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2a cardio > cardiomyopathy and heart failure > Flashcards

cardiomyopathy and heart failure Flashcards

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1
Q

Define heart failure

A

Inability for heart to deliver O2 blood to tissues at a satisfactory rate for the tissues metabolic requirements * a syndrome not a diagnosis

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2
Q

Cause of heart failure?

A

IHD Cardiomyopathy Valvular disease Cor pulmonale Anything that increases cardiac work: -obesity -htn -pregnancy -hyperthyroid -arrhythmias

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3
Q

Risk factors for heart failure

A

Age (65+) Smoking Obesity Previous MI Male

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4
Q

Pathophysiology for Cor pulmonale?

A

RH failure due to disease of lungs +/ pulmonary vessels Increased pressure and resistance in pulmonary arteries results in right ventricle being unable to pump blood out Leads to back pressure of blood into right atrium, the vena cava and the systemic venous system

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5
Q

Pathophysiology of heart failure

A

-Failing hearts = decreased CO due to dysfunctional frank starling law 1- compensatory mechanism activation —Raas + sns initially works (=increase BP) Increases aldosterone + ADH Increases ADR / NaD 2- soon compensation fails and heart undergoes ca

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6
Q

Normal physiology of heart

A

Normally- increased preload= increased afterload= increased cardiac output (frank starling law)

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7
Q

Three ways heart failure can be classified?

A

1) Time classified 2) Acute or chronic 3) Ejection fraction classified

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8
Q

How is heart failure ejection fraction classified?

A

Normal = 50–70% > 50% = preserved Diastolic failure (filling issues) Eg. Hypertrophic cardiomyopathy, LVH (aortic stenosis) < 40% = reduced Systolic failure (pump issues) Eg. IHD - ischaemic tissue

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9
Q

What does LHS failure result in?

A

Pulmonary vessel backlog —> pulmonary oedema

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10
Q

What does RHS failure result in?

A

Systemic venous backlog —> peripheral oedema

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11
Q

3 cardinal non specific symptoms of heart failure

A

SOBASFAT 1 Shortness of breath 2 Ankle swelling 3 Fatigue

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12
Q

Other symptoms of heart failure

A

-orthopnoea (dyspnoea worse lying flat) -increased JVP -bibasal crackles (pul oedema) -hypotensive -tachycardic

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13
Q

NY heart association class 1-4 of HF severity

A

1 no limit on physical activity 2 slight limit on moderate activity 3 marked limit on moderate + gentle activity 4 symptoms even at rest

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14
Q

Methods of diagnosing of heart failure?

A

Bloods ECG Chest X-ray ECHOcardiogram - gold standard

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15
Q

Blood results with heart failure?

A

BNP (brain natriuretic peptide) = key marker High >400ug/ml Level correlates with extent of damage So more severe heart failure = higher bnp It is released from stressed ventricles in response to increase mechanical stress *might also measure NT ProBNP (inactive BNP) and levels are 5x higher so increase of >2000 ug/ml

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16
Q

ECG results with heart failure?

A

Abnormal Eg evidence of LVH

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17
Q

Chest x ray results with heart failure

A

ABCDE Alveolar bat wing oedema B-lines Cardiomegaly Dilated upper lobe vessels Effusion (pleural)

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18
Q

Purpose of echocardiogram?

A

Assess heart chamber dimensions

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19
Q

Conservative treatment for heart failure

A

Lifestyle changes: Decrease bmi Exercise Stop smoking + alcohol

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20
Q

First line treatment for chronic heart failure

A

ABAL First line: -ACEi (eg ramipril titrated up to tolerated dose of 10mg) -Beta blocker (eg bisoprolol titrated up to 10mg) Add in: -Aldosterone antagonist when symptoms not controlled with A and B (eg spironactone or eplerenone) -Loop diuretic improves symptoms (eg. Furosemide 40mg once daily) *consider desynchronisation therapy (improves A-V coordination) - low dose and slow uptitration is key with ACEi and Bb

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21
Q

Surgical treatments for heart failure?

A

Revascularisation Valve surgery Heart transplant (last resort)

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22
Q

What if ace inhibitors are not tolerated?

A

ARB like candersartan titrated go 32mg can be used instead

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23
Q

What should patients have monitored when on diuretics, ace inhibitors and aldosterone antagonists?

A

U&E All three medications cause electrolyte disturbances

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24
Q

Patients with valvular heart disease should avoid which drug?

A

Ace inhibitors unless indicated by a specialist

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25
Respiratory causes of cor pulmonale?
-COPD is most common cause -pulmonary embolism -interstitial lung disease -cystic fibrosis -primary pulmonary hypertension
26
Presentation of Cor Pulmonale
Patients often asymptomatic Main presenting complaint is shortness of breath (Also caused by chronic lung disease) May also present with peripheral oedema, increased breathlessness of exertion, syncope or chest pain
27
Signs of Cor Pulmonale
-Hypoxia -cyanosis -raised JVP (due to backlog of blood in jugular veins) -peripheral oedema -third heart sound -murmurs (eg pan-systolic in tricuspid regurgitation) -hepatomegaly due back pressure in the hepatic vein
28
Management of cor pulmonale?
Management involves treating the symptoms and underlying cause Long term oxygen therapy often used Prognosis is poor unless reversible underlying cause
29
Define hypertensive heart disease?
Heart failure and conduction arrhythmias due to unmanaged high blood pressure
30
Three types of cardiomyopathy?
1) Hypertrophic 2) Restrictive 3) Dilated
31
What are cardiomyopathies?
Diseases of the myocardium (Muscular/conduction defects)
32
What is the most common cause of death in young people?
Hypertrophic cardiomyopathy
33
Causes of hypertrophic cardiomyopathy
Familial -inherited mutation of sarcomere proteins — troponin T and Myosin B
34
Pathophysiology of of hypertrophic cardiomyopathy
Thick non compliant heart = impaired diastolic filling => decrease in CO
35
Symptoms of hypertrophic cardiomyopathy
May present with sudden death Chest pain/angina Palpitations SOB Syncope/dizzy spells
36
Investigations to diagnose hypertrophic cardiomyopathy
Confirm with abnormal ECG ECHO (diagnostic) Genetic testing
37
Treatment for hypertrophic cardiomyopathy
Bb CCB Amiodarone (anti-arrhythmic)
38
What is the most common cardiomyopathy in general
Dilated cardiomyopathy
39
Cause of dilated cardiomyopathy
-Autosomal dominant familial inheritance (cytoskeleton gene mutation) -IHD -Alcohol
40
Pathophysiology of dilated cardiomyopathy
Thin cardiac walls poorly contract leading to a decrease in CO LV/RV or 4 chamber dilation and dysfunction
41
Symptoms of dilated cardiomyopathy
-SOB -heart failure (usually) -atrial fibrillation -thromboemboli
42
Investigations to diagnose dilated cardiomyopathy
ECG ECHO
43
Treatment for dilated cardiomyopathy
Treat underlying condition Eg Atrial fibrillation, heart failure
44
How common is restrictive cardiomyopathy
Rare
45
Causes of restrictive cardiomyopathy
-Granulomatous disease (sarcoidosis,amyloidodis) -idiopathic -post MI-fibrotic
46
Pathophysiology of restrictive cardiomyopathy
Rigid fibrotic nyocardium fills poorly and contracts poorly => decreased CO
47
Symptoms of restrictive cardiomyopathy
Severe: -dyspnoea -S3 + S4 sounds -oedema -congestive heart failure -narrow pulse pressure ( normally 120/80 but here it’s 105/95 and consequently blood stasis due to the decreased gradient)
48
Investigations to diagnose restrictive cardiomyopathy
ECG ECHO cardiac catheterisation (diagnostic)
49
Treatment for restrictive cardiomyopathy
None Consider transplant Patients typically die within 1yr
50
Epidemiology of hypertrophic cardiomyopathy
Affects 1 in 500 people
51
What is LVOT?
Left ventricular outflow tract obstruction is a recognised feature of hypertrophic cardiomyopathy
52
Cause of arrhythmogenic hypertrophy
Desmosome gene mutations
53
Main symptom of arrhythmogenic cardiomyopathy
Arrhythmia
54
What do all cardiomyopathies carry a risk of?
Arrhythmias
55
Likely cause of sudden cardiac death in a young person?
Often due to an inherited condition Most likely a cardiomyopathy or ion channelopothy
56
What is the cause of inherited arrhythmia? (Channelopothy)
Caused by ion channel protein gene mutations
57
Which ions do cardiac channelopothies relate to?
Potassium Sodium Calcium
58
Examples of cardiac channelopothies?
Long QT Short QT Brugada CPVT
59
Cardiac channelopothies effect on heart structure?
No effect- have a structurally normal heart
60
Symptom of cardiac channelopothy?
Syncope
61
QT prolonging drugs?
Many drugs on this list that may be used to treat other conditions eg some antidepressants But they can kill people with long QT syndrome
62
SADS sudden arrhythmic death syndrome?
Usually refers to normal heart/arrhythmia
63
Familial hypercholesterolaemia (FH)?
Inherited abnormality of cholesterol metabolism
64
What does familial hypercholesterolaemia lead to?
Serious premature coronary and other vascular diseases
65
Aortavascular syndromes
Marfan Loeys-Dietz Vascular Ehler Danos
66
What type of inheritance are inherited cardiac conditions usually?
Dominantly inherited Offspring have a 50% chance of inheritance
67
Why is screening important for inherited cardiac conditions?
Genetic testing is available Risk (arrhythmic death, vascular dissection) needs to be assessed for each individual Life saving treatments are available (ICD, beta blockers, statins, vascular surgery) Lifestyle modifications can save lives
68
Why is screening for inherited cardiac conditions highly contentious?
Because long QT has only a 1/5000 prevalence so it will very rarely be picked up and not a huge benefit to it in the normal population But for first degree relatives- 1/2 chance of it being passed on so highly recommended
69
What if patients are intolerant to ACEi and ARB? (Heart failure)
Hydralazine/nitrate combination
70
Main phenotypes of heart failure
HF with reduced ejection fraction (HFrEF) HF with preserved ejection fraction (HFpEF) HF due to severe valvular heart disease (HF-VHD) HF with pulmonary hypertension (HF-PH) HF due to right ventricular systolic dysfunction (HF-RVSD)
71
What investigations need to be done as part of a hypertension screening?
Urine dipstick (kidneys = end organ damage) ECG (LVH) HBA1c Renal function Fundosocopy (eyes) Lipid profile Qrisk Only check cortisol if there’s a secondary cause of hypertension
72
What do you need to calculate Qrisk?
Lipid profile
73
What changes in the arteries are likely to be seen due to angina?
-Smooth muscle proliferation and migration from the tunica media to the intima -decreased release of nitric oxide - infiltration of Subendothelial space by low-density lipoprotein (LDL) particles - formation of foam cells from macrophages
74
Which blood test is the most accurate marker for acute cardiac damage?
Troponin T - short term, released by cardiac myocytes
75
Blood marker for heart failure?
Brain natriuretic peptide
76
Inflammatory blood marker?
C reactive protein
77
Which investigation is diagnostic for heart failure?
Echocardiogram- allows you to see ventricles and valves (valves cause murmurs)
78
Which medication can be prescribed to relieve symptoms (swollen ankles) of heart failure?
Oral digoxin (cardiac glycoside)
79
Which two medications can cause postural hypertension?
Bisproplol Amlodipine
80
Non pharmacological treatment to help with postural hypertension?
Increase salt intake Increase oral fluid intake Compression stockings Sit + stand slowly
81
What is postural hypertension?
Sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within 3 minutes of standing
82
Causes of postural hypersensitivity?
Disorders affecting autonomic nervous system (eg. Parkinson’s disease) reduced blood volume, or iatrogenic causes eg. Antihypertensives
83
Pharmovological treatment options of postural hypertension?
Oral fludrocortisone
84
Prevalence of postural hypertension?
Affects 5% to 30% of people aged over 65 years and up to 60% of people with Parkinson’s disease
85
5 investigations to assess for infective endocarditis?
Bedside- ECG, urinalysis Bloods - FBC, CRP, blood cultures Imaging - Echo
86
Low amplitude p wave possible causes?
Atrial fibrosis Obesity Hyperkalemia
87
High amplitude p waves possible cause?
Right atrial enlargement
88
Broad notched ‘bifid’ p wave possible causes?
Left atrial enlargement
89
Broad QRS possible causes?
Ventricular conduction delay/ branch bundle block Pre-excitation
90
Small QRS complex possible causes?
Obese patient Pericardial effusion Infiltrative cardiac disease
91
What can T wave changes indicate?
- ischeamia/infarction - myocardial strain (hypertrophy) - myocardial disease (cardiomyopathy)
92
Ecg for ischeamia?
T wave flattening inversion ST segment depression

2a cardio (6 decks)

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