2 LOBS Flashcards
Explain the pathophysiology of congestive heart failure – link into physical exam findings.
Develop a differential diagnosis for dyspnoea.
- pneumonia,
- asthma and
- chronic obstructive pulmonary disease (COPD).
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How does cardiac failure effect the function and release of hormones? (This can be
related to the rationale for medication for CHF)
bnp
Name 4 common heart murmurs
Aortic stenosis
Pulmonary stenosis
Tricuspid regurgitation
Mitral stenosis/regurgitation
explain the anatomy and basic
pathophysiology of Aortic stenosis
this is a type of heart valve disease (valvular heart disease). The valve between the lower left heart chamber and the body’s main artery (aorta) is narrowed and doesn’t open fully. This reduces or blocks blood flow from the heart to the aorta and to the rest of the body.
explain the anatomy and basic
pathophysiology of Pulmonary stenosis
this is a narrowing of the valve located between the lower right heart chamber (right ventricle) and the lung arteries (pulmonary arteries). In a narrowed heart valve, the valve flaps (cusps) may become thick or stiff. This reduces blood flow through the valve
explain the anatomy and basic
pathophysiology of Tricuspid
regurgitation
this occurs when the valve’s flaps (cusps or leaflets) do not close properly. Blood can leak backward into the atrium from the leaky tricuspid valve, causing your heart to pump harder to move blood through the valve.
explain the anatomy and basic
pathophysiology of Mitral stenosis/regurgitation
this occurs when the mitral valve in your heart narrows, restricting blood flow into the main pumping chamber. Your mitral valve may also leak, causing blood to flow back through the valve each time the left ventricle contracts.
Explain the CXR findings for congestive heart failure.
- Alveolar oedema (perihilar/bat-wing opacification)
- Kerley B lines (interstitial oedema)
- Cardiomegaly (cardiothoracic ratio >50%)
- Dilated upper lobe vessels
- Effusions (e.g. pleural effusions – blunted costophrenic angles)
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relevant bedside investigations of acute heart failure. (include side effects + contraindications.)
- Vital signs: may show hypoxia (often SpO2 < 90%), tachycardia, and tachypnoea. The systolic blood pressure may be normal, elevated, or reduced (hypotension is associated with cardiogenic shock and poor prognosis). The pulse pressure may be narrow (<25% of the sBP).
- ECG: the ECG is rarely normal. Abnormalities (e.g. signs of ischaemia or arrhythmias) are very common in AHF and an alternative diagnosis should be considered if the ECG is completely normal.
pharamacological
management of acute heart failure
(include side effects + contraindications.)
- oxygen
- loop diurectics
- nitrates
- Non-invasive ventilation (NIV)
- Cardiogenic shock
When is a loop diuretic considered in the management of heart failure?
- All ‘WET’ patients will require diuretics as the cornerstone of their management.
- Patients with chronic kidney disease and those already on oral diuretics will need a greater dose.
Understand the impact of a cardiovascular diagnosis on a family, and the future implications for the family
Understand the mechanism of action, side effects and contraindications for loop and potassium-sparing diuretics.
What are idiopathic and iatrogenic?
Idiopathic disease: any disease which is of uncertain or unknown origin, arising spontaneously.
Examples: acute idiopathic polyneuritis, diffuse idiopathic skeletal hyperostosis, idiopathic pulmonary fibrosis, idiopathic scoliosis.
Iatrogenic disease: disease induced by drug/s prescribed by a physician and/or diagnostic or therapeutic procedures undertaken on a patient. With the multitude of drugs prescribed to a single patient adverse drug reactions are bound to occur.
Define dyspnoea
difficult or laboured breathing.
Differentials diagnosis for dyspnoea
- Asthma
- COPD
- Heart failure
- Pneumonia
- mental disorders
- lung cancer
- cystic fibrosis
What causes pallor?
Pallor- paleness. Caused by reduced blood flow and oxygen or by a decreased number of red blood cells. Can be a symptom of serious medical conditions such as anaemia, bloodstream infection, frostbite, leukaemia, low BP
What is paroxysmal nocturnal dyspnoea (PND)?
Sensation of shortness of breath that awakens a patient after 1-2 hours of sleep, usually relieved in the upright position. Caused by failure of left ventricle.
What is orthopnoea?
Sensation of breathlessness whilst lying down, relieved by sitting or standing. Usually occurs when heart isn’t strong enough to pump out all the blood sent from the lungs. Heart failure, build-up of fluid in lungs.
What is jugular venous pressure and what happens if it is distended?
Jugular venous pressure provides an indirect measure of central venous pressure. Jugular vein distention is the bulging of the major veins in the neck. Increased pressure of the superior vena cava causes the jugular vein to bulge. Key symptom of heart failure and other circulatory problems
What is the mechanism for ventricular hypertrophy?
Left ventricular hypertrophy is induced by an increased filling pressure of the left ventricle, otherwise known as diastolic overload. This condition is caused by changes in genes that cause the heart muscle to thicken. The thickening makes it harder for the heart to pump blood. It can occur even without high blood pressure.
Describe the pathophysiology of congestive heart failure
Heart failure develops when there are changes to the structure of the heart muscle and it can’t pump blood as efficiently as it should. When this happens blood can back up and fluid may build up in the lungs or arms and legs, indicating congestive heart failure.
what does the FBC indicate?
Full blood count. This is a test to check the types and numbers of cells in your blood, including red blood cells, white blood cells and platelets.