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Flashcards in SOB Deck (27):
1

What is dyspnea?

Abnormally uncomfortable awareness of breathing

2

what is common DDX for dyspnea?

CHF
Angina
Obstructive airway Dz
Anemia
Hypothyroid
Metabolic acidosis
Anxiety and hyperventilation

3

Dyspnea not related to exertion?

Sudden episode at rest
- PE
- Pneumothorax
- Anxiety

4

What is orthopnea and its ass?

Dyspnea when supine
- CHF, ashthma and COPD

5

What is paroxysmal nocturnal dyspnea (PND)? Ass?

Waking at night from SOB
- CHF and COPD

6

What is Trepopnea and its ass?

Dyspnea when lying on side
- CHF

7

What are the receptors involved for dyspnea that relay to brainstem respiratory centers?

1. Chemoreceptors
- Co2, O2 and pH
2. Stretch receptors
3. Intrathoracic receptors

8

What is CHF?

Syndrome of dyspnea on exertion, edema of lungs or extremities and fluid retention resulting from cardiac dysfunction

9

What is high output failure?

Persistent high CO that eventually results in ventricular dysfunction

Caused by anemia, beriberi, thyrotoxicosis , pregnancy and AV fistulas

10

Systolic vs diastoli dysfunction?

Systolic is ventricular contractile dysfunction caused by CAD, HTN, Dilated congestive cardiomyopathy (Viral, ETOH, B-blockers and Ca blockers)

11

Systolic vs diastoli dysfunction?

Diastolic is prolonged ventricular realization time and resistance to filling (ventricular stiffness) caused by HTN and increased Age

12

What is BNP?

B-Types natriuretic peptide
- Neurohormone secreted from the cardiac Ventricles in response to volume expansion and pressure overload

Helps diff CHF from other causes of dyspnea

13

What are the sx of HF?

Dyspnea L
Orthopnea L
PND L
Fatigue L and R
Weakness L and R
Leg Edema R
Abdominal fullness R

14

What are the examine findings in CHF?

-Lung crackles
-Dullness to percussion of lung bases
-Elevated JVD
-Positive hepatojugular reflux
-S3 and MR
-Ankle edema
-Hepatomegaly and ascites

15

What er the New york heart ass function classification of CHF?

-Class I – no limitation of physical activity
-Class II – slight limitation. Comfortable at rest, dyspnea or fatigue with activity
-Class III – marked limitation with physical activity, comfortable at rest
-Class IV – symptoms at rest, unable to carry on any physical activity without symptoms

16

How does one dx CHF?

-PE
-CXR (cardiomeg, Pulmonary venous congestio nand pleural effusions)
-ECG rule out MI
-Echo (decrease LV function
-Stress testing or coronary angiography

17

How does one treat CHF?

Fix
- preload
-Myocardial contractility
- Afterload

18

How doe we treat preload in CHF?

Diuretics like furosemide and ethacrynic acid
- Vasodilators like isosorbide, Nitro and nesiritide

19

How does one treat myocardial contractility of CHF?

Digoxin (oral)
Dobutamine (IV only)
Milrione (IV only)

20

Afterload treatment for CHF?

Arterial vasodilators like apresoline
- ACE inhibitors
-Angioreceptor II receptors blockers

21

Neurohumeral treatment for CHF?

Spironolactone
Carvedilol

22

What is Natrecor or nesiritide?

for stage IV HF to improve dyspnea and major SE is HoTN
- Treat BNP

23

How do we treat diastolic dysfunction?

Diuretic and vasodilators are contraindicated
- Ace inhibitors
-B-blockers

24

What is the subset of increase cap pressure?

-vena cava obstruction
-deep venous obstruction
-right atrial HTN

25

What is the subset of reduced lymphatic clearance?

Lymphatic obstruction

26

What is the subset of decreased cap oncotic pressure?

Malnutrition
Liver/renal/GI dz

27

What is the subset of increase cap permeability?

Ca channel blockers
Idiopathic cyclic edema