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CHD + HF Flashcards

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1
Q

Causes of high output HF

A

Anaemia, pregnancy

Hyperthyroidism

Pagets Beri beri

Arteriovenous malformation

Causes RVF then LVF

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2
Q

NY Heart association classification of HF - classes + how else is HF classified?

A

1 = no limitations

2 = slight limitations, comfortable at rest

3 = less than ordinary activity will lead to symptoms

4 = symptoms when at rest

Also classified as reduced or preserved ejection fraction

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3
Q

Types of HF

A

Left ventricular = causes a backup, pulmonary oedema

Right ventricular failure = result of left sided HF

Both L + R are systolic

Congestive = mix of LVF + RVF

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4
Q

Most common cause of LVF

A

Myocardial ischaemia - most common

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5
Q

Common cause of RVF

A

LVF

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6
Q

Causes of systolic + diastolic HF

A

Systolic = IHD, MI, cardiomyopathy

Diastolic = constrictive pericarditis, tamponade, restrictive cardiomyopathy, HTN

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7
Q

Causes of low output HF

A

Pump failure, decreased HR (B blockers)

Negatively inotropic drugs (antiarrhythmics)

Excessive preload (mitrl regurg, fluid overload)

Chronic excessive afterload (aortic stenosis, HTN)

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8
Q

Non pharmacological management of HF

A

Exercise

Low salt diet

Daily weights

Stop smoking

Alcohol reduction

Flu vaccine

Inform DVLA if large goods vehicle

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9
Q

Pharmacological management of HF

A

LMNOP if symptomatic

Reduced ejection fraction: ACEi + B blockers (ARBs 2nd line) + Furosemide

In preserved ejection fraction: furosemide + specialist management. Can add: spironolactone, ivabradine, digoxin

AVOID CCB

Consider antiplatelet + statin

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10
Q

Complications of furosemide, cautions + SE

A

Monitor renal function, electrolytes + BP

Ototoxic + sensitivity to sun

Gout from hyperuricaemia

Hyperglycaemia

Hypokalaemia

Caution in kidney disease, urinary retention, cirrhosis, liver disease

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11
Q

SE of spironolactone

A

Renal failure

Agranulocytosis

Alopecia

Gynaecomastia, breast pain, changes in libido

Confusion, dizziness

Electrolyte + GI disturbance

Hyperkalaemia - discontinue

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12
Q

SE + cautions of digoxin

A

Arrhythmias

Blurred vision

Conduction disturbances

Dizziness

GI disturbances

Yellow vision

Eosinophilia + rash

Caution in hypercalcaemia, hypokalaemia, hypomagnesaemia + hypoxia

Monitor plasma conc in renal impairment

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13
Q

SE of ACEi

A

Hypotension Dry cough GI side effects

Altered LFTs

Monitor U+Es

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14
Q

SE + cautions + CI with B blockers

A

Prolongs QT

GI disturbance

Bradycardia Hypotension

Sexual dysfunction

Cold extremities

Caution in asthma, diabetes + renal impairment

CI in heart block, uncontrolled asthma or diabetes, unstable HF

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15
Q

What is a TAVI used for?

A

Transcatheter aortic valve implantation - severe airotic stenosis

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16
Q

Investigations in acute heart failure

A

ECG Bloods = BNP or NT-proBNP CXR

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17
Q

CXR findings for acute HF

A

Alveolar oedema

Kerly B lines

Cardiomegaly

Diversion to upper lobes

Effusions

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18
Q

Management of acute HF

A

Pain = diamorphine

Pee = furosemide 40-80mg IV

Puff = GTN 2 puffs

PAP = CPAP if severe acidaemia/ dyspnoea

Posture = sit up, oxygen

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19
Q

What is QRISK2?

A

Risk assessment to assess CVD risk

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20
Q

What are common secondary causes of dyslipidaemia?

A

Excess alcohol

Uncontrolled diabetes

Hypothyroidism

Liver disease

Nephrotic syndrome

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21
Q

How to diagnose CVD?

A

Measure total + HDL

If total >9 mmol = specialist assessment

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22
Q

How to prevent CVD?

Study These Flashcards
A

Cardioprotective diet: reduced saturated fat, more wholegrains, reduce sugar, 2 portions of fish, 5 fruit + veg

Exercise

Smoking cessation

Alcohol advice

Atorvastatin 20mg for primary prevention in those with >10% 10 year risk of developing CVD

23
Q

Primary prevention in T1DM

Study These Flashcards
A

Offer statins if: >40 y/o

Established nephropathy/ other CVD RF

24
Q

What is secondary prevention of CVD?

Study These Flashcards
A

Atorvastatin 80mg in people with CVD

25
Monitoring whilst on atorvastatin
Measure liver transaminase within 3 months of starting treatment + at 12 months Aiming for \>40% reduction in non-HDL cholesterol
26
General advice for statins
Check for persistent generalised unexplained muscle pain Measure CK levels Contraindicated in pregnancy
27
ECG results for angina
Pathological Q waves ST + T abnormalities
28
Management of angina
Beta blockers Ca channel blockers GTN spray
29
Acute LV failure - presentation + pathophysiology
Pulmonary oedema due to increasing pressure in alveoli, causing fluid to leak out Presentation: PND, orthopnoea, pulmonary congestion, pitting oedema, SOB, pink frothy sputum
30
Causes of pulmonary oedema
Cardiogenic: LVSD, MI Non cardiogenic: fluid overload, ARDS
31
CXR for LVF
ABCD Alveolar oedema - Bat wing B - Kerley B lines Cardiomegaly (should be less than 50%) Diverted upper lobe vessels
32
Management of pulmonary oedema
LMNOP Loop diuretics 40mg furosemide Morphine (+antiemetic) Nitrates - GTN spray or infusion if systolic \>100 Oxygen Posture - sit up
33
How to diagnose chronic HF
ECG - are they in AF? BNP - brain naturolytic peptide, released by atria under stress - will be high in HF CXR - ABCD signs Echo - measures ejection fraction + output
34
What does inotropic mean + give example of positive + negative inotropes?
Affecting contraction of heart Positive inotropes increase force of contraction Digoxin = positive Negative = beta blockers, diltiazem + verapamil
35
What does chronotropic mean + give example of positive + negative chronotropes?
Affect heart rate Positive = adrenaline Negative = beta blockers, digoxin
36
Pulsus paradoxus causes
Cardiac tamponade Pericarditis Asthma
37
What is Pulsus bisferiens + what causes it?
Double peak per cardiac cycle Due to aortic stenosis existing with aortic regurgitation
38
What is Pulsus alternans and what causes it?
Physical finding of alternating strong and weak beats Left sided heart failure
39
What is Unstable vs stable angina?
Stable - occurs with exertion Unstable - occurs randomly
40
What is Variant angina?
Also called Prinzmetal's Occurs at rest Caused by spasm of coronary vessels
41
What is Decubitus angina?
Occurs when patient lies down Complication of HF
42
When do you start statins?
CKD, T1DM for more than 10 years, stroke/ TIA QRISK2 \>10%
43
What is the target cholesterol?
\<5 \<3 if they have heart problems
44
What is the most common cause of HF?
Coronary artery disease
45
Complications of heart failure
Arrhythmias, depression, cachexia, CKD, sexual dysfunction, sudden cardiac death
46
What are you looking for on a urine dip for someone with HF?
Proteinuria = indicates CKD
47
What meds should be stopped in HF?
NSAIDs
48
How is bisoprolol different to atenolol?
More cardioselective
49
What is involved in annual review for HF?
depression screen, flu jab, BP, med review, bloods (FBC, U+E)
50
What was the INTERHEART study?
Canadian lead = 9 modifiable RF accounted for \>90% of MI
51
S+S of left sided HF
Fatigue Syncope Hypotension Cool extremities Slow CRT Peripheral cyanosis Pulsus alternans Mitral regurg S3 Cough, SOB + crackles
52
S+S of right sided HF
Same as left + tricuspid regurg + right sided S3 Peripheral oedema, elevated JVP, hepatomegaly, pulsatile liver
53
5 most common causes of CHF
CAD HTN Idiopathic (dilated cardiomyopathy) Valvulat Alcohol (dilated cardiomyopathy)
54
Precipitants of HF exacerbation
Forgot medication Arrhythmias/ aneia Ischemia/ infarction/ infection Lifestyle Upregulations of cardiac output - pregnancy, hyperthyroidism Renal failure Embolism

Cardiovascular (15 decks)

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