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MedEd > Cardiac SOB > Flashcards

Cardiac SOB Flashcards

1
Q

Causes of SOB general?

A

Not enough O2 reaching lungs = asthma, COPD, anaphylaxis

V/Q mismatch = PE, pulmonary oedema, pulmonary fibrosis

Not enough O2 reaching rest of bodies = heart issues or anaemia, shock

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2
Q

General breakdowns of HF?

A

Acute or chronic
Left or right (both = CHF)
High output state or low output state

Def: the failure of te heart to maintain teh CO required to meet the bodys demands

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3
Q

Acute HF features?

A

Rapid onsent severe symptoms, causes by ACS or decompensation of chronic HF

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4
Q

Categories of left HF?

A

Valvular = AS, AR or MR
Muscular = IHD, cardiomyopathy, myocarditis and arryhthmias
Systemic: HTN, amyloidosis, drugs e.g. chemo,cocaine

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5
Q

Categories of right HF?

A

Lungs: pulmonary HTN (cor pulmonale), PE, chronic lung disease e.g. CF, IPF

Valvular: TR, Pulmonary valve disease

LHF -> CHF

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6
Q

Conditions that require higher CO?

A 
NAP MEALS
Nutrional (B1/thiamine)
Anaemia
Pregnancy
Malignancy
Endocrine
AV malformations
Liver Cirrhosis
Sepsis
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7
Q

What happens if fluid is congested back?

A

LHF: fluid backs up pulmonary vein and accumulates in lungs -> respiratory symptoms

RHF: Fluid bacs up vena cava = accumulates in peripheries = swelling

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8
Q

LHF symptoms?

A

Dyspnoea (PND = paroxysmal nocturnal dysponoea, exertional dysponoea, orthopnoea)
Nocturma cough +/- pink frothy sputum
Fatigue
Crackles and wheeze
Cyanosis, fatigue, confusion and restlessness

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9
Q

Heart signs of LHF?

A

Increased HR, increased RR, irregularly irregular heartbeat, pulsus alternans, displaced apex beat
S3 gallop rhythm
S4 severe HF
Murmur = AS,MR,AR

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10
Q

Lung signs of LHF?

A

Fine end-inspiratory crackles at lung bases (pulmonary oedema)
Wheeze (cardiac asthma)

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11
Q

symptoms of RHF?

A

Symptoms: fatigue, reduced exercise tolerance, anorexia, nausea and NOCTURIA

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12
Q

Signs of RHF?

A

Face swelling, increased JVP, TR murmur, increased HR and RR

Ascites and hepatomegaly, ankle and sacral pitting oedema

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13
Q

Ix for HF?

A

ECG
Bloods: FBC, U&E, LFTs, TFTS, BNP is key
Imaging: CXR, TransThoracicEcho

If BNP is low, HF unlikely
If BNP high -> TTE

TTE with doppler is diagnostic

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14
Q

How to use TTE for EF?

A

EF <40% indicates ventricular inability to contract normally

EF>50% indicates ventricle inability to relax and fill normally

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15
Q

CXR for HF assessment?

A 
ABCDE
Alveolar oedema
B-lines (Kerley)
Cardiomegaly
Dilated upper lobe vessels + diverted upper lobe
Effusion (transudative pleural effusion)
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16
Q

What is used for HF diagnosis?

A

Framingham criteria

2+ major or 1 major and 2 minors

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17
Q

Chronic HF Mx?

A

1) treat the underlying cause
2) treat the eacerbating factors
3) lifestyle modifications
4) Drugs ABD: Acei, Beta, diuretics

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18
Q

What drugs are given for HF?

A

ACEi: for all patients with LV dysfunction e.g. enalapril, preindopril, ramipril

beta bloceker to reduce O2 demand of heart e.g. bisoprolol, carvedilol

Duresemide (loop) or aldosterone antagonist (spirinolactone)

Hydralazine + nitrates - considered in afro-carribean patients

Digoxin

19
Q

Acute HF management>

A 
Sit patient up
60-100% O2
IV diamorophine 2.5-5mg
GTN infusion
IV fureosemide 40-80mgs

DMONS
Diuretics, morphine, oxygen, nitrates, sit up

20
Q

Complications of HF?

A

Respiratory failure, renal failure (hypoperfusions), acute exacerbations and death

Very poor prognosis

21
Q

Cardiomyopathy definition?

A

A group of diseases in which the myocardium becomes structurally and functionally abnormal. In the absenee of coronary artery disease, valvular disease and congenital heart disease.

It can affect young people

Primary: confined to myocardium
Secondary: part of systemic disease

22
Q

General types of cardiomyopathy?

A

Normal, dilated, hypertrophic and restrictive

23
Q

Presentation of cardiomyopathy?

A

Symptoms of HF: SOBOE< fainting, fatigue
Suddent death adn Fhx

Ask above young deaths in family

24
Q

Pathophysiology of dilated cardiomyopathy?

A

Ventricles enlarge and become dilated so walls thinner and weaker. therefore LAw of Laplace: increased radius = reduced ventricular pressure

25
Q

RFs for dilated cardiomyopathy?

A

ALCOHOL, post viral, haemochromotosis, genetic

26
Q

PC for Dilated CM?

A

Signs and symtoms of HF, displaced apex beat,

TR/MR murmur, S3`

27
Q

Ix for dilated CM?

A

Globular heart on CXR and dilated ventricle in ECHO

28
Q

Pathophysiology of hypertrophic CM (HCM)?

A

Increased stiffness affects pumping and disrupts electrical conduction = arrhythmia
HOCM = affected outflow
50% is familial (autosomnal dominant)

29
Q

PC of HCM?

A

usually asymptomatc, sudden cardiac death

Angina, dyspnoea, palpitations and syncope

30
Q

Signs of HCM?

A

Ejection systolic murmur, jerky carotid pulse, double apex beat but NOT DISPLACE
S4`

31
Q

Ix for HCM?

A

ECG: q waves, left axis deviation and signs of LVH
ECHO: ventricular ypertophy

32
Q

LVH by voltage criteria?

A

Deep s in V1/2
Tall R in V5/6
S in V1 + R in V5 or V6 >7 large squares

33
Q

Restrictive cardiomyopathy pathophysiology?

A

R is for rigid as loses flexibility so impaired ventricular filling during diastole

34
Q

Causes of restrictive cardiomyopathy?

A

OSIS: sarcoidosis, amyloidosis, haemochromotosis
Familial and idiopathic

Rarer than other two types

35
Q

Symptoms and signs of RCM?

A

Asx or HR symptoms
RHF signs: raised JVP, S3, ascites and oedema, hepatomegaly
Kussmauls signs = paradoxical rise in JVP during inspiration

36
Q

What are the other cardiomyopathies?

A

Arrhythmoemc right ventricular cardiomyopathy: progressive fatty and fibrous replacement of the ventricular myocardium (autosomnal dominant)

Takotsubo cardiomyopathy = broken heart syndrome

37
Q

Causes of constrictive pericarditis?

A

idiopathic, infectious e.g. TB, bacteriale.g. strep, staph and pneumococcus, viral
Acute pericarditis causes
cardiac surgery and radiation

38
Q

Signs and symptoms of restrictive pericarditis?

A

Similar to restrictive cardiomyopathy

RHF presentation (raised JVP, oedema)
Jussmauls signs
39
Q

Ix for constricitve pericarditis?

A

CXR: pericardial calcification
ECHO: increased pericardial thickness (to differentiate to RCM)
Cardiac CT/MRI

40
Q

Mx for constrictive pericarditis?

A

Pericardectomy

41
Q

What is and causes of myocarditis?

A

Inflammation of the myocardium

Infectious, drugs e.g. cocaine, metals and radiation

Coxsackie B most common cause in europe

42
Q

Signs and symptoms of myocarditis?

A

Flu-like prodome
Chest pain (worse lying down)
SOB
Palpitations

43
Q

investigations for Myocarditis?

A

ECG: non-specific ST and T wave changes
Cardiac biomarkers: CK and troponin
Endomyocardial biopsy: diagnostic but not routinely preferred

MedEd (32 decks)

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