Investigations + treatments Flashcards
(33 cards)
Bloods FBC?
Anaemia
Bloods Blood cholesterol, glucose and HbA1c?
abnormal cholesterol and glucose are risk factors for ischaemic heart disease.
Bloods TFTs?
hyperthyroidism can cause tachycardia and high-output cardiac failure.
Bloods U&Es?
if you think the patient is fluid overloaded, need to give diuretics
Bloods BNP?
hormone that is released by ventricular cells in heart failure, has high negative predictive value (tells if you don’t have heart failure).
CXR?
signs of heart failure,
pneumonia,
pleural effusion,
bronchiectasis,
or fibrosis.
image shows pulmonary fibrosis
ECG?
normally abnormal in patients with heart failure, an important cause of heart failure is necrosis to areas of the heart by previous MI.
Peak expiratory flow rate?
stratify the severity of an asthma attack in chronic asthma.
Spirometry?
used to distinguish between restrictive (FVC <70% and FEV1 >70%) and obstructive (FEV1<70% and FVC >70%)lung diseases.
how does heart failure explain SOB?
not pumping enough blood, back pressure forces fluid out from the pulmonary vasculature into the alveoli so decreased lung compliance, decreased gas exchange and airway obstruction
How does heart failure explain orthopnoea?
lying down increases venous return to the heart making congestion of blood in the pulmonary vessels worse forcing more fluid into the lungs
How does heart failure explain displaced apex beat?
doesn’t pump out all the blood, so dilates displacing apex beat. This is a volume overloaded heart, not hypertrophic (which is caused by hypertension and aortic stenosis and is a pressure overloaded heart).
How does heart failure explain crackles in lungs?
fluid in alveoli collapses them, as patient breathes in deeply, they pop back open
How does heart failure explain peripheral oedema?
heart cant cope with venous return, leading to back pressure in venous system, can manifest as raised JVP and hepatomegaly + tender, and fluid is forced out into surrounding tissue.
Treatment for congestive heart failure secondary to ischaemic heart disease. Symptomatic relief?
left ventricular failure leads to pulmonary oedema. Sit them upright, give O2, reduce cardiac preload with vasodilators and morphine to reduce sensation of SOB.
Treatment for congestive heart failure secondary to ischaemic heart disease. Pathophysiological mechanism?
reduce the O2 demand of the heart with Beta blockers which slow heartbeat.
Inhibit the renin-angiotensin-aldosterone system with ACE inhibitors, this reduces reabsorption of Na and water from the kidneys
Treatment for congestive heart failure secondary to ischaemic heart disease. Treat underlying cause?
the most common cause of heart failure atherosclerosis of the coronary arteries.
To prevent it getting worse, give statin to reduce cholesterol, aspirin to reduce risk of thrombosis
Reasons for postoperative SOB (5)?
Atelectasis; (alveolar collapse), pain stops patients breathing properly and mucus eventually plugs the bronchioles preventing air entry, the areas of lung collapse as air is absorbed into surrounding tissue.
Pneumonia; poor clearance of mucus and weakened immune response.
Pulmonary oedema; due to heart failure or excessive fluids.
PE; DVT isn’t uncommon after surgery due trauma and immobilisation.
Anaemia; if there’s blood loss.
Management of asthma?
Avoidance of triggers; smoke, pets, any allergens, exercising…
Bronchodilation; Beta agonists increase sympathetic stimulation to the heart.
Reduction of immune response in lungs; inhaled corticosteroids
Chronic bronchitis?
productive cough every day for >3 consecutive months a year for at least 2 years.
COPD management?
Stop smoking, inhaled therapy (Beta2 agonists, inhaled corticosteroids should be added to long acting bronchodilators in patients with exacerbations), pulmonary rehab (physio, exercise), vaccination, non-invasive ventilation (NIV), long term O2 to hypoxic patients
Restrive lung pathology?
FEV1 >70% but FVC <70%. Interstitial lung disease is restrictive and fits with fine crackles in all lung fields.
Difference between asthma and COPD?
Asthma is a reversible and transient obstruction of the airways caused by excessive mucus production, airway inflammation and constriction of the bronchi.
COPD is irreversible and progressive obstruction of the airways with a history of chronic bronchitis and emphysema.
Short-acting bronchodilators?
Salbutamol; Beta2 agonist. Ipratropium; antimuscarinic/cholinergic, often used in COPD, but less in asthma
