Heart Failure + Cardiomyopathy

Question 1

what is the definition of heart failure

Answer 1

cardiac output doesn’t meet the body’s requirements

Question 2

what’s the prognosis of HF

Answer 2

25-50% within 5 years

Question 3

what is systolic failure?

Answer 3

ventricle can’t contract normally so decreased cardiac output

Question 4

what is diastolic failure?

Answer 4

ventricle can’t relax and fill properly causing increased filling pressures

Question 5

what is the ejection fraction in diastolic

Answer 5

50%

Question 6

causes of systolic failure

Answer 6

IHD (ischaemic heart disease), MI, cardiomyopathy

Question 7

causes of diastolic failure

Answer 7

constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension

Question 8

what are the symptoms of left ventricular failure

Answer 8

dyspnoea, PND, orthopnoea, poor exercise tolerance, wheeze, nocturia, cold peripheries, weight loss, muscle wasting

Question 9

what are the symptoms of right ventricular failure

Answer 9

peripheral oedema, ascites, nausea, anorexia, facial engorgement, pulsation in neck and face (tricuspid regurg), epistaxis

Question 10

causes of RVF

Answer 10

LVF, pulmonary stenosis, lung disease

Question 11

what is acute heart failure

Answer 11

new onset acute or decompensation of chronic HF; pulm and or peripheral oedema with or without signs of peripheral hypoperfusion

Question 12

what is chronic heart failure

Answer 12

develops/progresses slowly. venous congestion common but arterial pressure well maintained until very late

Question 13

what is low output HF

Answer 13

cardiac output low and fails to increase with exertion

Question 14

causes of low output HF

Answer 14

pump failure (low HR, systolic and or diastolic failure, -vely inotropic drugs), excessive preload (mitral regurg, fluid overload- NSAIDS causing retention), chronic excessive afterload (aortic stenosis, hypertension)

Question 15

what is congestive heart failure

Answer 15

LVF and RVF

Question 16

what is high output HF

Answer 16

rare. output normal or increase to meet needs, but fails.

Question 17

causes of high output HF

Answer 17

anaemia, pregnancy, hyperthyroidism, Pagets, beri beri, arteriovenous malformation

Question 18

what is the initial presentation of high output HF

Answer 18

RVF, then later signs of LVF

Question 19

what criteria is made to diagnose

Answer 19

Framingham

Question 20

Framingham criteria requires 2 maj and 1 minor criteria or 1 maj and 2 min. what are the major criteria?

Answer 20

PND, creps, S3 gallop, neck vein distention, acute pulm oedema, increased hepatojugular reflex, cardiomegaly, weight loss, increased central venous pressure

Question 21

what are the minor criteria

Answer 21

bilat ankle oedema, dyspnoea, nocturnal cough, tachycardia, decr vital capacity, hepatomegaly, pleural effusion

Question 22

other signs HF

Answer 22

exhaustion, cool peripheries, cyanosis, decr BP, narrow pulse pressure, displaced apex, rv heave, murmurs, wheeze

Question 23

if what 2 tests are normal makes HF unlikely

Answer 23

ECG, BNP. if one abnormal do echo

Question 24

what is the ABCDE of ECG showing LVF

Answer 24

Alveolar oedema (bats wings), Kerley B lines (interstitial oedema), Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion

Question 25

what may ECG show

Answer 25

cause- ischaemia, LVH, MI

Question 26

what may echo show

Answer 26

cause- valvular disease, MI, LV dysfunction

Question 27

what is the management in chronic heart failure

Answer 27

treat the cause, treat exacerbating factors, avoid exacerbating factors eg NSAIDs, verapamil, drugs

Question 28

what are the drugs used in chronic heart failure

Answer 28

diuretics, ACE-I, B blockers, spironolactone, digoxin, vasodilators

Question 29

what is the New York classification of heart failure

Answer 29

I- heart disease present, no dyspnoea. II- comfortable at rest, dyspnoea ordinary activities. III- less than ordinary activities cause dyspnoea which is limiting. IV- dyspnoea present at rest, all activity causes discomfort.

Question 30

what is dilated cardiomyopathy

Answer 30

dilated, flabby heart of unknown cause

Question 31

what are the associations with dilated cardiomyo

Answer 31

alcohol, incr BP, haemochromatosis, viral infection, autoimmune, peri or post partum, thyrotoxicosis, congenital

Question 32

presentation of dilated cardiomyo

Answer 32

fatigue, pulm oedema, RVF, emboli, AF, VT.

Question 33

signs of dilated cardiomyo

Answer 33

incr pulse, decr BP, incr JVP, displaced diffuse apex, S3 gallop, mitral or tricuspid regurg, pleural effusion, oedema, jaundice, hepatomegaly, ascites

Question 34

tests for dilated cardiomyo

Answer 34

BNP, decr Na; CXR- cardiomegaly and pulm oedema; ECG- tachycardia, T wave changed, poorR wave progression. Echo- dilated hypokinetic heart, low ejection fraction (MR, TR,LV mural thrombus)

Question 35

treatment dilated cardiomyo

Answer 35

diuretics, digoxin, ACE-I, anticoag, pacing, ICDs, transplant

Question 36

mortality of dilated cardiomyo

Answer 36

40% in 2 years

Question 37

what is hypertrophic cardiomyo

Answer 37

LV outflow tract obstruction from asymmetrical septal hypertrophy

Question 38

what are the genetics involved in HCM

Answer 38

autosomal dominant but 50% sporadic. 70% mutations in genes encoding B myosin, alpha tropomyosin, troponin T. presents at any age

Question 39

symptoms and signs HCM

Answer 39

VF, angina, dyspnoea, palpitation, syncope, CCF, jerky pulse, alpha wave in JVP, double apex beat, systolic thrill

Question 40

what can the ECG show for HCM

Answer 40

LVH, T wave inversion, deep Q waves, AF, WPW, ventricular ectopics, VT

Question 41

what would the echo show for HCM

Answer 41

asymmetrical septal hypertrophy, small LV cavity, midsystolic closure of aortic valve

Question 42

treatment for HCM

Answer 42

B blockers, verapamil- reduce ventricular contractility. amiodarone for arrhythmias. anticoagulate for paroxysmal AF or systemic emboli

Question 43

what is the mortality HCM

Answer 43

5.9% per year if 14 years

Question 44

what are the causes of restrictive cardiomyopathy

Answer 44

idiopathic, amyloidosis, haemochromatosis, sarcoidosis, scleroderma, Lofflers eosinophilic endocarditis, endomyocardial fibrosis

Question 45

what are the types of cardiomyopathy

Answer 45

dilated, hypertrophic, restrictive

Question 46

what is the presentation of restrictive cardiomyo

Answer 46

like constrictive pericarditis. features RVF- incr JVP, hepatomegaly, oedema, ascites

Question 47

diagnosis of restrictive cardiomyo

Answer 47

cardiac catheterisation

Question 48

what is acute myocarditis

Answer 48

inflammation of the myocardium

Question 49

causes of myocarditis

Answer 49

viral (flu, hep, mumps, coxsackie, polio, HIV), bacterial (clostridia, diphtheria, TB, meningococcus, mycoplasma), spirochetes (lyme, syphilis), toxins, vasculitis

Question 50

what drugs can lead to acute myocarditis

Answer 50

cyclophosphamide, Herceptin, penicillin, chloramphenicol, sulphonamides, methyldopa, spironolactone, phenytoin, carbamazepine

Question 51

symptoms and signs acute myocarditis

Answer 51

fatigue, dyspnoea, chest pain, fever, palps, tachy, soft S1, s4 gallop

Question 52

what does the ECG show in acute myocarditis

Answer 52

ST elevation or depression, t wave inversion, atrial arrhythmias, transient AV block,

Question 53

what confirms diagnosis acute myocarditis

Answer 53

positive troponin.

Question 54

what excludes active myocarditis

Answer 54

negative antimyosin scintigraphy