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CP3 Medicine > CARDIOLOGY - Heart Failure > Flashcards

CARDIOLOGY - Heart Failure Flashcards

(62 cards)

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1
Q

What is the most common cause of pulmonary oedema?

A

Left ventricular failure

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2
Q

Clinical features - pulmonary oedema (5)

A 
Dyspnoea 
Paroxysmal nocturnal dyspnoea 
Orthopnoea 
Cough 
Production pink, frothy, blood stained sputum
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3
Q

How to ask pt about their orthopnoea in pulmonary oedema

A

How many pillows is the patient using to prop themselves up at night

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4
Q

Ix pulmonary oedema (5)

A 
ABG
FBC (U+E, glucose, D-dimer, CRP, trops) 
CXR
ECG
Echocardiography
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5
Q

How does the ‘ABG picture’ progress in pulmonary oedema

A

Intially: T1RF b/c hyperventilation
Later: T2RF b/c impaired gas exchange

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6
Q

CXR pulmonary oedema (5) (A-E)

A 
Alveolar Bat-wing oedema
Kerley B lines 
Cardiomegaly 
Dilated Upper zone vessels 
Pleural Effusion
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7
Q

What is Bat wing oedema

A

Oedema on the frontal chest radiography
Bilateral - perihilar opacities
Assoc w/: Pulmonary oedema

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8
Q

What are Kerley B lines

A

Septal lines

B/c of lymphatic engorgment/oedema of CT of interlobular septa

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9
Q

Signs pulmonary oedema on ECG (2)

A

TachyC

Arrhythmia

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10
Q

Causes pulmonary odema - increased capillary pressure (8)

A 
LVF
Valve disease 
Arrythmias 
VSD
cardiomegaly 
negatively inotropic drugs 
pulmonary vv obstruction
Iatrogenic fl overload
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11
Q

Causes pulmonary oedema - increased cap permeability (4)

A

ARDS
Infection e.g. pneumonia
DIC
Inhaled toxins

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12
Q

Causes pulmonary oedema - reduced plasma oncotic pressure

A

Renal /liver failure

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13
Q

Causes pulmonary oedema - lymphatic obstruction

A

Tumour/parasitic infection

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14
Q

Mx pulmonary oedema

A 
Sit upright 
100% O2 
IV diamorphine 1.25-5mg
IV furosemide 40/80mg 
GTN x2 puffs
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15
Q

Mx pulmonary oedema if SBP >100

A

Start IV infusion nitrates

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16
Q

Mx pulmonary oedema SBP <100

A

Tx as cardiogenic shock –> ICU

May req invasive ventilation

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17
Q

What is cor pulmonale

A

Enlargement and failure of right ventricle of heart as a response to increased vascular resistance or high BP in lungs

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18
Q

What is acute respiratory distress syndrome

A

Pulmonary insults –> non-cardiogenic pulmonary oedema

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19
Q

Direct causes ARDS (4)

A

Aspiration
Smoke/toxin inhal
Pneumonia
Near-drowning

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20
Q

Indirect causes ARDS (6_

A 
Sepsis 
Multiple trauma 
Pancreatitis 
Transfusion reactions 
Anaphylaxis 
Drug reactions
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21
Q

Features ARDS (4)

A

Hypoxaemia
Absence signs RA P
CXR - diffuse bilateral infiltrates
Impaired lung compliance

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22
Q

Mx ARDS (6)

A 
Sit pt up w/ 100% O2
CPAP 
IV NO3 
IV furosemide 
Morphine + IV metocloperamide 
Aminophylline (if bronchospasm)
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23
Q

Common causes heart failure (3)

A

IHD
Dilated cardiomyopathy
HTN

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24
Q

Rarer causes heart failure (ACV = 321)

A 
Anaemia 
AF/Heart block 
Alcohol/Dx 
Cor pulmonale 
Congenital heart disease 
Valvular causes
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25
What is meant by congestive heart failure
RHF resulting from pre-existing LHF
26
Maladaptive neurohormonal adaptations occurring in heart failure
Reduced CO --> activates SNS + RAAS RAAS --> VC + Na/H2O retention --> Incr BP + cardiac work SNS --> myocyte aptptosis and necrosis
27
What is ANP released in response to
Atrial stretch
28
What does ANP antagonise
Fluid conserving effects of aldosterone
29
Benefit of adrenergic remodelling signal
Contractility | Hypertrophy
30
Harm of adrenergic remodelling signal
Myocyte apoptosis | Myocyte toxicity
31
Benefit of A-II remodelling signal
Hypertrophy
32
Harm of A-II remodelling signal
Changed expression of contractile proteins
33
Benefit of TNF-a remodelling signal
Hypertrophy
34
Harm of TNF-a remodelling signal
Remodelling of matrix | Dilatation
35
Early warning of CCF (FACES)
``` Fatigue Activity mod Congestion Edema SOB ```
36
Causes LVF (6)
``` HTN (longstanding) Cardiomyopathies Congenital heart disease MI and IHD Acute ventricular dysrhythmias (VF) Valve disease ```
37
PS LVF (5)
``` Fatigue Exertional dyspnoea/orthopnoea Cardiomegaly + displaced apex beat 3rd HS + gallop rhythm Bibasal crackles ```
38
Causes RHF
LVF Acute- massive PE Cor pulmonale Valve disease
39
Sx RVF (4)
fatigue breathless A=N Swollen ankles
40
Signs RVF (5)
``` Jugular venous distention Hepatomegaly Dependent pitting oedema Pleural effusions Cardiomegaly, gallop rhythm ```
41
What is cardiac cachexia
Life threatening weight loss due to combination of Hmegaly and increased metabolic demands
42
NY heart association of HF - stage 1
Disease present, no undue dyspnoea from normal activity
43
NY heart association of HF - stage 2
Dyspnoea present on normal activities
44
NY heart association of HF - stage 3
Less than ordinary activity causes dypsnoea which = limiting
45
NY heart association of HF - stage 4
Dyspnoea present at rest, any activity causes discomfort
46
Ix HF - bloods (6)
``` FBC `LFT U+e TFT Cardiac enzymes BNP ```
47
What is the gold standard Ix for HF
Echo
48
What numerical value is diagnostic on echo for HF
Ejection % <45
49
Mx HF
Lifestyle advice ACEi + b-blocker Diuretic (if Sx)
50
2nd line Mx HF
Spironolactone/ATRA/hydralazine + nitrate
51
3rd line Mx HF
digoxin
52
Lifestyle advice HF
``` Pt education Obesity control Dietary mod Endurance activity recommended Vaccines - pneumococcal and influenza No viagra ```
53
What electrolyte imbalance can diuretics and ACEi -->
hyperkalaemia
54
SE ACEi
Renal - monitor urea/creatinine/ K+ + before Tx
55
C/I ACEi
``` PARK Preg Allergy/angiodema Renal aa stenosis K+ hyper ```
56
Who are thiazide diuretics used in
Mild failure | Elderly pt w/ massive diuresis
57
Who are loop diuretics used in
pulm oedema
58
what metabolic disturbance do diuretics cause
hypokalaemia
59
digoxin mode of action
+ve inotrope + -ve chronotrope hence increase force of contraction and decreasing hR Inhibits Na/K pump Impairs AVN conduction, incr vagal stim
60
C/I digoxin
Concurrent heart block | BradyC
61
Indicators digoxin toxicity
Anorexia Nausea visual disturbance diarrhoea
62
how is digoxin's dosage modified
according to eGFR

CP3 Medicine (29 decks)

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