1. Cardiac SOB Flashcards
What, at its core, causes breathlessness?
Poor carbon dioxide removal
Poor oxygen delivery
What is heart failure?
The failure to the heart to maintain cardiac output required for body’s demands.
How can we classify HF?
Chronic - long term inadequacy to maintain the body’s circulation
Acute - a medical emergency rapid onset, caused by acute coronary syndrome or decompensation of chronic HF
Also by
low output - heart fails to pump in response to normal exertion
high output - normal CO but higher metabolic needs e.g. anaemia, pregnancy
What is congestive heart failure?
Left and right sided heart failure – usually started with congestion in the left that floods into the right
Valvular causes of left heart failure?
Aortic stenosis
Aortic regurg
Mitral regurg
Muscular causes of lhf
Ischaemia
Cardiomyopathy
Myocarditis
Arryhythmias
Systemic lhf causes
Hypertension
Amyloidosis
Drugs e.g. cocaine, chemo
Right hf causes?
Lung causes - pulmonary hypertension
- pulmonary embolism
- chronic lung disease
tricuspid regurg
pulm regurg
congestive HF
Causes of high output HF?
Nutritional
Anaemia
Pregnancy
Malignancy Endocrine Av malformations Liver cirrhosis Sepsis
Symptoms of HF?
LHF - fluid accumulates in lungs causes resp symptoms e.g. dyspnoea (PND, exertional, orthopnoea - how many pillows), nocturnal cough with pink frothy sputum (pulm oedema, fatigue
RHF - fluid accumulates in peripheries causing swelling signs
Signs of LHF?
Heart -
- increase HR and RR
- irregularly irregular heartbeat
- pulsus alternans
- displaced apex beat
- S3 gallop
- S4 in severe
- murmur (AS, AR, MR)
Lungs -
- fine end inspiratory crackles
wheeze
Signs of RHF?
Face swelling Increased JVP TR murmur, increased HR, RR Peripheral oedema Ascites/hepatomegaly
HF Investigations
Bedside - ECG
Bloods - FBC, UES, LFT, TFT (high output), BNP
Imaging - CXR (pulm oedema), TTE (transthroracic echo gold standard)
What does BNP mean??
BNP is sensitive for cardiac damage, if low it’s not HF, if high need to do TTE
What can you calculate with TTE?
Ejection fraction, normal is 50-70%
If low, systolic HF, if high/normal then could be diastolic HF
What can you see of HF cxr?
Alv oedema B-lines Cardiomegaly Dilation upper lobe vessels/lobe Divertion of upper lobe Effusion
What is the framingham criteria?
Major - 2+ of crepitations, weight loss, neck vein distension, hep jug reflex etc.
Minor e.g. hepatomegaly
How do we manage chronic HF?
Treat, not cure.
- Treat underlying
- Treat exacerbating
- Lifestyle mod
- Drugs - ABD, ACE inhibitors (ramipril), beta-blockers (bisoprolol to reduce o2 demands on heart), diuretics (furosemide)
How do we manage acute HF?
- Upright
- 60-100% oxygen
- IV Diamorphine
- GTN infusion
- IV furosemide (40-80mg)
Complications and prognosis of HF?
Comp - respiratory failure, renal failure (hypoperfusion), acute exacerbations, death.
Prog - worse than most malig
What are primary and secondary cardiomyopathy?
Prim - confined to myocardium
Sec - part of a systemic disease
Presentation of cardiomyopathy?
Symptoms of HF
Sudden death/FHx of
Exam - signs of HF
Investigations - echo!! (bloods etc. too)
What happens in dilated cardiomyopathy?
Ventricles enlarge and become dilated, walls thin and weaken - law of laplace
RF - alcohol, post-viral, genetic, haemochromatosis
Sign in dilated cardiomyopathy?
Displace apex beat!!!! (signs of HF too)
Globular heart on CXR!!
