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Y3 MedEd > Cardiac causes of SOB > Flashcards

Cardiac causes of SOB Flashcards

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1
Q

Which valvular disease is most common through HF

A

Mitral regurgitation

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2
Q

Which is the biggest sign of CHF

A

Breathlessness with pulmonary oedema due to abnormal salt and water retention

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3
Q

Three ways chronic low CO LHF manifests

A

Valvular pathology
Heart muscle pathology
Systemic pathology

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4
Q

What are the valvular causes of low CO LHF (3)

A

Aortic stenosis,
Aortic Regurgitation
Mitral Regurgitation

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5
Q

What are the heart muscle causes of low CO LHF (4)

A

Ischaemic Heart Disease
Cardiomyopathy
Myocarditis
Arrhythmias (AF)

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6
Q

What are the systemic causes of low CO LHF (3)

A 
Hypertension, 
 Amyloidosis
 Drugs (e.g. cocaine, alcohol, chemotherapeutics - eg doxorubicin)
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7
Q

Which drugs can cause low CO LHF (4)

A

cocaine, alcohol, BBs*, chemotherapeutics - eg doxorubicin

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8
Q

How does aortic stenosis cause low CO LHF

A

causes excessive afterload. Basically the ventricle has to push harder to eject blood from a stenosed aortic valve. (NB: afterload = the pressure the heart must work against to eject blood during systole)

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9
Q

How does aortic regurg cause low CO LHF

A

There is increased pressure in the LV due to the regurgitant blood form the aorta to the LV (the LV in addition to having to pump the normal volume of blood, has to pump the regurgitant blood as well). These changes lead to cardiac remodeling (dilatation, hypertrophy) leading to heart failure.

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10
Q

How does mitral regurg cause low CO LHF

A

If significant (moderate to severe) MR is present, the Left Ventricle must work harder to keep up with the body’s demands for oxygenated blood. Over time, the heart muscle and circulatory system undergo a series of changes to maintain this increased demand – due to mechanical overload the LV overtime can become, hypertrophied, fibrotic, dilated and scarred, ending up with an impaired myocardial function. This can lead to LHF (mitral regurgitation increases preload)

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11
Q

How does hypertension cause LHF

A

increases afterload. LV has to push harder in order to push blood against high systemic pressures. This over time puts strain in the LV leading to LHF.

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12
Q

How does amyloidosis cause LHF

A

In amyloidosis, an abnormal protein called amyloid builds-up in tissues and organs. If amyloid gets deposited in the heart, the heart becomes increasingly stiff and eventually the pumping function deteriorates

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13
Q

Three ways chronic low CO RHF manifests

A

LHF
Lungs
Heart valves

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14
Q

What are the lung causes of low CO RHF (3+3 examples)

A 
Pulmonary HTN (can lead to cor pulmonale)
 PE
Chronic Lung Disease (interstitial lung disease, pulmonary fibrosis, cystic fibrosis)
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15
Q

What is cor pulmonale

A

Enlargement and failure of RV due to increased pressure in the lungs/vascular resistance

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16
Q

Which interstitial lung diseases can cause low CO RHF (3)

A

interstitial lung disease, pulmonary fibrosis, cystic fibrosis

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17
Q

Which valvular diseases can cause low CO RHF (2)

A

TR

Pulmonary valve Disease

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18
Q

How do chronic lung diseases cause heart failure

A

Chronic lung disease can result in chronic hypoxia: The pulmonary vasculature results to chronic hypoxia by vasoconstriction. This increases vascular resistance and and results in increased pulmonary arterial pressure. The right heart reacts to this by remodeling (hypertrophy and dilatation). Over time it can lead to RHF.

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19
Q

What can cause high output HF (8)

A

NAP MEALS

Nutritional (B1: thiamine)
Anaemia
Pregnancy
Malignancy (multiple myeloma)
Endocrine (hyperthyroidism)
AV malformations
Liver cirrhosis
Sepsis
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20
Q

How does high CO HF present

A

High output HF presents initially with features of RHF and then LHF becomes more apparent

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21
Q

What are the main symptoms of RHF due to

A

RHF: symptoms due to fluid accumulation in the periphery

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22
Q

What are the main symptoms of LHF due to

A

LHF: respiratory symptoms due to fluid accumulation in the lungs

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23
Q

Which HF gives pulmonary symptoms

A

LHF

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24
Q

Which HF gives systemic symptoms

A

RHF

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25
LHF symptims (6)
``` Exertional dyspnea Orthopnoea (SOB when lying flat) Paroxysmal nocturnal dyspnea – PND (attacks of SOB at night) Fatigue Nocturnal Cough (+/- pink frothy sputum) Wheeze ```
26
Which murmurs are seen in LHF
Murmur (AS, MR, AR)
27
Which heart sounds are added in LHG
S3 Gallop rhythm | S4 in severe HF
28
What signs are seen in the lung in LHF (2)
Fine end-inspiratory crackles at lung bases (pulmonary oedema) Wheeze (cardiac asthma)
29
What are the signs of LHF (10 heart 2 lung)
``` ↑HR, ↑RR Irregularly Irregular heart beat Pulsus alternans Displaced apex beat S3 Gallop rhythm S4 in severe HF Murmur (AS, MR, AR) Fine end-inspiratory crackles at lung bases (pulmonary oedema) Wheeze (cardiac asthma ```
30
RHF symptoms (7)
``` Swelling (ankles, facial engorgement, ascites) Weight gain (due to oedema) Fatigue Reduced exercise tolerance Anorexia Nausea Nocturia ```
31
Main 3 causes of raised JVP
RHF Tricuspid regurg Constrictive pericarditis
32
Signs of RHF (8)
``` Face: face swelling Neck: ↑JVP Heart/Chest: TR murmur, ↑HR, ↑RR Abdomen: Ascites, hepatomegaly Other: pitting oedema in ankles & sacrum ```
33
HF Ix
ECG FBC, U&Es, LFTs, TFTs BNP CXR TTE - DIAGNOSTIC
34
What is HFrEF also known as and what does it suggest
systolic HF Indicates inability of the ventricle to contract normally
35
What is HFpEF also known as and what does it suggest
diastolic HF Indicates inability of the ventricle to relax and fill normally
36
What is a normal EF
50-70%
37
What % is HFrEF
<40%
38
What % is HFpEF
>50%
39
CXR features of HF (5)
``` Alveolar oedema B-lines (kerley) Cardiomegaly Dilated upper lobe vessels Effusion (pleural, transudative) ```
40
Conservative Mx of HF (3)
smoking cessation, weight management (exercise), diet (reduce salt intake)
41
Medical Mx of chronic HF (4)
ACE inhibitors (enalapril): should be given to ALL pts with LV dysfunction as it improves survival and slows down progression. BBs (carvedilol, bisoprolol): reduce O2 demand on the heart. All patients with CHF should receive a BB once established on an ACEi – improve survival & synergistic effects with ACEi. Diuretics (furosemide, chlorothiazide, spironolactone): use if evidence of fluid retention, monitor electrolytes (spironolactone can cause hyperkalaemia) Digoxin: +inotrope (increases heart contractility), helps improve symptoms but does NOT increase overall survival.
42
What can lead to acute decompensation of chronic heart failure (5)
MI, Arrhythmias, Infection, Hypo/hyperthyroidism, Uncontrolled HTN
43
What are the 2 ways of getting acute HF
Decompensation of previous chronic HF | Acute Coronary Syndrome
44
What additional heart sound is present with what rhythm in acute HF
S3 gallop rhythm
45
What is heard in the lungs in acute HF
Fine end inspiratory crackles
46
What is pulses alternans
is alternating strong and weak pulses. In left ventricular systolic failure, the ejection fraction is low, which causes a reduced stroke volume and an increased end-diastolic volume. The high end-diastolic volume, following one weak contraction, stretches the ventricular muscle fibres which, by Starling’s law, leads to a stronger subsequent contraction.
47
Acute HF Mx
Sit patient up High-flow Oxygen via non rebreathe mask (Target SpO2 = 94-98%) Furosemide 40-80mg IV (GTN infusion evidence of pulmonary oedema AND SBP > 90mmHg) Consider CPAP (if sats are dropping) Treat cardiogenic shock if BP < 90mmHg with positive inotropes (e.g. dobutamine)
48
What is the target SpO2 when managing acute HF
94-98%
49
Which mask do we use when managing acute HF
Non-rebreathe
50
What do you need to monitor and why when giving furosemide during acute HF
Monitor U & Es bc you can get hypokalaemia
51
When is GTN indicated in acute HF
GTN infusion evidence of pulmonary oedema AND severe hypertension or angina
52
When is CPAP indicated in acute HF
Consider CPAP (if sats are dropping)
53
How do you treat cardiogenic shock if BP < 90mmHg in acute HF
with positive inotropes (e.g. dobutamine)
54
Complications of HF (4)
Pleural effusion Renal failure (long standing HF can lead to hypoperfusion) Acute exacerbations Death
55
Prognosis of HF
50% of severe HF pts die within 2 years | In AHF, in hospital mortality: 2-20%
56
Define cardiomyopathy
A group of diseases in which the myocardium becomes structurally and functionally abnormal (in the absence of coronary artery disease, valvular disease and congenital heart disease)
57
What is the difference between primary and secondary cardiomyopathy
Primary: Confined to myocardium | Secondary: Part of a systemic disease
58
What are the 4 types of cardiomyopathy
HCM = Hypertrophic cardiomyopathy, DCM = Dilated cardiomyopathy, ARVC = Arrhythmogenic right ventricular cardiomyopathy, RCM = Restrictive cardiomyopathy
59
History of a cardiomyopathy (3 (+4 specific symptoms))
``` Symptoms of HF SOB on exertion Fainting Dizziness Fatigue ``` Sudden death often 1st presentation Family History
60
What is dilated cardiomyopathy associated with (5)
``` Alcohol Post viral AI Haemochromatosis genetic ```
61
Symptoms of dilated cardiomyopathy (6)
HF (dyspnoea, fatigue, | arrhythmias, ankle swelling, ascites)
62
Signs of dilated cardiomyopathy (5)
↑ JVP TR, MR murmur S3 Displaced apex beat
63
Which valvular pathology is seen in dilated cardiomyopathy
TR, MR murmur
64
What extra heart sound is heard in dilated cardiomyopathy
S3
65
What Ix for dilated cardiomyopathy
CXR | Echo
66
What happens in hypertrophic cardiomyopathy
The heart thickens inwards. The thickened ventricle may block the Blood flow out of the ventricle
67
What happens in dilated cardiomyopathy
the Ventricles enlarge, become dilated, Weaken and can’ t contact effectively.
68
What proportion of HOCM is congenital and what is its mode of inheritance
50% is familial (Autosomal dominant)
69
Symptoms of HOCM
Angina, dyspnea on exertion, palpitations, syncope | Often sudden cardiac death might be the 1st presentation
70
Signs of HOCM (4)
``` Ejection systolic murmur Jerky carotid pulse Double apex beat S4 Apex beat NOT displaced ```
71
Difference between apex beat in HOCM and dilated cardiomyopathy
NOT displaced in HOCM and double in HOCM
72
ECG findings of HOCM (3)
ECG findings: Q waves Left axis deviation Signs of Left Ventricular Hypertrophy
73
LVH by voltage criteria (3)
Deep S in V1/2 Tall R in V5/6 S in V1 + R in V5 or V6 ≥ 7 large squares
74
Ix for HOCM
ECG | Echo
75
What happens in restrictive cardiomyopathy
The ventricles become abnormally rigid and lack the flexibility to expand as the ventricles fill with blood
76
Causes of restrictive cardiomyopathy (3)
Idiopathic, familial, | Systemic (e.g. infiltrative)
77
What is Kussmaul's sign
Kussmaul’s sign (paradoxical rise in JVP in inspiration due to restricted filling of the ventricles)
78
Which cardiomyopathy has Kussmaul's sign
Restrictive
79
Symptoms of restrictive cardiomyopathy (4)
Asymptomatic or | symptoms of HF (dyspnea, fatigue)
80
What is arrhythmogenic right ventricular cardiomyopathy
There is progressive fatty and fibrous replacement | of the ventricular myocardium.
81
Aetiology of ARVC
inherited (AD)
82
Presentation of ARVC
Can be asymptomatic initially or present | with symptoms of arrhythmias especially during exercise
83
Define constrictive pericarditis
chronic inflammation of the pericardium with thickening and scarring
84
Causes of constrictive pericarditis (6)
Idiopathic Infectious (TB, Bacterial, Viral) Acute pericarditis Cardiac surgery and radiation
85
S/s of constrictive pericarditis (4)
(resembles Restrictive cardiomyopathy): RHF symptoms (dyspnea, ↑ JVP, fluid congestion) Kussmaul’s sign
86
Ix for constrictive pericarditis (3)
CXR: pericardial calcification ECHO: ↑ pericardial thickness Cardiac CT/MRI
87
What happens in constrictive pericarditis
the pericardium, the sac that encloses the heart becomes inflamed. There are 2 layers of pericardium (visceral and parietal). These 2 layers are normally distensible with a small space between them containing fluid. However, in constrictive pericarditis they become inflamed and they fuse. Basically it acts as if there was a box around the heart.
88
Bacterial causes of constrictive pericarditis (2)
staphylococci and pseudomonas
89
Viral causes of constrictive pericarditis (2)
coxsackievirus, hepatitis
90
What is myocarditis
Inflammation of the myocardium
91
Causes of myocarditis (5)
Infectious, Drugs, cocaine, | metals, radiation
92
What drugs have been associated with myocarditis (4)
penicillins, cephalosporins, digoxin antiepileptic
93
Presentation of myocarditis (5)
Flu-like prodrome Positional chest pain (worse when lying down) SOB Palpitations
94
Why does CK rise in myocarditis and not pericarditis
Because myocarditis is inflammation of cardiac muscle
95
Ix myocarditis (3)
``` ECG: non-specific ST changes, T-wave abnormalities Cardiac biomarkers (CK & troponins) Endomyocardial biopsy (diagnostic but not routinely performed) ```
96
Which valvular pathologies lead to pan systolic murmur (2)
Tricuspid and mitral regurgitation
97
Which diseases is Kussmaul's sign usually seen in
Seen in constrictive pericarditis & restrictive cardiomyopathy

Y3 MedEd (34 decks)

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