?

  12. CASE # 3 • A 91 yo female who has not seen a physician in 30 yrs comes to your office with a 2 month h/o fatigue & dyspnea and now cannot walk 10 feet without SOB. • PE shows 2+ LE edema, 2+ presacral edema, abd dullness 1/3 up flanks & thoracic dullness 2/3 up. • EKG shows a fib, otherwise neg, no evidence ischemia, infarct, atrial or ventr enlargement.

  13. CASE #3: question This patient has: A. Stage A heart failure. B. Stage B heart failure. C. Stage C heart failure. D. Stage D heart failure.

  14. CASE #4 • A 54 yo postmenopausal female has awoken at 3 AM twice in the past 3 months with anxiety & SOB that subsided after 20 minutes. At the E.D. both times, ALT was in the low 100s and AST in the mid 100s as the only abnl finding. • All labs were normal when tested elsewhere. Evaluations by cardiologist and gastroenterologist were neg.

  15. CASE #4: question At this juncture, you would: A. Refer the pt to a psychologist to evaluate for a possible panic attack. B. Refer the to a rheumatologist for a possible connective tissue disorder. C. Reassure the pt that 4 evaluations have been negative. D. Send the patient back to the cardiologist.

  16. CASE #5 • A 72 yo longstanding pt of yours is admitted to the hospital with evidence of an IWMI that occurred 2 days ago. The cardiologist recommends a cath and CABG or PTCA as indicated. The pt prefers medical management and asks your opinion.

  17. CASE #5: question You would: A. Explain the rationale for possible revascularization. B. Review the pros and cons of the various options. C. Arrangement for medical management.

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