Acute Heart Failure

Question 1

Definition

Answer 1

Rapid or gradual onset of symptoms of heart failure

Question 2

Classification based on or according to Caleb

Answer 2

Class I- No heart failure_ no signs of LV dysfunction No clinical signs of cardiac decompensation
Class II heart failure characterized by 53 gallop with or without mild to moderate pulmonary congestion with wet rales in lower half of lungs
Class iii- severe heart failure -frank pulmonary edema with rales throughout lungs
Class iv-cardiogenic shock

Question 3

Acute heart failure - risk factors/ causes/ triggering factors

Answer 3

Unstable angina
Myocardial infarction
Pulmonary embolism
Infection (pneumonia, sepsis)
Infective endocarditis
Acute coronary syndrome

Question 4

Acute heart failure in parent with pulmonary-dema

Answer 4

Pulmonary edema- accumulation of fluid in alveoli we see lung congestion

Question 5

AHF patient with pulmonary edema - pathogenesis of pulmonary edema

Answer 5

Decrease cardiac output due to necrosis
Congestion of blood in LV
Dilation of the heart
Regurgitation of blood through the mitral valve to the LV
Elevation of pressure on small circulation
Development of pulmonary edema

Question 6

Clinical Picture of p.e

Answer 6

Dyspnea(inspiratory)
Tachypnea
Ortopnea
Cough dueto swelling of bronchial wall/
Cough receptors are found in mouth and bronchus
Chest tightness
Tachyarhythmia
Redlpinksputum (non-inflammation)

Question 7

General examination of p. E patient

Answer 7

. Pale skin- acrocyanosis

Ortopnea position
Palpation-apex beatshitt to the left due to LV dilation
Percussion-left border ship to the left
Upper border shifts upper
Ausultation-s1 sound is weak due to necrosis and low cardiac output s3-s4 sounds are present
Development of pathological sound
Galloprhythms weak s1s2 pathological S4 and S3 plus tachycardia
Systolic murmur due to relative mitral insufficiency

Auscultation of heart- accentuation S 2 over pulmonary trunk
Auscultation of lungs- wheeling crackles -

Question 8

Lab for p.e

Answer 8

X-ray -edema in the root of lungs looks like butterfly
-scan CT
Ultrasound _ ejection fraction
Echocardiogram

Question 9

Treatment of p.e

Answer 9

Diuretics -furosemide-reduce intensity of edema
Vasodilators - nitroglycerin(reduce congestion in small circulation)
Morphine-relieve shortness of breath
Ace inhibitors-dopamine and dobutamine -control bp

Question 10

A-H’F associated with cardiogenicshok

Answer 10

Characterized by low BPsystolic <90mmhg
Low tine output Anuria

Question 11

Causes gcardiogenic shock

Answer 11

Arthymia
Myocarditis endocarditis
ventricular fibrillation
cardiac tamponade
acute coronary syndrome

Question 12

Pathogenesis

Answer 12

Due to mi we see decrease cardiac output
Low ejection fraction

Elevation of catecholamine in blood
Centralisation of blood supply
Development of microvascular disorders
Pulling of blood element in capillaries
Development of intravascular coagulation
Progressive acidosis
Cellular hypoxia

Question 13

Conical picture of cardiogenic shock

Answer 13

Arterial hypotension
Signs of peripheral collapse_ coldskin, cold sweat,clammy skin mumble skin,
Oligura or anuria
Impaired consciousness

Question 14

General examinationof patient with cardio genic shock

Answer 14

Cyanosis (acro)
Pale skin with cold sweat
Lowbp
Patent lies down
Auscultation reveals arrhythmia, gallop rhythms, decrease s1 sounds ,weak pulse/absent pulse
Filiform pulse

Question 15

Treatment for cardiogenic shock

Answer 15

Oxygen therapy
Vasopressors
Anti-arhythmic drug
Morphine
Dobutamine if systolic BP is 70/100mmHg
Noerphinephrine if systolic BP is. Lessthan 70 mmhg