heart failure Flashcards
(36 cards)
what are left sided HF symptoms
respiratory:
dyspnea on exertion
orthopnea
paroxysmal nocturnal dyspnea
wheezing
right sided heart failure
symptoms spread to body:
peripheral edema
ascites
raised JVP
hepatomegaly
what is heart failure with reduced ejection fraction
-EF <45
-systolic dysfunction gets impaired so contraction is bad
-dilation of the heart (high LV volume)
-added s3 sound (dilated ventricle) lub-dub-ta
-MI , valvular heart disease, dilated cardiomyopathy
heart failure with preserved ejection fraction
-EF is = or more than 50%
-diastolic dysfunction, left ventricle becomes stiff and less compliant affect the filling process
-ejection fraction is within normal range
-added s4 sound
causes : LV hypertrophy and HTN
what do u request if what to know EF
echocardiogram
transthoracic echo best initial test (shows chamber dilation/hypertrophy)
what component in blood test do u look for to exclude CHF to determine etiology of acute dyspnea
BNP
why do u ask for thyroid function test in HF patients
o Thyroid function (esp. in those with A. Fib; both hypo and hyperthyroid : HF)
what is the tx of HF
o ACE I/ ARB: Must be given to all patients at all stages
o B-Blockers: Benefit only with Metoprolol, Bisoprolol, Carvedilol (mnemonic: MBC)
o Mineralocorticoid antagonists (Spironolactone)
SE: hyperkalemia and gynecomastia (less with eplerenone) o Hydralazine and isosorbide dinitrates
o ARNI (angiotensin receptor-neprilysin inhibitor)
when to do coronary revascularization
is the cause is CAD to prevent further ischemia and promote recovery of function
coronary artery disease
insufficient perfusion of coronary arter due to decreased supply or increased demand
what is the most common cause of coronary artery disease
obstruction(coronary atherosclerosis)
coronary arter diease is dived into two
stable angina and acute coronary syndrome
risk factors of coronary artery disease
male gender
smoking
age>45
fam history of premature CAD
DM
HTN
obesity no exercise
drugs
alcohol/cocaine
what is common presentation of angina
central or substernal heavy tight gripping chest pain that may radiate to jaw/arms caused by MI due to imbalance btwn blood supply and o2 demand
features of stable angina
-chest pain on exertion/ stress/emotion
-lasts 5-15min (gradual onset)
-no pain at rest
-releived by rest or GTN
features if unstable angine
• Chest pain at rest
• Crescendo/deterioration in previously
stable angina
• Angina of recent onset (<24 h)
• Due to reduced resting coronary blood
flow, not due to demand
• Usually >15 mins, not relieved by rest
• No ST elevation, normal cardiac
enzymes
what do u request if suspect angina
Workup:
• Blood tests:
o CBC, coagulation profile
o Lipid profile, fasting glucose, HbA1c
o TFT, RFT
o Troponin (done to exclude MI in unstable angina; should be negative)
• Chest x-ray
• Resting ECG: usually normal. May show ST depression and T-wave inversion
during attack. Normal between attacks.
• Holter monitoring to detect silent ischemia (diabetics/elderly)
• Stress test:
o Done if normal ECG
tx of stable angina
BB
GTN
CCB- avoid if low EF
aspirin statins given to all pts
tx of unstable angina
aspirin
anticoagulants
nitrates- dilate BVs
BB
statins (lower chol lvl)
what is rheumatic fever
•Infection with Group A Streptococcus Pyogens (GAS) –> autoimmune reaction.
• Develops 2-3 weeks after the onset of sore throat.
• While rheumatic heart disease is the chronic valvular abnormalities secondary to acute rheumatic fever mostly MS.
what is seen in pathology pf the heart in rheumatic fever
Aschoff’s bodies
what is the diagnostic criteria for rheumatic fever
Major criteria: Mnemonic: Jones (J♥NES)
o Joints: Polyarthritis of large Joints; fleeting
o ♥: Cardiac: murmurs (MR or AR), CHF, pericarditis (pericardial rub)
o Subcutaneous Nodules over tendons/joints/bony prominences
o Erythema marginatum (transient pink coalescent rings on trunk)
o Sydenham’s chorea (involvement of CNS)
• Minor criteria:
o Fever
o ESR or CRP elevated or Leukocytosis (acute phase reactants)
o Prior history of rheumatic fever or rheumatic heart disease
o Prolonged PR interval on ECG
o Arthralgia
• Diagnosis requires 2 major criteria OR 1 major and 2 minor + throat culture
what is the tx of rheumatic fever
pencillin
what are categories rules for rheumatic fever antibiotic treatmet
-Rheumatic Fever with carditis and residual heart disease (persistence valvular disease) :10 years or until age 40 whichever longer
-RF with carditis but no heart disease (valvular) : 10yrs or until age 21 whichever longer
-RF without carditis : 5yrs or until age 21
choose whatever longer for extra protection
