Breathlessness

Question 1

How do you classify breathlessness?

Answer 1

New York classification

Stage 1 - no symptoms during physical Stage 2
Stage 3

Question 2

What is paroxysmal nocturnal dyspnea?

Answer 2

Waking up at night to gasp for air

Question 3

What is orthopnoea? What would you ask to confirm this?

Answer 3

SOB when lying flat

How many pillows do they have at night?

Question 4

Breathlessness, chest pain plus syncope, what are you thinking?

Answer 4

Aortic stenosis

Question 5

Other things you’d ask about

Answer 5

Palpitations
Chest pain
Do legs feel more heavy than usual? Pain in legs when walking?

Question 6

What does pink frothy sputum suggest?

Answer 6

HEART FAILURE as they’re trying to cough up the excess fluid in their lungs

Question 7

What might you ask to rule our asthma

Answer 7

Wheeze

Asthma pumps

Question 8

What might you ask in terms of previous medical history?

Answer 8

Previous stroke
Previous MI
Diabetes 
High cholesterol 
High BP

Question 9

What might you ask about the drugs?

Answer 9

Do you have any SE with these meds?

Question 10

Which drug should be stopped in heart failure?

Answer 10

CCB because they’re negative inotropes - decrease cardiac contractility which would mean the heart would struggle more

Question 11

Which drugs should be stopped in heart failure?

Answer 11

CCB because they’re negative inotropes - decrease cardiac contractility which would mean the heart would struggle more

NSAIDS - it interferes with COX and prostaglandin synthesis, thereby causing renal artery vasoconstriction and

Anaesthetics

Question 12

What causes heart failure?

Answer 12

Left ventricular dilation

Left ventricular hypertrophy

Question 13

Immediate management of acute heart failure

Answer 13

Hx failure
Sit them upright
High flow oxygen

Question 14

What would you order on bloods?

Answer 14

BNP over ?100 (heart failure)

Trops (heart attack)

Question 15

What tests would you order?

Answer 15

Bloods
ECG
CXR

Question 16

What would you see on a CXR in someone with heart failure?

Answer 16

Alveoli batwings 
Kurley B lines (interstitital oedema)
Cardiomegaly 
Dilated upper blood vessels 
Effusion

Question 17

What’s the definitive test to diagnose HF?

Answer 17

Echo cardiogram

Question 18

Treatment of HF

Answer 18

Diamorphine
Frusemide
GTN spray or nitrate infusion

Question 19

Long term management of HF

Answer 19

Stop smoking
Cut salt
Lose weight