Cardiac Dyspnea

Question 1

HF dyspnea is related to… (3)

Answer 1

Increased LV end-diastolic pressure
Increased pulmonary capillary wedge pressure
Hypoxia from V/P mismatch

Question 2

MCC of LV systolic dysfunction is:

Answer 2

IHD

Question 3

S3 gallop

Answer 3

3rd heart sound

In adult, usually sign of failing ventricle (HF)

Question 4

Cough in HF looks like…

Answer 4

Pink, frothy. From pulm capillaries.

Question 5

Hepatomegaly is a sign of HF. What does it present/look like?

Answer 5

Venous congestion
RUQ tenderness
Increased LFTs
Altered coagulation states

Question 6

ACC/AHA stages of HF

Stage A

Answer 6

At risk for HF (DM, HTN, vascular dz, metabolic syndrome, etc.) but NO current heart disease.
No symptoms.
1 year mortality = 5-10%

Question 7

ACC/AHA stages of HF

Stage B

Answer 7

Structural heart disease (LVH, red EF, chamber hypertrophy, previous MI, etc.)
No symptoms.
1 year mortalitiy = 5-10%

Question 8

ACC/AHA stages of HF

Stage C

Answer 8

Structural heart disease
HF symptoms currently or prior
1 year mortality = 15-30%

Question 9

ACC/AHA stages of HF

Stage D

Answer 9

Refractory HF
Needs biventricular pacemaker, LVAD, transplant, etc.
1 year mortality = 50-60%

Question 10

NYHA functional classification

Class I

Answer 10

No limitation of physical activity
ASX
1 year mortality = 5-10%

Question 11

NYHA functional classification

Class II

Answer 11

Slight limitation in physical activity
Exertional SX with ordinary activity
No SX at rest
1 year mortality = 15-30%

Question 12

NYHA functional classification

Class III

Answer 12

Marked limitations of physical activity
Less than ordinary activity causes SX
No SX at rest
1 year mortality = 15-30%

Question 13

NYHA functional classification

Class IV

Answer 13

Unable to carry out physical activity w/o SX/discomfort
SX at rest*
1 year mortality = 50-60%

Question 14

Systolic HF on exam (HFeEF)

Answer 14

EF < 40%, decreased SV, hypoperfusion
Weak, fatigued, dec exercise tolerance
DOE, orthopnea, PND, S3 gallop

50% of HF cases

Question 15

Diastolic HF on exam (HFpEF)

Answer 15

Normal EF
Ventricles don’t relax, increased stiffness, resistance to filling, etc.
Assoc. with myocardial fibrosis, amyloidosis, ischemia, etc.
SOB, DOE, pulm edema

Question 16

Causes of acute HF

Answer 16

Acute MI
Ruptured papillary m.
MR
AI/R

Question 17

High output HF

Occurs in:

Answer 17

EF reduced, but high CO

Ex: hyperthyroidism, pregnancy, anemia, Beriberi, Paget’s disease, etc.

Question 18

Low output HF occurs in:

Answer 18

IHD, HTN

DCM, Valvular/pericardial dz

Question 19

How do tachy and brady rhythms lead to HF

Answer 19

Tach: decreased ventricular filling time, leading to ischemia
Brady: slow rate, leads to dec perfusion

Question 20

HF Tx (non-pharm)

Answer 20

Immunize vs. pneumonia
Avoid NSAIDs
Reduce salt intake
No smoking
No EtOH

Question 21

AHA diet

Answer 21

Watch calories, stimulants, salt
Stool softeners, Lovenox
Low flow O2
Treat DM, HTN, hyperlipidemia