Shortness of Breath Flashcards by Anouk Wijeratne

What are the three categories of why someone might be breatheless?

Not enough oxygen reaching the lungs
Not enough reaching the blood
Not enough reaching the rest of the body

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What are the cardiac causes of breathlessness?

Heart Failure
Cardiomyopathy
Constrictive Pericarditis
Myocarditis

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Define heart failure

The failure of the heart to maintain CO to meet body’s demands

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How can HF be classified?

Acute or Chronic
Left or Right or Both
High or Low output state

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What is HF where both sides of the heart are effect known as?

Congestive HF

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What is the natural history of Congestive HF?

LH to start
Pressure backs up into the pulmonary system
Backs up into RH

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What is low output state HF?

Heart fails to pump un response to normal exertion

Low CO

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What is high output state HF?

CO is normal but higher metabolic needs

e.g. pregnancy, anaemia and hyperthyroidism

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What are the causes of LHF?

Valvular
Muscular
Systme

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What are the valvular causes of LHF?

Aortic stenosis
Aortic regurg
Mitral regurg

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What are the muscular causes of LHF?

IHD
Cardiomypopathy
Myocarditis
Arrythmias

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What are the systemic causes of LHF?

HTN
Amyloidosis
Drugs e.g. cocaine, chemo

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What are the causes of RHF?

Lungs

Valvular

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What are the lung related causes of RHF?

Pulmonary HTN
PE
Chronic lung ddisease

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What are the valvular causes of RHF?

Tricuspid regurg

Pulmonary valve disease

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High output heart failure causes?

NAP MEALS

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Which vein does the LHS of the heart receive blood from?

Pulmonary veins

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What causes symptoms in LHF?

Fluid accumulates in lungs –> respiratory systen

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What causes symptoms in RHF?

Fluid accumulates in the peripheries –> swelling signs

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What are the symptoms of LHF?

Dyspnoea
Nocturnal cough (pink, frothy sputum)
Fatigue

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What types of dyspnoea can be present in LHF?

Paroxysmal nocutrnal
Exertional
Orthopnoea

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What cardiac signs are present in HF?

High HR
High RR
Irregulary irregular pulse
Pulsus alternans
Dispaced apex beath
S3 Gallop
S4 in severe HF
Murmur (AS, MR, AR)

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Why do we get signs in LHF?

Consequence of HF

Because of the underlying cause of the HF

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What are some signs of RHF?

Face swelling
Raised JVP
Weight gain
Ascites

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What investigations should be done for HF?

ECg FBC, U&Es, LFTs, TFTs, BNP CXR, TTE

Why do a CXR for HF?

Rule out MI

What is a TTE?

Trans-thoracic echocardiography Gold standard for HF

What is BNP? When is it raised?

Released when heart muscle stretches

What is the issue with BNP?

Sensitive but not specific If high need to do TTE to confirm

What does TTE allow us to do?

Visualise the structure and function of the heart Calculate the EF

What are the CXR signs for HF?

``` Alveolar oedema B-lines Cardiomegaly Dilated upper lobe vessels Diverted upper lobe Effusion ```

What is the criteria for HF diagnosis clinically?

Framingham criteria

What are the major framingham criteria?

Paroxysmal nocturnal dyspnea Weight loss of 4.5 kg in 5 days in response to treatment Neck vein distention Rales Acute pulmonary edema Hepatojugular reflux S 3 gallop Central venous pressure greater than 16 cm water Circulation time of 25 seconds or longer Radiographic cardiomegaly Pulmonary edema, visceral congestion, or cardiomegaly at autopsy

What are the minor framingham criteria?

Ankle edema, night cough, dyspnea on exertion, hepatomegaly, tachycardia and weight loss

What is the management for Chronic HF?

Treat underlying cause Treat the exacerbating factors Lifestyle modification Drugs

What are the drugs for HF?

ABD Villiers ACE inhibitors Beta Blockers Diuretics

In which HF patients should ACE inhibitors be given?

Anyone with LV dysfunction

Why are beta blockers used?

To reduce O2 demand

What can be used in place of ACEi if not tolerated?

ARB Sometimes get cough with ACEi

When are diuretics used?

Evidence of fluid retention

What are some ACEi?

-pril

What are some Beta blockers?

-olol

What are some diuretics?

Furosemide

Define cardiomyopathy

A group of diseases in which the myocardium becomes structurally and functionally abnormal - in the absence of CAD, valvular disease and congenital heart disease

What are the types of cardiomyopathy?

Dilated Hypertrophic Restrictive

What are the types of cardiomyopathy?

Dilated Hypertrophic Restrictive (less compliant muscle)

How might cardiomyopathy present?

HF symptoms SOB on exertion Fainting Fatigue Ask about FH Esp. sudden death

Signs of cardiomyopathy on examination?

Respiratory crackles | Murmurs S3, S4

Describe the pathophysiology of dilated cardiomyopathy?

Ventricles enlarge and become dilated Walls thin and weaken, cannot contract well Law of LaPlace

What are the RFs for dilated cardiomyopathy?

Alcohol Post-viral Haemochromatosis Genetic

What are the signs of dilated cardiomyopathy?

Displaced apex beat TR/MR murmur SM

What will you see on investigation in dilated cardiomyopathy?

Globular heart CXR

What is the pathophysiology for HOCM

H for hench Muscle thickens inward Increased stiffness Thickened muscle disrupts electrical conduction

What are the symptoms of HOCM?

``` Usually asympto Sudden cardiac death Angina Dyspnoea on exertion Palpitations Syncope ```

What are the signs of HOCM?

Ejection systolic murmur Jerky carotid pulse Double apex beat NOT DISPLACED (muscles grows inwards) S4

What is the pathophysiology of restrictive cardiomyopathy?

R for rigid Ventricles become abnormally rigid and lose flexibility Impaired ventricular filling Reduced preload Reduced blood flow and backing up of blood

What are some causes of restrictive cardiomyopathy?

Sarcoidosis Amyloidosis Famililal Idiopathic

What does HOCM stand for?

Hypertrophic cardiomyopathy

What are the causes of constrictive endocarditis?

Idiopathic Infectious (TB, ba Acute pericarditis Cardiac surgery and radations

What are the signs/symptoms of constrictive pericarditis?

Similar to restrictive cardiomyopathy RHF presentation Kussmaul's

What are the investigations for constrictive pericarditis?

CXR - pericardial calcification | Echo - increased pericardial thickness

What are the causes of constrictive endocarditis?

Idiopathic Infectious (TB, bacterial, viral) Acute pericarditis Cardiac surgery and radations

What are the causes of myocarditis?

``` Infectious Drugs Metals Radiation Coxsackie B virus ```

What are the signs and symptoms of myocarditis?

Flu-like prdome Chest pain SOB Palp

Define myocarditis

Inflammation of the myocardium

What are the signs and symptoms of myocarditis?

Flu-like prodome Chest pain SOB Palpitations

Shortness of Breath Flashcards

(66 cards)