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Cardiology > 21.8.2013(acute Heart Failure) > Flashcards

21.8.2013(acute Heart Failure) Flashcards

0
Q

Atrial and ventricular arrythmias are present in ______ % of DCM pts

A

50

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1
Q

Mechanical ventilation in pulmonary Edema

A

Inability to maintain oxygenation by non invasive ventilation
Coexisting Hypercapnia

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2
Q

Diagnosis of DCM is confirmed by

A

Echo

Radionuclide ventriculography

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3
Q

Anti coagulation in DCM patients

A

H/O thromboembolic events
AF
Evidence of LV thrombus

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4
Q

Vaccinations recommended in DCM

A

Influenza

Pneumococci

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5
Q

Diastolic heart failure is common in

A

Elderly women

Most of whom have HT and DM

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6
Q

Myocardial disorders associated with diastolic heart failure

A

RCM
obstructive and non obstructive HCM
Infiltrative cardiomyopathies
Constrictive pericarditis

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7
Q

Most common inherited heart defect

A

HCM

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8
Q

LV obstruction in HCM is enhanced by

A

Increased contractility

Decreased ventricular volume

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9
Q

Components of HOCM

A

Assymmetric septal hypertrophy

Systolic anterior motion of mitral leaflet leading to MR and outflow obstruction

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10
Q

SCD in HCM is common in

A

10-35yrs

Occurs during strenuous exertion

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11
Q

Physical exam findings in HCM

A

Pulsus bisferiens
Forceful double or triple apical impulse
Systolic outflow murmur along left sternal border accentuated by manuevers that decrease ventricular preload

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12
Q

Rx of HCM

A

Beta blockers

Verapamil,diltiazem

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13
Q

SVT s are poorly tolerated in

A

HOCM

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14
Q

ICD placement in HCM pts,risk factors

A

Genetic mutations associated with SCD
Sustained ventricular tachyarrythmias
H/O syncope or near syncope recurrent or exertional in young pts
Multiple non sustained episodes of VT
Hypotensive response to exercise
LV hypertrophy with wall thickness of 30mm
H/o SCD in relatives

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15
Q

Surgical management of HCM

A

Septal myotomy-myectomy

Alcohol septal ablation

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16
Q

Restrictive cardiomyopathy must be differentiated from

A

Constrictive pericarditis

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17
Q

Causes of restrictive cardiomyopathy

A 
Amyloidosis
Sarcoidosis
Hunter,hurler
Hemochromatosis 
Hypereosinophilic syndrome
Carcinoid heart disease
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18
Q

ECG finding in amyloidosis induced restrictive cardiomyopathy

A

Low voltage QRS complexes

Poor R wave progression

19
Q

Cardiac catheterisation findings in restrictive cardiomyopathy

A

Dip and plateau pattern in RV and LV pressure tracing

20
Q

Drug to be avoided in cardiac amyloidosis

A

Digoxin

21
Q

ECG finding in cardiac sarcoidosis

A

Conduction block

22
Q

Peripartum cardiomyopathy

A

LV systolic dysfunction diagnosed in last month of pregnancy upto 6 months post partum

23
Q

Causes of Peripartum cardiomyopathy

A

Viral triggers- cox sackie,parvovirus,adeno,herpes
Fetal microchimerism
Prolactin cleavage product

24
Q

Risk factors for PPCM

A 
Advanced maternal age
Multiparity
Multiple pregnancy
Preeclampsia
Gestational hypertension
25
Q

Warning signs that PPCM may be present

A 
Cough
Orthopnea
PND
displaced apical impulse
New MR murmur
26
Q

Rx of PPCM

A

ACE inhibitors in postpartum,Hydralzine in pregnant
Beta1 selective blockers(atenolol,metoprolol)
Digoxin
Diuretics

27
Q

Causes of constrictive pericarditis

A 
TB
idiopathic
Viral pericarditis
Post cardiotomy
Chest irradiation
Autoimmune connective tissue disease
ESRD
Malignancy(breast,lung,lymphoma)
28
Q

Key pathophysiologic feature in constrictive pericarditis

A

Equalisation of pressure in all four chambers

29
Q

Physical findings specific for constrictive pericarditis

A

Pericardial knock(loud S3)
Kussmaul sign
elevated JVP with prominent y descent

30
Q

Features of constrictive pericarditis differentiating it from restrictive cardiomyopathy

A

Ventricular interdependence
Pericardial thickening,calcification,adherence
Preserved or increased tissue Doppler velocities on ECHO
Pulmonary hypertension mild or absent
Septal bounce
Equalisation of pressure seen in all cardiac chambers
RVEDP/RVSP>1/3
BNP low or mildly elevated

31
Q

ECHO features of constrictive pericarditis

A

Thickened echogenic pericardium
Tethering of pericardium to myocardium
Dilated,incompressible IVC
Septal bounce
Inspiratory variation in mitral flow velocity curves
Expiratory reversal of hepatic vein flow
Preserved or increased tissue Doppler velocities of the mitral annulus

32
Q

Drugs to be avoided in constrictive pericarditis

A

Beta blockers and CCB

Pts have resting tachycardia to compensate for reduced stroke volume

33
Q

Causes of cardiac tamponade

A 
More likely:
 Idiopathic pericarditis
 Infection(bacterial,fungal,viral)
 Neoplasms
Post cardiotomy
Autoimmune connective tissue disorders
Uremia
Trauma
Radiation
MI(Subacute)
Drugs(Hydralzine,procainamide,isoniazid,phenytoin)
Hypothyroidism
34
Q

Beck triad

A

Hypotension
Elevated JVP
muffled heart sounds

35
Q

Pts with cardiac tamponade feel more comfortable

A

Sitting forward

36
Q

ECG features of cardiac tamponade

A

Low voltage
Tachycardia
Electrical alternans

37
Q

Features suggestive of hemodynamically significant effusion

A

Dilated,incompressible IVC
Significant respiratory variation of tricuspid and mitral inflow velocities
Early diastolic collapse of right ventricle and right atrium
Circumferential effusion

38
Q

Role of TEE in pericardial effusion

A

Loculated effusion,especially that which develops at atrial level after cardiac surgery

39
Q

Rx for cardiac tamponade

A

Maintain adequate filling pressures with IV fluids
Avoid diuretics,nitrates or other preload reducing drugs
Avoid efforts to slow sinus tachycardia

40
Q

Causes of MS

A 
Rheumatic
SLE
RA
Congenital
Substantial mitral annular calcification
Mitral valve prosthesis dysfunction
Oversewn or small mitral valve annuloplasty ring
Functional MS
 Myxoma
 LA thrombus
 IE vegetation
 Cor triatrium
41
Q

MS is aggravated by(pathophysiology)

A

Increase in trans valvular flow(increased cardiac output)

Decrease diastolic filling time(tachycardia)

42
Q

MS is aggravated by(conditions)

A 
Fever
Pregnancy
AF with rapid ventricular response
Exercise
Hyperthyroidism
43
Q

Pulmonary Edema in MS

A

Rare

44
Q

Severity of MS

A

Duration of MDM(not intensity)

A2-OS gap(inversely related to severity)

Cardiology (16 decks)

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