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Cardio > Heart Failure + Cardiomyopathy > Flashcards

Heart Failure + Cardiomyopathy Flashcards

1
Q

what is the definition of heart failure

A

cardiac output doesn’t meet the body’s requirements

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2
Q

what’s the prognosis of HF

A

25-50% within 5 years

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3
Q

what is systolic failure?

A

ventricle can’t contract normally so decreased cardiac output

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4
Q

what is diastolic failure?

A

ventricle can’t relax and fill properly causing increased filling pressures

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5
Q

what is the ejection fraction in diastolic

A

50%

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6
Q

causes of systolic failure

A

IHD (ischaemic heart disease), MI, cardiomyopathy

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7
Q

causes of diastolic failure

A

constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension

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8
Q

what are the symptoms of left ventricular failure

A

dyspnoea, PND, orthopnoea, poor exercise tolerance, wheeze, nocturia, cold peripheries, weight loss, muscle wasting

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9
Q

what are the symptoms of right ventricular failure

A

peripheral oedema, ascites, nausea, anorexia, facial engorgement, pulsation in neck and face (tricuspid regurg), epistaxis

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10
Q

causes of RVF

A

LVF, pulmonary stenosis, lung disease

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11
Q

what is acute heart failure

A

new onset acute or decompensation of chronic HF; pulm and or peripheral oedema with or without signs of peripheral hypoperfusion

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12
Q

what is chronic heart failure

A

develops/progresses slowly. venous congestion common but arterial pressure well maintained until very late

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13
Q

what is low output HF

A

cardiac output low and fails to increase with exertion

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14
Q

causes of low output HF

A

pump failure (low HR, systolic and or diastolic failure, -vely inotropic drugs), excessive preload (mitral regurg, fluid overload- NSAIDS causing retention), chronic excessive afterload (aortic stenosis, hypertension)

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15
Q

what is congestive heart failure

A

LVF and RVF

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16
Q

what is high output HF

A

rare. output normal or increase to meet needs, but fails.

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17
Q

causes of high output HF

A

anaemia, pregnancy, hyperthyroidism, Pagets, beri beri, arteriovenous malformation

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18
Q

what is the initial presentation of high output HF

A

RVF, then later signs of LVF

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19
Q

what criteria is made to diagnose

A

Framingham

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20
Q

Framingham criteria requires 2 maj and 1 minor criteria or 1 maj and 2 min. what are the major criteria?

A

PND, creps, S3 gallop, neck vein distention, acute pulm oedema, increased hepatojugular reflex, cardiomegaly, weight loss, increased central venous pressure

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21
Q

what are the minor criteria

A

bilat ankle oedema, dyspnoea, nocturnal cough, tachycardia, decr vital capacity, hepatomegaly, pleural effusion

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22
Q

other signs HF

A

exhaustion, cool peripheries, cyanosis, decr BP, narrow pulse pressure, displaced apex, rv heave, murmurs, wheeze

23
Q

if what 2 tests are normal makes HF unlikely

A

ECG, BNP. if one abnormal do echo

24
Q

what is the ABCDE of ECG showing LVF

A

Alveolar oedema (bats wings), Kerley B lines (interstitial oedema), Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion

25
Q

what may ECG show

A

cause- ischaemia, LVH, MI

26
Q

what may echo show

A

cause- valvular disease, MI, LV dysfunction

27
Q

what is the management in chronic heart failure

A

treat the cause, treat exacerbating factors, avoid exacerbating factors eg NSAIDs, verapamil, drugs

28
Q

what are the drugs used in chronic heart failure

A

diuretics, ACE-I, B blockers, spironolactone, digoxin, vasodilators

29
Q

what is the New York classification of heart failure

A

I- heart disease present, no dyspnoea. II- comfortable at rest, dyspnoea ordinary activities. III- less than ordinary activities cause dyspnoea which is limiting. IV- dyspnoea present at rest, all activity causes discomfort.

30
Q

what is dilated cardiomyopathy

A

dilated, flabby heart of unknown cause

31
Q

what are the associations with dilated cardiomyo

A

alcohol, incr BP, haemochromatosis, viral infection, autoimmune, peri or post partum, thyrotoxicosis, congenital

32
Q

presentation of dilated cardiomyo

A

fatigue, pulm oedema, RVF, emboli, AF, VT.

33
Q

signs of dilated cardiomyo

A

incr pulse, decr BP, incr JVP, displaced diffuse apex, S3 gallop, mitral or tricuspid regurg, pleural effusion, oedema, jaundice, hepatomegaly, ascites

34
Q

tests for dilated cardiomyo

A

BNP, decr Na; CXR- cardiomegaly and pulm oedema; ECG- tachycardia, T wave changed, poorR wave progression. Echo- dilated hypokinetic heart, low ejection fraction (MR, TR,LV mural thrombus)

35
Q

treatment dilated cardiomyo

A

diuretics, digoxin, ACE-I, anticoag, pacing, ICDs, transplant

36
Q

mortality of dilated cardiomyo

A

40% in 2 years

37
Q

what is hypertrophic cardiomyo

A

LV outflow tract obstruction from asymmetrical septal hypertrophy

38
Q

what are the genetics involved in HCM

A

autosomal dominant but 50% sporadic. 70% mutations in genes encoding B myosin, alpha tropomyosin, troponin T. presents at any age

39
Q

symptoms and signs HCM

A

VF, angina, dyspnoea, palpitation, syncope, CCF, jerky pulse, alpha wave in JVP, double apex beat, systolic thrill

40
Q

what can the ECG show for HCM

A

LVH, T wave inversion, deep Q waves, AF, WPW, ventricular ectopics, VT

41
Q

what would the echo show for HCM

A

asymmetrical septal hypertrophy, small LV cavity, midsystolic closure of aortic valve

42
Q

treatment for HCM

A

B blockers, verapamil- reduce ventricular contractility. amiodarone for arrhythmias. anticoagulate for paroxysmal AF or systemic emboli

43
Q

what is the mortality HCM

A

5.9% per year if 14 years

44
Q

what are the causes of restrictive cardiomyopathy

A

idiopathic, amyloidosis, haemochromatosis, sarcoidosis, scleroderma, Lofflers eosinophilic endocarditis, endomyocardial fibrosis

45
Q

what are the types of cardiomyopathy

A

dilated, hypertrophic, restrictive

46
Q

what is the presentation of restrictive cardiomyo

A

like constrictive pericarditis. features RVF- incr JVP, hepatomegaly, oedema, ascites

47
Q

diagnosis of restrictive cardiomyo

A

cardiac catheterisation

48
Q

what is acute myocarditis

A

inflammation of the myocardium

49
Q

causes of myocarditis

A

viral (flu, hep, mumps, coxsackie, polio, HIV), bacterial (clostridia, diphtheria, TB, meningococcus, mycoplasma), spirochetes (lyme, syphilis), toxins, vasculitis

50
Q

what drugs can lead to acute myocarditis

A

cyclophosphamide, Herceptin, penicillin, chloramphenicol, sulphonamides, methyldopa, spironolactone, phenytoin, carbamazepine

51
Q

symptoms and signs acute myocarditis

A

fatigue, dyspnoea, chest pain, fever, palps, tachy, soft S1, s4 gallop

52
Q

what does the ECG show in acute myocarditis

A

ST elevation or depression, t wave inversion, atrial arrhythmias, transient AV block,

53
Q

what confirms diagnosis acute myocarditis

A

positive troponin.

54
Q

what excludes active myocarditis

A

negative antimyosin scintigraphy

Cardio (15 decks)

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