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Y4 Cardiology > 7. Heart Failure, Cardiomyopathy & Pericardial Disease > Flashcards

7. Heart Failure, Cardiomyopathy & Pericardial Disease Flashcards

1
Q

What is Beck’s Triad ( disease + Sx)

A

For cardiac tamponade
hypotension, elevated jugular venous pressure (JVP), and diminished heart sounds.

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2
Q

Gold standard investigation and Mx for cardiac tamponade

A

Echo
Pericardiocentensis

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3
Q

What is the most likely finding on ECG of pt with pericarditis

A

PR depression

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4
Q

Pericarditis Sx

A

chest pain improved on sitting upright or leaning forwards, tachypnoea, tachycardia, and a pericardial rub on auscultation

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5
Q

Causes of LVSD

A

CHD/MI - Causes scarring and loss of contractile fx leading to enlargement of LV and rEF

HyperT- Caused by pressure overload, reduced contractile fgx, and scarring of the ventricle

Dilated cardiomyopathy - genetic, alcohol or viral

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6
Q

What valvular heart diseases can cause LVSD

A

ASMR
AR
Due to volume and pressure overload of left heart

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7
Q

What valvular disease can cause HF but not LVSD

A

MS - due to obst of mitral valve

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8
Q

Sx of LVSD

A

Dyspnoea including OND, orthopnoea, dyspnoea on exertion
Fatogue on exercise, ankle swelling , palpitations - May be due to normal heart rhythm but also abnormalities such as AF ( persistent or paroxysmal), or more serious ventricular arrhythmias

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9
Q

Signs of LVSD
`

A

Ankle oedema, elevated jugular venous pressure, basal lung crepitation, pleural effusions at lung bases, dullness to percussion with reduced lung entry

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10
Q

Routine bloods for LVSD- what to exclude

A

Glucose and TFT to exclude diabetes and hypothyroid

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11
Q

What might CXR show in LVSD

A

might also indicate enalrgement of heart shadow, or show effusion at lung bases or pulm oedema

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12
Q

What might ECG for LVSD indicate

A

For features that suggest structural heart disease, including AF, LBBB, or Q waves, suggesting prev MI

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13
Q

What does plasma natriuretic peptide tell you in LVSD

A

Elev levels suggest possible HF but also other forms of structural disease
Normal level- unlikely to be due to HF, high negative predictive value

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14
Q

Ix to exclude structural heart disease

A

Echo, look for reduced LVEF, and any other valvular heart disease that might cause breathlessness

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15
Q

Drug tx for HF- and what is first line?

A

Loop diuretics to reduce fluid retention and improve sx eg. furo or bume - IV if acute heart failure
ACEi like ramipri or enalapril
BB like bisoprolol or cravedilol or meto
MRA like spiro

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16
Q

Advanced LVSD drug treatments

A

Sacubitril valsartan (ARNI)
ARB and Neutral endopeptidase inhibitor
Used in place of ACEi
Must be stopped 36 hrs before using ARNI
Drug benefirs pts with sig reduced EF who continue to experience breathlessness despite use of drugs above

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17
Q

When can CRT or ICD be used for LVSD

A

CRT - HF + LBBB on ECG. Tx resynchronises BBB pattern and helps to improve CO and reduces MR severity

ICD- In pts with high risk pf vent arrhhythmias or who have experience VA

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18
Q

Lifestyle changes for LVSD

A

Weight, salt and fluid restriction, exercise

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19
Q

What should be reviewed for LVSD pts

A

6-12 mo BP and renal fx

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20
Q

Risk factors for HF

A

Age, Gender (F>M!!!), hyperT and T2DM, obesity, CAD, hypertophic or infiltratice HD like amyloidosis of haemachromatosis
Rad therapy

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21
Q

diff btw preserved and reduced EF in HF

A

In PEF, Stiff pump, impaired ability to fill ventricle
Increased LV wall mass which is stiff and non compliant
* Reduced volume within V
* Also impairs ability of LA to fill heart properly

In EF, thinned out and weak vent wall
LV is dilated/ ballooned out, inability to emoty heart and meet met demads

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22
Q

Sx of HF

A

Fatigue and reduced effort tolerance, dyspnoea, orthopnoea, PND, swollen ankles

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23
Q

What causes pulm oedema in HF

A

Incr hydrostat pressure pushes fluid out of veins and capp and fills lungs

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24
Q

Signs of HF

A

Crackles (bibasal, FINE), raised JVP due to increased pressure in RA, hepatomegaly and ascites as late sign of congestion, pitting oedema in bothh limbs, extra heart sound - S3 gallop in HFrEF and S4 in HGpEF

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25
Ix for HF
NT pro BNP- elevated Echo Both most impt for clinching Dx ----- ECG- may have LVH and BBB CXR- May show cardiomegaly and pulm congestion- Upper lobe diversions or increased vasc markings. May have bilat PE
26
Will echo show systolic or diastolic dysfx for HF-PEF
DIALSTOLIC
27
What type of RF can acute pulm oedema lead to
Type 1 RF
28
Causes of pulm oedema
Cardio- MI, Valvular HD (AR or MR), or AF, VT Non cardio- ARDFS, neurogenic
29
What does pulm oedema mean
Accumulation of fluid within lung alveoli
30
Pathophysiology of pulm oedema
Decreased ABP causes symp activation and release of neural hormones such as norepinephrin Decreased renal perf activates RAAS, retains sodium and water and causes vasoconstriction Incr circulating neurohormones cause peripheral vasocon, incr. afterload and cardiotoxicity leading to sec ,yocardial activity Splanchic vasocon leads to redist of blood cont to incr preload and pulm volume overload
31
Sx of acute pulm oedema
Breathlessness, orthopnoea and PND Chest pain if markedly hypoxic, haemoptysis and anxiety
32
Signs of pulm oedema
Tachypnoea, cyanosis, tachycardia, hypotension, sweaty and pale, elevated JVP, gallop rhythm, crepitations rales, peripheral oedema, hepatomegaly
33
What bloods should be done in acute P oedema
FBC, U and E, LFT, Troponin, Lactate( tissue perfusion), BNP may suggest HF as likely Dx
34
Is echo impt for pulm oedema
NO, use for heart structure and fx when normovolaemic, but gecan give hint at dx in acute stage as may show valvular or RWA
35
What does CXR show in acute pulm oedema
Upper lobe venous diversion (bats wings) and kerley B lines ( small lines of fluid towards film periphery). May have CT ratio or more than 50% of thorax esp if hv LVSD LVSD= elevation of Left atrial pressure transmitted to pulm circ, Widespread opacification on the CXR and pulm oedema
36
What does ECG show in acute pulm oedema
Anterior ST elevation from V1 to V4 Inferolateral ST depression So anterior MI
37
Treatment for acute pulmonary oedema
Sit patient upright, give oxygen therapy, IV diuretic ( furo or bumetanide), IV GTN IF BP not too low PAP/BiPAP in pts who need vent support CONSIDER IV morphine to reduce preload
38
67 YO women with acute HP and PO, sat 85%, high flow O2 and IV diuretics+ nitrates given. Still tachyc (140bpm). Becoming drowsy. What next?
Urgent review from ITU and start CPAP
39
Pt recovered from pulm oedema (LVSD after MI), currently euvolaemic. What to start on apart from aspirin and statin
ACEi and BB
40
What is the main Ix when CHF is suspected and what else should be done
Measure NT-proBNP Perform ECG and consider CXR, blood tests, urinalysis, peak flow or spirometry
41
What to do if: 1) moderate NT-proBNP (400-2000) 2) High (>2000) 3) Low (<400) is measured
Refer urgently to be seen within 6 weeks and 2 weeks respectively and do TTE to confirm or not confirm 3) Consider other causes
42
IMMEDIATE tx for CHF
Offer diuretics for congestive Sx and fluid retention
43
Mx for HF-PEF after diuretics are given
Manage comorbidities and offer cardiac rehab . No other meds offered
44
First line Tx for HF-REF after diuretics are given. What if pts are intolerant of first-line drugs. What if Sx persist despite first line treatment
ACEi and BB MRA if Sx continue --- ARB if intolerant of ACEi, Hydralazine and nitrate if intolerant of both --- -Replace ACEi/ARB with ARNI if EF<35% -Add ivabradine if HR>75, sinus rhythm and EF<35% -Add hydralazine and nitrate esp if afro carribean - Digioxin for HF with sinus rhythm
45
How does eGFR of 30-45 affect Mx of CHF
Lower doses of ACEi, ARB, MRA, ARNI and digoxin
46
Causes of pericarditis
Idiopathic, infxn- viral illness most common but also TB or bacterial pneumonia post MI iatrogenic due to pacemaker, autoimmune like lupus, neoplastic ( metastatic tumour spread), metabolic ( uraemia, anorexia or myoedema)
47
Sx of pericarditis
Sharp central chest pain accentuated by lying supine, relieved by sitting upright, and exacerbated by deep inspiration or coughing May have fever, palpitations and dyspnoea
48
Clinical signs of pericarditis
BECK's triad - muffled heart sounds, elevated JVP, hypotension IF CARDIAC TAMPONADE Fever, pericardial rub- Auscultated as a biphasic scratching type sound heard during systole, best detected by lying pt supine Pulsus paradoxus- Variation in bp greater than 10mm with fall during inspiration, or disappearance of radial pulsae during inspiration
49
Ix for pericarditis
ECG Bloods CXR- GLOBULAR contour Echo considered CT/MRI only if pt is refractory or if echocardiogram gives incomplete pic
50
What are major predictors of risk of complications in pericarditis
Major predictors of pts with high risk of complications include fever over 38 deg, subpacute onse, PE greater than 2cm in diameter, cardiac tamponade, or lack of response to aspirin and NSAID after one week
51
How to treat pericarditis
NSAIDs, Aspirin or ibuprofen (1-2wk until Sx resolved), with PPI is risk of gastric upset May give prolonged course of colchicine to reduce risk of relapse Exercise restriction, CST (second line) if relapsing or AI course
52
Tx of acute cardiac tamponade. When else can this be used to treat pericarditis
Pericardiocentesis Also considered in pt with moderate to late effiusion not responding to conv. Therapy, or if prevalent pericarditis with uncontrolled sepsis.
53
When should pericardiocentesis be used to assist Dx of ppl that have pericarditis
Pts who have suspected infective or neoplastic aetiologies. If PE is drained then should be sent for culture, cell count, cytology and PCR test for TB
54
What are the causes of pulmonary hypertension
Conditions that cause problems with the smaller branches of the pulmonary arteries (PAH) conditions that affect the left side of the heart lung diseases or a shortage of oxygen in the body (hypoxia) blood clots that cause narrowing or a blockage in the pulmonary arteries
55
What genetic disorder can cause heart failure, why, and how to identify it
Sedc to dilated cardiomyopathy Haemachromatosis, sx may include fatigue, erectile dysfunction and arthralgia (often of the hands) 'bronze' skin pigmentation diabetes mellitus liver: stigmata of chronic liver disease, hepatomegaly, cirrhosis, hepatocellular deposition) hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism) arthritis (especially of the hands)
56
What infective condition can cause HF
Myocarditis
57
Myocarditis presentation
usually young patient with an acute history chest pain dyspnoea arrhythmias
58
Ix of myocarditis
bloods:↑ inflammatory markers in 99% ↑ cardiac enzymes ↑ BNP ECG: tachycardia arrhythmias ST/T wave changes including ST-segment elevation and T wave inversion
59
Main cause of cardiogenic shock
IHD. acute heart failure
60
What drugs should be contraindicated in cardiogenic shock for AHF and how to treat
Loop diuretics and nitrates contra Use inotropic agents like dobutamine for pts with severe LVSD Vasopressors like norepinehrine if insuff response to inotropes
61
Ix for cardiogenic shock
Echo may be impt
62
Fx and Dx restricitve pericarditis
dyspnoea right heart failure: elevated JVP, ascites, oedema, hepatomegaly JVP shows prominent x and y descent pericardial knock - loud S3 Kussmaul's sign is positive Pericardial calcification on CXR
63

Y4 Cardiology (6 decks)

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