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YEAR 3 Manchester Medicine > 9 - Congestive Cardiac Failure > Flashcards

9 - Congestive Cardiac Failure Flashcards

1
Q

What is heart failure?

A

Heart failiure is a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation

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2
Q

Symptoms of heart failure?

A

dycpnoea

peripheral oedema

elevated JVP

basal crepitations

enlarged liver

orthopnoea

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3
Q

What doe A,C,X,V,Y represent in the JVP wave?

A

A - Atrial contraction

C - Tricuspid valve urges into right atria

X - atrial relaxes, ventricle systole

V - venous return

Y - Tricuspid opens, atrial contraction

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4
Q

Why might JVP be raised?

A

Heart failure

Constrictive pericarditis - Kussmaul’s sign

Cardiac tamponade

Fluid overload

superior vena cava obstruction

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5
Q

How to describe a heart murmur?

A

Timing

Location and radiation

Shape

Pitch

Intensity

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6
Q

A heart mumur is heard through out sytole and diastole. What does this indicate?

A

Patent ductus arteriolsus

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7
Q

Which heart mumur radiates to the carotids?

A

Mitral stenosis

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8
Q

Which heart mumur radiates to the axila?

A

Mitral regurgitation

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9
Q

Which murmur is loud but is not palpable as a thrill?

A

Grade 3 mumur

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10
Q

Which mumu is faint and cannot be heard initially?

A

Grade 2 mumur

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11
Q

If a mumur is loud and palpable, what grade is it?

A

4

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12
Q

How can you atenuate mitral stenosis?

A

Mitral stenosis

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13
Q

3 most common causes of heart failure?

A

Ischeamia

HTN

daibetes - promots CAD,\ and cardiomyopathy

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14
Q

Other causes of aetiologies of heart failure?

A

valvular - AS and MR

Tachycardia

toxins and drugs

endocrine - thyrotoxicosis and phaeochromocytoma

dilated cardiomyopahty

HOCM

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15
Q

What is the first line treatment for heart failure?

A

ß-blockers

ACEi

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16
Q

What is ejection fraction?

A

Stroke volume devided end diastolic volume

SV

EDV

17
Q

What is stroke volume?

A

EDV - ESV

End diastolic volume - end systolic volume

18
Q

What is preserver ejection fraction

A

EF > 40%

This is diastolic dysfunction due to ventricle not being able to relax

Due to: hypertrophy, obesity, tamponade, constrictive pericarditis, restrictive cardiomyopathy.

19
Q

What is systolic dysfunction?

A

EF < 40%

Due to ventricle not being able normally

MI, IHD and cardiomyopathy

20
Q

After ß blockers and ACEi, what medication can be used for heart failure?

A

mineralcorticoid antagonists - spiranolactone

Digoxin

Isosorbides dinitrates and other peripheral dilators

Cardiac re-synchronisation therapy

21
Q

What is the managment of atrial fibrilation?

A

1st line is rate limiting therapy: ß blocker or CCB, digoxin in sedentary/ paroxysmal

2nd line is rythmn control: Flecanide or amiodarone (for abdnormal structure)

22
Q

When do you cardio evert someone in AF?

A

< 48 hours since onset

or after being fully anticoagulated.

23
Q

What is cardioevertion in AF?

A

A form of rythmn control therapy.

sedation and then 200-360J

Drugs: flecanide and amiodarone

24
Q

Patholgy of arrythmias?

A

Re-entrant activity

Delayed after repolarisation due to Ca overload leading to spontanoues depolariesation after repolarisation,

Early after depolaristion - spontaneouns depolarisation during plateau of cardiac cycle

25
Q

Causes of mitral regurgitation?

A

Vegitations for endocarditis

Dilation of left ventricle

Rheumatic disease

papillary muscle rupture from MI

26
Q

What cardiac issue causes roth spots?

A

Infective endocarditis

27
Q

What is the clincal criteria for enfective endocarditis?

A

Modified Dukes criteria

28
Q

What is the modified Dukes criteria?

29
Q

Fever + new mumur is what until proven otherwise?

A

infective endocarditis

30
Q

Management of acute heart failure?

A

Cannulas

Investigations

Morphine

Furosemide - 40-80mg

IV nitrates if systolic < 100mg

CPAP

31
Q

What investigation would be used for acute heart failure?

A

ABG, CXR, ECG - most important

Trops, BNP (in case negative)

echo within 48 hours

32
Q

What is contraindicated in acute heart failure?

A

inotrops and vassopressors e.g:

ß-blockers

CCB

33
Q

Patient has presents with suspected heart failure with a previous MI. What is the next best investigation?

A

NICE says - do Echo

34
Q

Patient presents with suspected heart failure and has no previous cardiac history or MI, what investigation should come next?

35
Q

Patient with heart failure has SoB at rest and cannot do any activity. What NYHA classification?

A

NYHA class IV

36
Q

Patient with heart failure has SoB on slight activity, like walking up the stairs. What NYHA classification?

A

NHYA class III

37
Q

Patient with heart failure has no SoB. What NYHA classification?

A

NHYA class 1

YEAR 3 Manchester Medicine (34 decks)

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