21.8.2013(acute Heart Failure) Flashcards
Atrial and ventricular arrythmias are present in ______ % of DCM pts
50
Mechanical ventilation in pulmonary Edema
Inability to maintain oxygenation by non invasive ventilation
Coexisting Hypercapnia
Diagnosis of DCM is confirmed by
Echo
Radionuclide ventriculography
Anti coagulation in DCM patients
H/O thromboembolic events
AF
Evidence of LV thrombus
Vaccinations recommended in DCM
Influenza
Pneumococci
Diastolic heart failure is common in
Elderly women
Most of whom have HT and DM
Myocardial disorders associated with diastolic heart failure
RCM
obstructive and non obstructive HCM
Infiltrative cardiomyopathies
Constrictive pericarditis
Most common inherited heart defect
HCM
LV obstruction in HCM is enhanced by
Increased contractility
Decreased ventricular volume
Components of HOCM
Assymmetric septal hypertrophy
Systolic anterior motion of mitral leaflet leading to MR and outflow obstruction
SCD in HCM is common in
10-35yrs
Occurs during strenuous exertion
Physical exam findings in HCM
Pulsus bisferiens
Forceful double or triple apical impulse
Systolic outflow murmur along left sternal border accentuated by manuevers that decrease ventricular preload
Rx of HCM
Beta blockers
Verapamil,diltiazem
SVT s are poorly tolerated in
HOCM
ICD placement in HCM pts,risk factors
Genetic mutations associated with SCD
Sustained ventricular tachyarrythmias
H/O syncope or near syncope recurrent or exertional in young pts
Multiple non sustained episodes of VT
Hypotensive response to exercise
LV hypertrophy with wall thickness of 30mm
H/o SCD in relatives
Surgical management of HCM
Septal myotomy-myectomy
Alcohol septal ablation
Restrictive cardiomyopathy must be differentiated from
Constrictive pericarditis
Causes of restrictive cardiomyopathy
Amyloidosis Sarcoidosis Hunter,hurler Hemochromatosis Hypereosinophilic syndrome Carcinoid heart disease
ECG finding in amyloidosis induced restrictive cardiomyopathy
Low voltage QRS complexes
Poor R wave progression
Cardiac catheterisation findings in restrictive cardiomyopathy
Dip and plateau pattern in RV and LV pressure tracing
Drug to be avoided in cardiac amyloidosis
Digoxin
ECG finding in cardiac sarcoidosis
Conduction block
Peripartum cardiomyopathy
LV systolic dysfunction diagnosed in last month of pregnancy upto 6 months post partum
Causes of Peripartum cardiomyopathy
Viral triggers- cox sackie,parvovirus,adeno,herpes
Fetal microchimerism
Prolactin cleavage product
Risk factors for PPCM
Advanced maternal age Multiparity Multiple pregnancy Preeclampsia Gestational hypertension
Warning signs that PPCM may be present
Cough Orthopnea PND displaced apical impulse New MR murmur
Rx of PPCM
ACE inhibitors in postpartum,Hydralzine in pregnant
Beta1 selective blockers(atenolol,metoprolol)
Digoxin
Diuretics
Causes of constrictive pericarditis
TB idiopathic Viral pericarditis Post cardiotomy Chest irradiation Autoimmune connective tissue disease ESRD Malignancy(breast,lung,lymphoma)
Key pathophysiologic feature in constrictive pericarditis
Equalisation of pressure in all four chambers
Physical findings specific for constrictive pericarditis
Pericardial knock(loud S3)
Kussmaul sign
elevated JVP with prominent y descent
Features of constrictive pericarditis differentiating it from restrictive cardiomyopathy
Ventricular interdependence
Pericardial thickening,calcification,adherence
Preserved or increased tissue Doppler velocities on ECHO
Pulmonary hypertension mild or absent
Septal bounce
Equalisation of pressure seen in all cardiac chambers
RVEDP/RVSP>1/3
BNP low or mildly elevated
ECHO features of constrictive pericarditis
Thickened echogenic pericardium
Tethering of pericardium to myocardium
Dilated,incompressible IVC
Septal bounce
Inspiratory variation in mitral flow velocity curves
Expiratory reversal of hepatic vein flow
Preserved or increased tissue Doppler velocities of the mitral annulus
Drugs to be avoided in constrictive pericarditis
Beta blockers and CCB
Pts have resting tachycardia to compensate for reduced stroke volume
Causes of cardiac tamponade
More likely: Idiopathic pericarditis Infection(bacterial,fungal,viral) Neoplasms Post cardiotomy Autoimmune connective tissue disorders Uremia Trauma Radiation MI(Subacute) Drugs(Hydralzine,procainamide,isoniazid,phenytoin) Hypothyroidism
Beck triad
Hypotension
Elevated JVP
muffled heart sounds
Pts with cardiac tamponade feel more comfortable
Sitting forward
ECG features of cardiac tamponade
Low voltage
Tachycardia
Electrical alternans
Features suggestive of hemodynamically significant effusion
Dilated,incompressible IVC
Significant respiratory variation of tricuspid and mitral inflow velocities
Early diastolic collapse of right ventricle and right atrium
Circumferential effusion
Role of TEE in pericardial effusion
Loculated effusion,especially that which develops at atrial level after cardiac surgery
Rx for cardiac tamponade
Maintain adequate filling pressures with IV fluids
Avoid diuretics,nitrates or other preload reducing drugs
Avoid efforts to slow sinus tachycardia
Causes of MS
Rheumatic SLE RA Congenital Substantial mitral annular calcification Mitral valve prosthesis dysfunction Oversewn or small mitral valve annuloplasty ring Functional MS Myxoma LA thrombus IE vegetation Cor triatrium
MS is aggravated by(pathophysiology)
Increase in trans valvular flow(increased cardiac output)
Decrease diastolic filling time(tachycardia)
MS is aggravated by(conditions)
Fever Pregnancy AF with rapid ventricular response Exercise Hyperthyroidism
Pulmonary Edema in MS
Rare
Severity of MS
Duration of MDM(not intensity)
A2-OS gap(inversely related to severity)
