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Cardio Ped > Acute Hf > Flashcards

Acute Hf Flashcards

1
Q

What is acute congestive heart failure?

A

Pathophysiological state with abnormality of cardiac function and inability of the heart to supply the tissues with blood enough for their metabolic needs.

Clinical syndrome arising from any structural or functional cardiac disorder that impairs the ability of the ventricles to fill with or eject blood to the tissues.

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2
Q

What causes volume overload in acute congestive heart failure?

A
  • Hypervolemia: acute renal failure and over infusion of fluids or blood
  • Shunt lesions: Ventricular Septal Defect (VSD), ASD, PDA

These conditions lead to an increase in blood volume, affecting cardiac function.

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3
Q

What causes pressure overload in acute congestive heart failure?

A
  • Hypertension: pulmonary or systemic hypertension
  • Obstructive lesions: Stenosis such as aortic stenosis or coarctation of the aorta

These factors increase the resistance against which the heart must pump.

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4
Q

What is myocardial damage in the context of acute congestive heart failure?

A
  • Myocarditis: viral, toxic
  • Cardiomyopathy: dilated or constrictive & ischemic heart diseases
  • Negative inotropic factors: hypoxia, hypoglycemia, and acidosis

These conditions impair the heart’s ability to contract effectively.

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5
Q

What is arrhythmic failure?

A

Severe tachycardia (SVT) or bradycardia (Heart block).

This type of failure involves irregular heart rhythms that can compromise cardiac output.

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6
Q

What is the clinical grading of congestive heart failure?

A
  • Grade 1: Heart failure only
    *
  • Grade 2: Heart failure and respiratory failure (Pulmonary edema)
  • Grade 3: Heart failure and circulatory failure (Cardiogenic shock)

Each grade reflects the severity and symptoms of heart failure.

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7
Q

What are the symptoms of Grade I congestive heart failure?

A

Heart failure only.

At this stage, patients may show minimal symptoms.

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8
Q

What are the symptoms of Grade 1 congestive heart failure?

A

Tachypnea and tachycardia.

Patients begin to show signs of respiratory distress and increased heart rate.

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9
Q

What are the symptoms of Grade 2 congestive heart failure?

A
  • Moderate to severe respiratory distress
  • Cyanosis
  • Fine basal crepitation
  • If pulmonary edema: Coarse & bubbling crepitation

This grade indicates significant respiratory involvement due to fluid accumulation.

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10
Q

What are the symptoms of Grade 3 congestive heart failure?

A
  • Severe respiratory distress with cyanosis
  • Peripheral hypo-perfusion
  • May lead to multiple organ failure (MOSF)

This is the most severe stage, indicating critical cardiac and systemic compromise.

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11
Q

What laboratory findings are associated with pulmonary edema in congestive heart failure?

A
  • CXR: marked congestion & pulmonary edema
  • ABG: Hypoxia

These tests help confirm the presence and severity of heart failure.

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12
Q

What is a symptom of pulmonary congestion associated with left ventricular failure (LVF)?

A

Dyspnea

Dyspnea can occur during exercise or even at rest.

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13
Q

What does orthopnea refer to?

A

Dyspnea on lying flat

It is often associated with paroxysmal nocturnal dyspnea (PND).

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14
Q

What indicates severe pulmonary edema in LVF?

A

Coarse generalized crepitations or bubbling with frothy pink secretions

This is a critical symptom in severe cases.

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15
Q

What gastrointestinal symptoms can occur due to GIT congestion?

A

Dyspepsia, vomiting

This can lead to cardiac cachexia (weight loss).

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16
Q

What causes weight loss in patients with congestive heart failure?

A

Malabsorption, Poor tissue perfusion, Muscle wasting

These factors contribute to overall weight loss.

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17
Q

What type of edema is commonly seen in the lower limbs due to RVF?

A

Dependent and pitting edema

This edema is often more pronounced by the end of the day.

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18
Q

What is a characteristic finding on cardiac auscultation in congestive heart failure?

A

Galloping heart with S3

This is due to the vibration of flappy myocardium.

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19
Q

What does pulsus alternans indicate?

A

Alternation between strong and weak beats

It is a sign of varying stroke volume.

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20
Q

What is oliguria?

A

Urine output less than 1 cc/kg/hour or 400 ml/day

This is a common symptom in kidney involvement of heart failure.

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21
Q

What is a symptom of easy fatigue in patients with heart failure?

A

Claudication

This is often due to poor peripheral perfusion.

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22
Q

Fill in the blank: A symptom of pulmonary congestion in LVF is _______.

A

Dyspnea

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23
Q

True or False: Pulmonary edema in severe LVF can present with frothy pink secretions.

A

True

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24
Q

What is the term for weight loss due to heart failure-related malabsorption?

A

Cardiac cachexia

This can result from poor tissue perfusion and muscle wasting.

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25
Q

What type of edema is commonly observed in infants with RVF?

A

Sacral edema

This is a specific finding in pediatric patients.

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26
Q

What does CXR stand for in cardiology investigations?

A

Chest X-Ray

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27
Q

What indicates cardiomegaly in a chest X-ray?

A

Increased cardiothoracic ratio > 0.5

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28
Q

What does prominent vascular markings on a chest X-ray suggest?

A

Lung congestion

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29
Q

What is a characteristic shadow seen in pulmonary edema on a chest X-ray?

A

Bats wing shadow

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30
Q

What does a ventricular ECG help diagnose?

A

Arrhythmia (AF or VT)

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31
Q

What does a ventricular echo measure?

A

Ventricular function (distinguish systolic and diastolic HF)

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32
Q

What laboratory markers are used if myocarditis is suspected?

A

Creatine kinase (CPK) and troponin I

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33
Q

What does CBC detect in the context of heart disease?

A

Anemia

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34
Q

What is the purpose of measuring blood glucose in cardiology?

A

To detect diabetes mellitus (DM)

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35
Q

What does serum iron test for in cardiology?

A

Hemochromatosis

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36
Q

What does B-type Natriuretic Peptide (BNP) indicate?

A

Heart failure

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37
Q

What is the NYHA classification used for?

A

Functional classification of heart failure

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38
Q

What is the description of NYHA Class I?

A

No limitation of physical activity (Asymptomatic)

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39
Q

What is the description of NYHA Class II?

A

Slight limitation of physical activity (Fatigue & Dyspnea) Ordinary activity

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40
Q

What is the description of NYHA Class III?

A

Marked limitation of activity (Fatigue & Dyspnea) Less than Ordinary

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41
Q

What is the description of NYHA Class IV?

A

Unable to do any physical activity (Symptomatic at Rest)

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42
Q

What are the classifications of heart failure based on ventricular function?

A
  • Systolic heart failure
  • Diastolic heart failure
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43
Q

What are the classifications of heart failure based on cardiac output?

A
  • Low cardiac output
  • High cardiac output
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44
Q

What are the classifications of heart failure based on duration?

A
  • Acute heart failure
  • Chronic heart failure
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45
Q

What are the classifications of heart failure based on which ventricle is affected?

A
  • Left-sided heart failure
  • Right-sided heart failure
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46
Q

What condition is indicated by pulmonary edema?

A

Left-sided heart failure (LVF = Lung congestion)

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47
Q

What complication arises from long-standing hepatic congestion due to right-sided heart failure?

A

Cardiac Cirrhosis

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48
Q

What is a potential renal complication of heart failure?

A

Cardio-renal syndrome

49
Q

What does cardiac cachexia refer to?

A

Weight loss and muscle atrophy due to GIT malabsorption

50
Q

What electrolyte disturbances are associated with heart failure?

A
  • Hypokalemia
  • Hyponatremia
51
Q

Fill in the blank: The classification of heart failure includes _______ and _______ based on ventricular function.

A

[Systolic heart failure, Diastolic heart failure]

52
Q

What are ACE inhibitors?

A

Angiotensin-converting enzyme inhibitors that act as both arteriolar and venous dilators.

They help reduce after-load and pre-load, respectively.

53
Q

List contraindications for ACE inhibitors.

A
  • Bilateral renal artery stenosis
  • Hyperkalemia
  • Concomitant use of potassium-sparing diuretic spironolactone (Max. 50 mg/day)

These conditions can lead to serious complications when using ACE inhibitors.

54
Q

What is the dosage range for Captopril (Capoten)?

A

6 - 50 mg every 8 hours orally.

Captopril is considered a cornerstone in heart failure treatment.

55
Q

What are the typical dosages for Enalapril and Lisinopril?

A
  • Enalapril: 5 - 20 mg
  • Lisinopril: 5 - 20 mg daily

These ACE inhibitors are used to manage heart failure.

56
Q

What beneficial effects do ACE inhibitors have in heart failure?

A
  • Improve symptoms
  • Reduce mortality
  • Decrease frequency of hospitalization

Several studies have confirmed these benefits.

57
Q

Who should be prescribed ARBs instead of ACE inhibitors?

A

Patients who cannot take ACE inhibitors due to cough or renal failure.

ARBs do not affect bradykinin metabolism, thus avoiding cough.

58
Q

What are examples of ARBs and their typical dosages?

A
  • Losartan: 50 mg daily
  • Valsartan: 80 mg daily

ARBs are particularly useful in chronic heart failure.

59
Q

What is the mechanism of action of diuretics?

A

Increase in urinary sodium excretion leading to reduction in blood and plasma volume.

This helps reduce preload and improve venous congestion.

60
Q

What is the dosage range for Furosemide (Lasix)?

A

40 - 120 mg/day orally.

Furosemide acts on the loop of Henle and has a rapid onset of action.

61
Q

What are the side effects of Furosemide?

A
  • Hypokalemia
  • Hyponatremia
  • Hypochloremic alkalosis
  • Hypocalcemia
  • Hyperuricemia
  • Hyperglycemia
  • Hyperlipidemia

Furosemide can also be nephrotoxic and ototoxic.

62
Q

What is the site of action for Furosemide?

A

Acts on the thick ascending limb of the Loop of Henle.

This is where it inhibits the cotransport of Na+, K+, Cl-, and H2O.

63
Q

What is the main action of Digitalis?

A

Increases cardiac contractility (inotropic effect) and excitability, decreases heart rate (negative chronotropic effect)

Digitalis acts either directly or via vagal stimulation.

64
Q

How does Digitalis affect intracellular sodium and calcium levels?

A

Inhibits Na-K ATPase, leading to increased intracellular Na, which is exchanged for extracellular Ca

This process enhances muscle contraction.

65
Q

In which conditions is Digitalis a better choice?

A

Atrial fibrillation (AF) and heart failure (HF) for ventricular rate control

Especially in patients with symptoms of heart failure despite vasodilators and diuretics.

66
Q

What is a contraindication for the use of Digitalis?

A

Hypertrophic cardiomyopathy with diastolic dysfunction

This condition is characterized by reduced left ventricular compliance.

67
Q

What is the typical oral dosage of Digitalis?

A

0.25 - 0.5 mg/kg divided into 2 equal daily doses (every 12 hours)

Can also be administered intravenously.

68
Q

What are the two preparations of Digitalis mentioned?

A
  • Digoxin (Lanoxin) - renal excretion
  • DigiToxin - hepatic metabolism
69
Q

What CNS symptoms can indicate Digitalis toxicity?

A
  • Headache
  • Visual disturbances
  • Photophobia (colored yellow-green vision)

These symptoms reflect the central nervous system effects of toxicity.

70
Q

What cardiovascular effects can Digitalis toxicity cause?

A
  • Bradycardia
  • Heart block (except 2nd degree HB)
  • Increased excitability of atrium and ventricle
  • Arrhythmias (extrasystole, SVT)

It decreases AV conduction and can lead to various arrhythmias.

71
Q

What ECG changes are associated with Digitalis toxicity?

A
  • Prolonged P-R interval
  • Curved ST segment depression

These changes are indicative of digoxin effects on cardiac conduction.

72
Q

What are factors that increase the risk of Digitalis toxicity?

A
  • Hypokalemia
  • Hypercalcemia
  • Renal failure
  • Alkalosis
  • Accidentally large dose
  • Certain drugs (e.g., furosemide, thiazide, calcium, quinidine)
  • Old age
  • Thyroid disease
73
Q

What is the first step in the treatment of digitalis toxicity?

A

STOP digitalis

74
Q

What should be corrected in cases of digitalis toxicity?

A

Hypokalemia and hypercalcemia

75
Q

What medications are used to treat arrhythmias in digitalis toxicity?

A
  • Phenytoin
  • Lidocaine
76
Q

What is the antidote for digitalis toxicity?

A

Digitalis antibodies (Digibind) or immunotherapy (Digoxin immune Fab)

77
Q

True or False: DC is advisable in the presence of digitalis intoxication.

78
Q

What position should a patient be in for adequate oxygenation?

A

Semi setting position

79
Q

What is the recommended fluid restriction for patients with hf?

80
Q

What is the treatment approach for pulmonary edema in Grade II?

81
Q

What oxygen therapy methods are used for pulmonary edema?

A
  • Continuous positive airway pressure (CPAP)
  • Mechanical ventilation
82
Q

What are the inotropic drugs used in the treatment of cardiogenic shock Grade III?

A
  • IV dopamine
  • Dobutamine
  • Milrinone
83
Q

True or False: Digoxin is an appropriate treatment for cardiogenic shock due to its slow action and risk of toxicity.

84
Q

What specific causes may require treatment in cardiogenic shock?

A
  • Valve lesion
  • Shunt
  • Rheumatic
85
Q

Etilogy of hf

86
Q

Sympotoms of
Pulmonary cong
Systemic cong
Low co

87
Q

Inv done for therapy follow up

88
Q

Bat wing shadow

A

Pulmonary edema

89
Q

How to know lung cong

A

By cxr prominent vascular markings

90
Q

Mention BNP signifcance

A

Good negative test

91
Q

Mention inv done incase of hf

92
Q

Classsifcation of hf oral

93
Q

Mention comp of hf

94
Q

gr ; digoxin is not used in ttt of cardiogrnic shock

A

Slowly acting
High risk for toxicity

95
Q

Gr; CPAP is used in both insp exp

A

To avoid re entry of h2o

96
Q

Mention صعوبه dopamine

A

Iv infusion

97
Q

Ttt of hf (supportive mesure)

98
Q

Ttt of cardiogenic shock

99
Q

Mention mecha of dilators ace i

100
Q

Who is cormer stone in hf ttt

101
Q

Contra of ace i

A

Bilat renal artery stenosis’
Hyperkalemka
Spironola tone

102
Q

Indication. Of arbs

A

Who cannot take ace i dt renal of cough

103
Q

Side effects of ace i

A

Dry irritant cough
Angioneuritic edema

104
Q

Most useful vaso dilator in chronic hf

105
Q

Mention furosmide
Site
Potency
Action
Side effects

106
Q

Mention DC incase of digitalis toxicity

A

Inadvisabel
But if mandatory use low dose

107
Q

Ttt of digitalis toxicity

A

Stop diggalis
Correct
Ttt
Antidote

108
Q

Factors inc risk for toxicity

109
Q

Mention metabolism for digioxin
Digitoxin

A

Digoxin =renal
Digitoxin = hepatic

110
Q

Contra of digitalis

A

Hpertrophic cardiomyopathy

111
Q

Digitalis action

112
Q

When to choose digitalis in ttt hf

A

Af with hf

113
Q

Serum toxic level ofr digitalis

114
Q

Earliset symptoms for digitalis toxicity

115
Q

Mention cns symp for digitalis toxicity

A

Xanthopthia
Photophobia
Visual dist

116
Q

Mention hb degrees of digitalis toxicity

A

All except 2nd

117
Q

How to spot digitalis toxicity

A

Prolonged p-r
S-t segment curved depresiom

118
Q

Mention cvs signs for didtalis toxicity

Cardio Ped (10 decks)

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