MedED cardiac SOB Flashcards
(98 cards)
1
Q
What are some reasons that SOB arises?
A
Not enough oxygen reaching the lungs eg asthama, COPD
Not enough oxygen getting into the blood eg PE, pulmonary oedema and fibrosis
Not enough oxygen reaching the rest of the body eg heart issues, anaemia, shock
2
Q
What is the definition of heart failure?
A
The failure of the heart to maintain a cardiac output that is reuqired to meet the bodies demands
3
Q
What are the 3 ways heart failure can be classified?
A
Acute or chronic
Left or right
High output state or low output state
4
Q
What are the 2 main causes of acute heart failure?
A
Acute coronary syndrome ie massive heart attack causing the heart muscle to fail
Decompensation of chronic heart failure
5
Q
What is the combination of right and left heart failure called?
A
Congestive heart failure
6
Q
What is congestive heart failure?
A
Right and left heart failure
7
Q
In congestive heart failure which side of the heart if affected first?
A
Left
This then progresses to cause right heart failure
8
Q
What is a low output state in HF?
A
Heart fails to pump in response to normal exertion causing low cardiac output
9
Q
What is a high output state in HF?
A
Cardiac output is normal but there is increased metabolic demand eg pregnancy, anaemia hyperthyroidism etc
10
Q
What are valvular causes of chronic left heart failure?
A
Aortic stenosis
Aortic regurg
Mitral regurg
11
Q
What are muscular causes of chronic left heart failure?
A
Ischaemia
Cardiomypathy
Myocarditis
Arrhythmias (AF)
12
Q
What is the biggest systemic causes of chronic left heart failure?
A
Hypertension
13
Q
What are lung causes of chronic right heart failure?
A
Pulmonary hypetension (cor pulmonale) Pulmonary embolism Chronic lung disease eg interstitial, cystic fibrosis
14
Q
What are valvular causes of chronic right heart failure?
A
Tricuspid regurg
Pulmonary valve disease
15
Q
What are the 3 main causes of high output heart failure?
A
Hyperthyroidism
Anaemia
Pregnancy
16
Q
Where does fluid accumulate in left heart failure?
A
Lungs
17
Q
Where does fluid accumulate in right heart failure?
A
Peripheries
18
Q
What type of symptoms do you get with left heart failure?
A
respiratory
19
Q
Where does fluid accumulate in right heart failure?
A
Swelling signs
20
Q
What are symptoms of left HF?
A
Dyspnoea
Paroxsymal nocturnal dyspnoea
Nocturnal cough
Fatigue
21
Q
What is a buzz word for left HF?
A
Coughing up pink frothy sputum- due to pulmonary oedema
22
Q
What might you ask in OSCE when taking a history and you suspect left heart failure?
A
SOB: how far are you able to walk ie how many steps before you need to catch a breath, how many flights of stairs can you climb
Orthopnoea: have you noticed anything makes your sob worse? what about lying down or standing up
PND: do you wake up gasping for air, how many pillows do you need to sleep at night
23
Q
What are signs for left heart failure?
A
Heart= high HR and RR, S3 gallop, S4 if severe HF, may be an arrhythmia, murmur (AS, MR, AR) Lungs= due to pulmonary oedema fine end inspiratory crackles at lung bases, wheeze due to cardiac asthma
24
Q
What are signs of right heart failure?
A
Face: swelling Neck: raised JVP Heart/chest: TR murmur, high HR and RR Abdomen: ascites, hepatomegaly Other: ankle and pitting oedema
25
What are symptoms of heart failure?
```
Fatigue
Reduced exercise tolerance
Anorexia
Nausea
Nocturia
```
26
What is the main difference in symptoms between left and right heart failure?
```
Left= breathing symptoms
Right= swelling symptoms
```
27
What investigations are done for heart failure?
Bedside= ECG
Bloods=FBC, U+Es, LFTs, TFTs, BNP
Imaging= CXR, trans thoracic echocardiogram
28
What blood tests is most important for heart failure?
BNP
29
What is the gold standard imaging for diagnosing HF?
Trans thoracic echocardiogram coupled with a doppler
30
What is the sensitivity and specificity of BNP and what does this mean?
It is highly sensitive- this means if its low they arent in heart failure
It is not specific- this means if its high they may be in heart failure but other things also cause a high BNP
31
When is BNP released?
Whenever the ventricles are streched
32
What does TTE with doppler allow you to see and conclude in heart failure?
Allows you to see the structure and function of the heart and may show the cause of HF
Can calc EF
33
What is a normal EF?
50-70%
34
What occurs in HFrEF?
There is systolic dysfunction- the ventricles are unable to contract properly
35
What occurs in HFpEF?
The ventricles are unable to relax and fill normally
36
What type of HF do you get when systole vs diastole is impaired?
Impaired systole= HFrEF
| Impaired diastole= HFpEF
37
What are some chest x ray signs of heart failure?
Pleural effusion
Kerley B lines
Increased cardiothoracic ratio
38
Go through chest x ray A-E for someone with HF?
A- lveolar oedema
B- line (Kerley)
C- ardiomegaly
D- ilated upper lobes vessels and diverted upper lobe
E- ffusion (transudative pleural effusion)
39
What type of effusion do you get in heart failure?
Transudative pleural effusion
40
What criteria is clinically used to diagnose HF?
Framingham criteria
41
What score is needed on Framingham's criteria for diagnosis of HF?
2 majors or 1 major and 2 minors
42
What is Framingham's criteria?
It is used to clinically diagnose HF
43
How is chronic HF managed?
Treat underlying cause
Treat exacerbating factors
Lifestyle modifications- smoking cessation, diet (reduce salt intake), exercise
Pharmacologically- ABD (ace inhibitors, beta blockers, diuretics)
44
What 3 drugs are given for chronic HF?
Ace inhibitor
Beta blocker
Diuretic
45
Why are ace inhibitors used in chronic HF?
For left ventricular dysfunction- it reduces hypertension and stops heart failure from getting worse due to the hypertension
46
Why are beta blockers used in HF?
To reduce the oxygen demand of the heart muscle itself
47
Why might it seem beta blockers would be contraindiciated in heart failure and why aren't they?
They usually reduce cardiac output and if someone with HF had HFrEF why would you want to further reduce their cardiac output?
But they are given because they reduce the oxygen demand of the heart uscle itself and are therefore therapeutic
48
In heart failure if you have a low cardiac output which 2 systems are upregulated?
Sympathetic nervous system and renin angiotensin system
49
What are the 2 main types of diuretic given in heart failure and give an example of each
Loop diuretics- furosemide
| Aldosterone antagonists- spironolactone
50
What are some medications used in chronic HF? Give an example of each
```
Ace inhibitors- enalapril, ramipril
Beta blocker- bisoprolol, metoprolol
Diuretics- furosemide, spironolactone
Hydralazine+ nitrates
Digoxin
Cardiac resynchronisation therapy
```
51
How is acute HF managed?
```
Emergency, treat with ABC:
Sit them upright
Give oxygen (60-100%)
IV diamorphine 2.5-5mg (pain relief)
GTN (especially if due to CHD)
IV furosemide
```
52
What acronym can be used to remember how to treat acute HF?
```
DMONS:
Diuretics
Morphine
Oxygen
Nitrates
Sit up
```
Note: the acronym doesn't represent what order you should do this all in
53
What is the prognosis of HF?
Very poor (worse than most malignancies), if severe most patients will die in 2 years
54
What are complications of heart failure?
Respiratory failure
Renal failure (due to hypoperfusion)
Acute exacerbations
Death
55
What happens to cardio thoracic ratio in heart failure?
It is increased
56
Which lobes are diverted in heart failure?
Upper lobes
57
What is cardiomyopathy?
A group of the disease where the myocardium becomes structurally and functionally abnormal
58
What is the difference between primary and secondary cardiomyopathy?
```
Primary= confined to the myocardium
Secondary= part of a systemic disease
```
59
What must be absent in cardiomyopathy?
CAD
Valvular disease
Congenital heart disease
60
What are the layers of the heart from innermost to outermost?
Endocardium
Myocardium
Epicardium
61
What are the types of cardiomyopathy?
Dilated
Hypertrophic
Restrictive
62
What happens to muscle in restrictive cardiomyopathy?
It doesnt increase or decrease in volume but becomes more rigid eg due to infiltration and also becomes less complaint and effective at pumping
63
How will cardiomyopathy present?
Like HF: SOB, fainting, fatigue
| Can also present with sudden death: ask about family hx
64
What will you see on examination in cardiomyopathy?
S3 and S4 on auscultation
| Respiratory crackles
65
What is the best investigation for cardiomyopathy?
Echo
| Can also do bloods, BNP, stress test, ECG, CXR, cardiac catheterisation
66
What happens in dilated cardiomyopathy?
The ventricles enlarge and become dilated
| The walls are thing and weak so they cant contract effectively and cardiac output is reduced
67
What are the causes of dilated cardiomyopathy?
Alcohol (most common)
| Post viral
68
How can you differentiate dilated cardiac myopathy from HF?
The apex beat will be displaced (to the left)
69
What happens in hypertrophic cardiomyopathy?
The muscle is thicker so it can't pump effectively
| Thick muscle can lead to arrhythmia as it is not as good as conducting electricity
70
What is HOCM?
Hypertrophic obstructive cardiomyopathy= thickened ventricle obstructs the outflow of blood
71
What is the most common cause of hypertrophic cardiomyopathy?
Inherited (50%)
72
How will someone with hypertrophic cardiomyopathy commonly present and who does it most affect?
Usually a young person, who is an athlete and it will present with a sudden collapse out of no where and usually they die
Often patients are asymptomatic but some warning symptoms might be angina, dyspnoea on exertion, palpitations, syncope
73
What are buzz words for HOCM?
Ejection systolic murmur
Jerky carotid pulse
Double apex beat which is not displaced
S4
74
What might an ECG show if there is LVH?
```
Q waves
Left axis deviation
Deep S in V1/V2
Tall R in V5/V6
S in V1 and R in V5 or V6> 7 large squares
```
75
How do you remember what happens in restrictive cardiomyopathy?
R for RHF symptoms
76
What part of the cycle is affected in restrictive cardiomyopathy?
Diastole- there is reduced filling of the heart
77
What happens to preload in restrictive cardiomyopathy?
It is reduced
78
What are the causes of restrictive cardiomyopathy?
```
Infiltrative disease (they often end in 'osis') eg amyloidosis, sarcoidosis, haemochromatosis
Can also be familial and idiopathic
```
79
Which cardiomyopathy is more common?
Dilated and hypertrophic are more common than restricitve
80
How will restrictive cardiomyopathy present?
Asymptomatic
| HF symptoms
81
What are signs of restrictive cardiomyopathy?
RHF signs= raised JVP, S3, ascites, oedema, hepatomegaly
| Kussmaul's sign= paradoxical rise in JVP on inspiration
82
What is a buzzword for restrictive cardiomyopathy?
Kussmaul's sign= rise in JVP on inspiration
83
What are buzzwords for HOCM?
Jerky carotid pulse, double apex beat that isn't displaced, S4, ejection systolic murmur
84
What is constrictive pericarditis?
Chronic inflammation of the pericardium (outermost sac of the heart) with thickening and scarring
85
What are caused of constrictive pericarditis?
Idiopathic
Infectious (TB, bacterial, viral)
Acute pericarditis
Cardiac surgery and radiation
86
What condition will present similarly to restrictive cardiomyopathy?
Constrictive pericarditis
87
What investigation is best for constrictive pericarditis?
Echo
88
How is constrictive pericarditis treated?
Surgical removal of the pericardium can cure the condition
89
How do you differentiate between constrictive pericarditis and restrictive cardiomyopathy?
Echo- you can see if there is increased pericardial thickness and also check the thickness of the myocardium
90
How do restrictive cardiomyopathy and constrictive pericarditis differ in terms of management?
In constrictive pericarditis you can cure the patient by surgically removing the pericardium
In cardiomyopathy there is no cure, the only way would be to do transplant surgery
91
What is myocarditis?
Inflammation of the myocardium
92
What are causes of myocarditis?
Infections- coxsackie B virus is the most common cause
Drugs- cocaine
Metals
Radiation
93
What are signs and symptoms of myocarditis?
Flu like prodrome
Chest pain (worse when lying down)
SOB
Palpitations
94
What investigations are done for myocarditis? What will they show
CK and troponin to rule out other causes of chest pain- they will be raised
ECG- non specific ST and T wave changes
Diagnostic investigation is endomyocardial biopsy but this is not routinely done
95
How can you differentiate myocarditis from thing like restrictive pericarditis etc?
The cardiac biomarkers (troponin and CK) will be raised
| There will be chest pain and this may be worse when lying down
96
What does endomyocardial biopsy diagnose definitively and when is it used? Why is it used then?
It diagnoses myocarditis
It is only used if you have tried to treat myocarditis unsuccessfully to find out what specific agent has caused it
It is only done after initial treatment is unsuccessful because it is very invasive and risky
97
In HOCM what causes sudden death in an asymptomatic patient?
Arrhythmia
98
In HOCM what causes sudden death in a patient who has experienced some warning symptoms before hand?
Obstruction of blood flow from the heart
| Reduced pumping of blood due to stiff myocardium
