Eisenmenger's syndrome + HF + Heart sounds Flashcards
(36 cards)
What is eisenmenger’s syndrome?
Reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension
Why does Eisenmenger’s syndrome occur?
Uncorrected left-to-right leads to remodeling of the pulmonary microvasculature, eventually causing obstruction to pulmonary blood and pulmonary hypertension
What is Eisenmenger’s syndrome associated with?
- Ventricular septal defect
- Atrial septal defect
- Patent ductus arteriosus
What are the features of Eisenmenger’s syndrome?
- Original murmur may disappear
- Cyanosis
- Clubbing
- Right ventricular failure
- Haemoptysis, embolism
What is the management of Eisenmenger’s syndrome?
Heart-lung transplantation
What is acute heart failure?
- Life-threatening emergency
- Sudden onset or worsening of the symptoms of heart failure
- May present with or w/o background history of pre-existing heart failure
- AHF without a past history of heart failure = de-novo AHF
- Decompensated AHF more common (66-75%)
:. presents with a background history of HF
When does acute HF present?
- presents after the age of 65-years
- major cause for unplanned hospital admission in such patients
What is the pathophysiology of AF?
- reduced cardiac output that results from a functional or structural abnormality
What causes de-novo HF?
- Increased cardiac filling pressures and myocardial dysfunction usually as a result of ischaemia
:. reduced cardiac output :. hypoperfusion :. pulmonary oedema
What are less common causes of de-novo HF?
- Viral myopathy
- Toxins
- Valve dysfunction
What are causes of decompensated HF?
- Acute coronary syndrome
- Hypertensive crisis
- Acute arrhythmia
- Valvular disease
What are the signs of decompensated heart failure?
- There is generally a history of pre-existing cardiomyopathy
- Fluid congestion
- Weight gain
- Orthopnoea
- Breathlessness.
What groups are AHF patients characterised into?
- With or without hypoperfusion
- With or without fluid congestion
What are the signs and symptoms of AHF?
What is the BP of AHF patients?
Over 90% of patients with AHF have a normal or increased blood pressure (mmHg)
What is the diagnostic workup for patients with AHF?
- Blood tests – anaemia, abnormal electrolytes or infection.
- Chest X-ray – pulmonary venous congestion, interstitial oedema and cardiomegaly
- Echocardiogram – this will identify pericardial effusion and cardiac tamponade
- B-type natriuretic peptide – raised levels (>100mg/litre) indicate myocardial damage and are supportive of the diagnosis.
What is the management of AHF?
- Oxygen
- Loop diuretics
- Opiates
- Vasodilators
- Inotropic agents
- CPAP
- Ultrafiltration
- Mechanical circulatory assistance: e.g. intra-aortic balloon counterpulsation or ventricular assist devices
Consideration should be given to discontinuing beta-blockers in the short-term.
What are the features of CHF?
- Dyspnoea
- Cough: may be worse at night and associated with pink/frothy sputum
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Wheeze (‘cardiac wheeze’)
- Weight loss (‘cardiac cachexia’): occurs in up to 15% of patients May be hidden by weight gained secondary to oedema
- Bibasal crackles on examination
- Signs of right-sided heart failure:
- raised JVP
- ankle oedema
- hepatomegaly
What drugs have been shown to improve mortality in patients with CHF?
- ACE inhibitors
- Spironolactone
- Beta-blockers
- Hydralazine with nitrates
What is the management of CHF?
- Offer annual influenza vaccine
- Offer one-off pneumococcal vaccine (adults usually require just one dose but those with asplenia, splenic dysfunction or chronic kidney disease need a booster every 5 years)
What is the NYHA classification for HF?
NYHA Class I
- no symptoms
- no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations
NYHA Class II
- mild symptoms
- slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
NYHA Class III
- moderate symptoms
- marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
NYHA Class IV
- severe symptoms
- unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
What causes S1?
- closure of mitral and tricuspid valves
- soft if long PR or mitral regurgitation
- loud in mitral stenosis
What causes S2?
- closure of aortic and pulmonary valves
- soft in aortic stenosis
- splitting during inspiration is normal
What causes S3?
- caused by diastolic filling of the ventricle
- considered normal if < 30 years old (may persist in women up to 50 years old)
- heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
