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Yr 3 MedEd > Cardiac causes of SOB > Flashcards

Cardiac causes of SOB Flashcards

1
Q

Define heart failure

A

Failure of heart to maintain cardiac output needed to meet body’s requirements.

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2
Q

Differentiate low and high output heart failure. Which is more common?

A

Low output: CO is low and fails to increase with exertion

High output: CO is normal but you have increased needs.

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3
Q

Give 3 valvular causes of LHF.

Give 4 heart muscle causes of LHF.

Give 3 systemic causes of LHF.

A

Valvular: aortic stenosis, aortic regurgitation, mitral regurgitation.

Heart muscle: Ischaemic heart disease, cardiomyopathy, myocarditis, arrhythmia.

Systemic: Hypertension, amyloidosis, drugs- cocaine, alcohol, BBs.

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4
Q

Give 1 heart related cause of RHF
Give 3 lung causes of RHF
Give 2 valvular causes of RHF

A

LHF
Lungs: Pulmonary hypertension -> cor pulmonale, PE, Chronic Lung disease (interstitial lung disease, pulmonary fibrosis, cystic fibrosis).
Heart valves: Tricuspid regurgitation, pulmonary valve disease.

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5
Q

What is the acronym for causes of high output heart failure?
High output HF presents initially with features of RHF and then LHF more apparent.

A

NAP MEALS:

  • Nutritional: B1, thiamine
  • Anaemia
  • Pregnancy
  • Malignancy - multiple myeloma
  • Endocrine- hyperthyroidism
  • AV malformations
  • Liver cirrhosis
  • Sepsis
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6
Q

Give 5 symptoms of LHF

A
  • Exertional dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Nocturnal cough (+/- pink frothy sputum)
  • Wheeze
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7
Q

Give 7 cardiac signs of LHF

Give 2 respiratory signs of LHF

A

Cardiac:

  • Increased HR and RR
  • Irregularly irregular heart beat
  • Pulsus alternans- alternating strong and weak pulse
  • Displaced apex beat
  • S3 gallop rhythm- Kentucky- sound of blood hitting ventricle wall.
  • S4- Tennessee, if severe HF, due to poor compliance of scarred ventricle.
  • Murmur- AS, MR, AR

Respiratory:

  • Fine end-inspiratory crackles at lung bases- pulmonary oedema
  • Wheeze- cardiac asthma
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8
Q

Give 7 symptoms of RHF

A
  • Swelling- ankles, facial engorgement, ascites
  • Weight gain- due to oedema
  • Fatigue
  • Reduced exercise tolerance
  • Anorexia
  • Nausea
  • Nocturia- as fluid returns from legs when patient lies down.

Symptoms of fluid congestion due to back pressure of venous system. Further compounded by salt and water retention due to activation of RAS by renal hypoperfusion.

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9
Q

Give 5 signs of RHF

A
  • Face: swelling
  • Neck: increased JVP.
  • Heart/ chest: TR murmur, raised HR, raised RR.
  • Abdomen: ascites, hepatomegaly
  • Other: pitting oedema in ankles and sacrum
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10
Q

Give 3 differentials of a raised JVP.

A
  1. RHF
  2. Tricuspid regurgitation
  3. Constrictive pericarditis
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11
Q

Give the following investigations for heart failure:

  • Bedside (1)
  • Bloods (5)
  • Imaging (2)
A

Bedside; ECG
Blood: FBC, U&E, LFTs, TFTs, BNP
Imaging: CXR, Transthoracic Echocardiogram (TTE)

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12
Q

What is BNP and how does its level (raised/ lowered) relate to diagnosis of heart failure?
What does it reduce?
What investigation should be done after high level found?

A

Brain Natriuretic peptide, released by cardiomyocytes in response to stretching. Reduces renal sodium reabsorption, reducing blood volume.

Low level means heart failure unlikely. High level indicates need for Transthoracic Echocardiogram (TTE)

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13
Q

TTE coupled with doppler can calculate ejection fraction- % of blood present in LV pumped during systole (normal 50-70%).

What does EF < 40% indicate?
What does EF > 50% indicate?

A

< 40: HF with reduced ejection fraction, HFrEF- systolic HF. Inability of ventricle to contract normally.

> 50: HF with preserved ejection fraction, HFpEF- diastolic HF. Inability of ventricle to relax and fill normally.

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14
Q

Give 5 features of HF on chest X-ray. What acronym is used?

A

ABCDE

  • Alveolar oedema- batwing appearance
  • B-lines, Kerley
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Effusion- pleural, transudative (no protein), after pulmonary oedema.
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15
Q

Which criteria is used to diagnose heart failure? What grading is needed for diagnosis?

A

Framingham criteria: >2 major or 1 major and 2 minor.

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16
Q

Give 3 conservative steps for management of heart failure.

A
  • Smoking cessation
  • Weight management
  • Diet- reduce salt intake.
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17
Q

Give 5 steps in medical management for heart failure. Give drug names

A
  1. ACE inhibitors - enlalalpril, for all patients with LV dysfunction.
  2. BBs (carvedilol, bisoprolol), reduce O2 demand on heart. Synergistic effects with ACEi.
  3. Diuretics (furosemide, spironolactone, chlorothiazide), use if evidence of fluid retention, monitor electrolytes- spironolactone causes hyperkalaemia.
  4. Digoxin: +inotrope (increases heart contractility), helps improve symptoms.
  5. Other: hydralazine nitrate, cardiac resynchronisation, implantable defibrillator.
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18
Q

Give 3 features of chronic heart failure regarding:

  • Progression
  • Blood pressure
  • Compensation
A
  • Develops and progresses slowly
  • Arterial pressure maintained until very late
  • Periods of acute decompensation
19
Q

Give 2 aetiologies of acute heart failure

A
  1. decompensation of previous chronic HF: MI, cardiac arrhythmias, infection, thyroid disease, uncontrolled HTN.
  2. Acute coronary syndrome- most common cause of acute new onset HF.
20
Q

Give 6 features of HF history.

A
  • Dyspnoea
  • Cough
  • Wheeze
  • Pink frothy sputum
  • Swelling of legs
  • Symptoms of underlying condition
21
Q

Give 6 examination findings of a HF patient.

A
  • Raised HR and RR
  • Pulsus alternans
  • Cyanosis
  • Peripheral shutdown
  • S3 gallop rhythm
  • Fine end inspiratory crackles
22
Q

Give first 3 steps in patient with acute heart failure

A
  1. sit patient upright
  2. High-flow oxygen via non rebreathe mask, sats target 95-98%
  3. IV Furosemide 40-80mg
23
Q

Give 2 complications of heart failure

A
  • Pleural effusion

- Renal failure- long standing HF can lead to hypoperfusion

24
Q

What is the 2 year prognosis for severe HF?

what is the hospital mortality for acute HF?

A
  • 50% of sever HF patients die within 2 years.

- 2-20% mortality.

25
Q

Define cardiomyopathy.

Differentiate primary and secondary cardiomyopathy.

A

Group of diseases in which the myocardium becomes structurally and functionally abnormal.
Primary: confined to myocardium
Secondary: part of systemic disease.

26
Q

Give 3 features of a history of cardiomyopathy

A
  • Symptoms of HF: SOB on exertion, fainting, dizziness, fatigue.
  • sudden death often 1st presentation
  • Family history- ask about FHx of sudden cardiac death when taking a cardio Hx
27
Q

Give 4 examination findings in HF.

A
  • Signs of HF
  • Murmurs
  • S3
  • S4
28
Q

What are the roles of the following investigations for cardiomyopathy:

  • Echo
  • Cardiac catheterisation
  • Stress test
A
  • Echo: differentiate types of cardiomyopathy and is diagnostic for HCM
  • Cardiac catheterisation: excludes coronary artery disease as cause of dilated cardiomyopathy and in distinguishing restrictive cardiomyopathy from constrictive pericarditis.
  • Stress test: excludes CAD.
29
Q

Give 4 causes for dilated cardiomyopathy

A
  • alcohol
  • Viral infection
  • haemochromatosis
  • genetic
30
Q

Give 4 signs of dilated cardiomyopathy

A
  • Raised JVP
  • TR, MR murmur
  • Displaced apex beat.
31
Q

What is the pathophysiology of hypertrophic cardiomyopathy?

A

Heart thickens inwards, thickened ventricle may block blood flow out of ventricle- Hypertrophic obstructive cardiomyopathy (HOCM). 50% is familial autosomal dominant.

32
Q

Give 4 symptoms of HCM

A
  • Angina
  • Dyspnoea on exertion
  • Palpitations
  • Syncope
  • Often sudden cardiac death might be first presentation.
33
Q

Give 4 signs of HCM

A
  • Ejection systolic murmur
  • Jerky carotid pulse- rapid upstroke (vigorous LV contraction), as vol. of LV decreases, sudden obstruction to LV outflow.
  • Double apex beat
  • S4
34
Q

Give 3 ECG findings of HCM

A
  • deep Q waves
  • Left axis deviation
  • Signs of LV hypertrophy: Deep/ wide S in V1/2. Tall wide R in V 5/6
35
Q

What is restrictive cardiomyopathy?

Give 3 aetiologies for restrictive cardiomyopathy.

A
  • Ventricles become abnormally rigid, lack flexibility to expand.
  • Idiopathic, familial, systemic (e.g. infiltrative)
36
Q

Give 4 signs of restrictive cardiomyopathy

A

Signs of RHF

  • Raised JVP
  • Kussmaul’s sign- paradoxical rise in JVP in inspiration (normally falls) due to restricted ventricular filling. Suggests impaired filling of RV due to poorly compliant pericardium or myocardium => increased blood flow back into venous system.
  • S3
  • Ascites, ankle oedema, hepatomegaly
37
Q

What is arrhythmogenic right ventricular cardiomyopathy?

What is the aetiology of ARVC?

What is the presentation of ARVC?

A

ARVC- progressive fatty and fibrous replacement of ventricular myocardium.

  • Aetiology: inherited, autosomal dominant.
  • Presentation: asymptomatic initially, symptoms of arrhythmias during exercise.
38
Q

What is constrictive pericarditis

A

Chronic inflammation of pericardium with thickening and scarring.

Parietal and visceral layers (normally distensible with fluid in-between) become inflamed and fuse, acts as a box around the heart.

39
Q

Give 4 aetiologies of constrictive pericarditis.

A
  • Idiopathic
  • Infectious- TB, bacterial, viral
  • Acute pericarditis
  • Cardiac surgery and radiation
40
Q

What symptoms are experienced in constrictive pericarditis?

  • What sign is seen in constrictive pericarditis?
  • What is seen on CXR and Echo?
A
  • RHF symptoms: dyspnoea, raised JVP, fluid congestion.
  • Kussmaul’s sign
  • CXR: pericardial calcification
  • Echo: increased pericardial thickness
41
Q

Give 4 aetiologies of myocarditis

A
  • Infection
  • Drugs, cocaine
  • Metals
  • Radiation
42
Q

Give 4 presenting symptoms of myocarditis

A
  • Flu-like prodrome- 2 weeks before fever, malaise, fatigue, lethargy
  • Orthopnoea
  • SOB
  • Palpitations
43
Q

Give 3 investigations for myocarditis

A
  • ECG: non-specific ST changes, T wave abnormalities
  • Cardiac biomarkers: CK and troponin
  • Endomyocardial biopsy: diagnostic but not routinely performed

Yr 3 MedEd (31 decks)

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