1. Cardiac SOB Flashcards

1
Q

What, at its core, causes breathlessness?

A

Poor carbon dioxide removal

Poor oxygen delivery

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2
Q

What is heart failure?

A

The failure to the heart to maintain cardiac output required for body’s demands.

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3
Q

How can we classify HF?

A

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

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4
Q

What is congestive heart failure?

A

Left and right sided heart failure – usually started with congestion in the left that floods into the right

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5
Q

Valvular causes of left heart failure?

A

Aortic stenosis
Aortic regurg
Mitral regurg

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6
Q

Muscular causes of lhf

A

Ischaemia
Cardiomyopathy
Myocarditis
Arryhythmias

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7
Q

Systemic lhf causes

A

Hypertension
Amyloidosis
Drugs e.g. cocaine, chemo

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8
Q

Right hf causes?

A

Lung causes - pulmonary hypertension

  • pulmonary embolism
  • chronic lung disease

tricuspid regurg
pulm regurg
congestive HF

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9
Q

Causes of high output HF?

A

Nutritional
Anaemia
Pregnancy

Malignancy
Endocrine
Av malformations
Liver cirrhosis
Sepsis
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10
Q

Symptoms of HF?

A

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

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11
Q

Signs of LHF?

A

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

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12
Q

Signs of RHF?

A
Face swelling
Increased JVP
TR murmur, increased HR, RR
Peripheral oedema
Ascites/hepatomegaly
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13
Q

HF Investigations

A

Bedside - ECG
Bloods - FBC, UES, LFT, TFT (high output), BNP
Imaging - CXR (pulm oedema), TTE (transthroracic echo gold standard)

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14
Q

What does BNP mean??

A

BNP is sensitive for cardiac damage, if low it’s not HF, if high need to do TTE

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15
Q

What can you calculate with TTE?

A

Ejection fraction, normal is 50-70%

If low, systolic HF, if high/normal then could be diastolic HF

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16
Q

What can you see of HF cxr?

A
Alv oedema
B-lines
Cardiomegaly
Dilation upper lobe vessels/lobe
Divertion of upper lobe
Effusion
17
Q

What is the framingham criteria?

A

Major - 2+ of crepitations, weight loss, neck vein distension, hep jug reflex etc.
Minor e.g. hepatomegaly

18
Q

How do we manage chronic HF?

A

Treat, not cure.

  1. Treat underlying
  2. Treat exacerbating
  3. Lifestyle mod
  4. Drugs - ABD, ACE inhibitors (ramipril), beta-blockers (bisoprolol to reduce o2 demands on heart), diuretics (furosemide)
19
Q

How do we manage acute HF?

A
  1. Upright
  2. 60-100% oxygen
  3. IV Diamorphine
  4. GTN infusion
  5. IV furosemide (40-80mg)
20
Q

Complications and prognosis of HF?

A

Comp - respiratory failure, renal failure (hypoperfusion), acute exacerbations, death.
Prog - worse than most malig

21
Q

What are primary and secondary cardiomyopathy?

A

Prim - confined to myocardium

Sec - part of a systemic disease

22
Q

Presentation of cardiomyopathy?

A

Symptoms of HF
Sudden death/FHx of

Exam - signs of HF

Investigations - echo!! (bloods etc. too)

23
Q

What happens in dilated cardiomyopathy?

A

Ventricles enlarge and become dilated, walls thin and weaken - law of laplace

RF - alcohol, post-viral, genetic, haemochromatosis

24
Q

Sign in dilated cardiomyopathy?

A

Displace apex beat!!!! (signs of HF too)

Globular heart on CXR!!

25
What is/what happens hypertrophic cardiomyopathy?
Muscle thickens comes inwards. Increased stiffness of muscle affects pumping and disrupts electrical conductions. HOCM - hypertrophic obstructive cardiomyopathy half is familial.
26
How does HOCM present?
Sudden cardiac death Angina, dyspnoea on exertion, palpitations, syncope may be warning but mostly asymptomatic.
27
HOCM signs?
Ejection systolic murmur Jerky carotid pulse Double apex beat, not displaced S4 ECG - q waves, left axis deviation Echo - shows hypertrophy
28
What is restrictive cardiomyopathy?
Same muscle, but muscle is rigid -- reduce preload
29
Causes of restrictive
Sarcoidosis, amyloidosis, haemochromatosis, familial, idiopathic
30
Signs of restrictive
Kussmaul's sign - paradoxical rise in JVP during inspiration | RHF signs
31
What is constrictive pericarditis?
Chronic inflammation of pericardium with thickening and scarring Can be idiopathic, infectious, acute pericarditis, cardiac surgery/radiation
32
Signs and symptoms of constrictive pericarditis?
Similar to restrictive cardiomyopathy Distinguish them using echo for pericardial thickness CXR - calcification (non-specific) This can be treated, unlike restrictive
33
What is myocarditis?
Inflammation of myocardium | Caused by infection (coxsakie B virus), drugs, metals, radiation
34
Signs and symptoms of myocarditis?
Flu-like prodrome Chest pain worse on lying SOB Palpitations ECG - non-specific ST and T wave changes Cardiac biomarkers- CK and troponins should rule out others Endomyocardial biopsy - diagnostic but rarely done