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Flashcards in LOBS Deck (32):
1

what is the immediate management of heart failure?

high flow oxygen
diamorphine
furosemide
GTN spray

2

what is the point of giving a loop diuretic for heart failure?

Increases sodium and water excretion
reduces preload
vasodilation

3

what are the side effects of loop diuretics?

hypotension
hypovalaemia
dose related hearing loss

4

what is the neurohormonal model of heart failure?

decreased CO leads to neurohormonal activation
two pathways of neurohormonal release
1. RAAS activation leading to increased preload and vascular resistance. also leading to aldosterone release causing vasoconstriction and hypertrophy

2. sympathetic activation; increased vascular resistance and after load. increased catecholamine release meaning increased workload

5

why do ACE inhibitors help in heart failure?

Decrease mortality and help prevent RAAS cycle in the neurohormonal model

6

why do beta blockers help in heart failure?

symptom relief and mortality

prevent renin release due to bet 1 receptors
decrease rate and contractility.

7

why does spirolactone help in heart failure?

It's an aldosterone antagonist
increases sodium and water loss decreasing preload
helps mortality

8

what are causes of aortic stenosis?

1. congenital in people born with a bicuspid valve
2. calcification associated with smoking and hypertension
3. Williams syndrome
4. post rheumatic valve

9

what are problems seen in Williams syndrome?

aortic stenosis
hernias
dental issues
renal issues
sensitive hearing
retardation
low birth weight

10

what are clinical features of aortic stenosis?

SOB
chest pain
syncope
ejection systolic murmur
narrow pulse pressure
slow rising pulse

11

what is the management of aortic stenosis?

observe if there are no symptoms
aortic valve replacement
transcatheter aortic valve implantation

12

when is an aortic stenosis patient considered for surgery?

Area <1cm
spontaneous symptoms
abnormal LV systolic function

13

what is aortic regurgitation?

the valve leaflets become incompliant and there is a leakage of blood into the LV during diastole

14

what are causes of aortic regurgitation?

1. congenital due to a bicuspid valve
2. aortopathy
3. acquired
4 syphilis
5. acute

15

what are causes of aortopathy aortic regurg?

collagen disorderes
ehler danlos
osteogenesis imperfect

16

what are causes of acquired aortic regurgitation?

rheumatic heart disease
dilated aorta
degeneration
giant cell arteritiis

17

what are signs of aortic regurgitation?

diastolic murmur
widened pulse pressure
displaced apex

18

what is the management of aortic regurgitation

Surgery
ACE inhibitor/ Ca channel blocker to reduce afterload

19

what are causes of mitral regurgitation?

1. leaflet problems such as myomatous MV disease, rheumatic, endocarditis
2. chordae causes
3. annulus problems
4. papillary muscles
5. LV dilation

20

what are the effects of BNP and ANP?

increased GFR, decreased sodium reabsorption, decreased fluid load

REDUCES PRELOAD

21

what causes release of ADH?

hypotension
nausea
increase osmolality
angiotensin II
adrenaline
cortisol
nicotine

22

what is laplaces law?

pressure = 2 x wall tension/ radius

23

how does laplaces law relate to heart failure?

As the radius of the cardiac chamber increases more tension is needed to create the same pressure

24

what causes pulsatile hepatomegaly and a 3rd heart sound?

tricuspid insufficiency

25

what are three types of AF?

paroxysmal: sself terminates in 7 days

persistant: lasts longer than 7 days and needs termination by cardioversion

long standing: over 1 year

26

what are complications of AF?

loss of atrial contraction reducing CO

thromboembolism

stroke

MI

heart failure

27

what is the management for acute AF?

direct current cardioversion in haemodynamic instability or when medication fails

28

what can be given for pharmacological cardioversion for AF?

IV flecainide, IV amiodarone, verapamil

29

what is the management for stable angina that started under 48 hours ago?

offer rate and rhythm control
start heparin

30

what can be offered for rate control in AF?

beta blocker and rate limiting calcium channel are first choice

31

what can be offered for rhythm control in AF?

cardioversion, pacing

32

who can't be given beta blockers?

people with ashtma