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MBBS VI - SpC - Medicine > Cardiac - Heart failure, Pulmonary edema > Flashcards

Cardiac - Heart failure, Pulmonary edema Flashcards

1
Q

Heart failure

Definition
NYHA Classification

A
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2
Q

Differentiate low vs high output heart failure

A
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3
Q

Differentiate left vs right heart failure S/S

A
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4
Q

Differentiate HFrEF and HFpEF

Demographics
Risk factors
Difference in CXR

A
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5
Q

Systolic HF/ HFrEF

Causes

A

+ Myocarditis
+ Immune disorders: RA, SLE, Chagas

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6
Q

Diastolic HF/ HFpEF

Causes

A
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7
Q

High output heart failure

Causes

A
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8
Q

Heart failure

Pathophysiology

A
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9
Q

Heart failure

Mechanism of compensation and decompensation

A
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10
Q

Heart failure

Pathophysiology of pressure overload
Evidence of pressure overload

A
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11
Q

Heart failure

Pathophysiology of volume overload
Evidence of volume overload

A
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12
Q

Heart failure

Symptoms

A
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13
Q

Heart failure

Precipitating factors

A
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14
Q

Heart failure

Diagnostic criteria

A
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15
Q

Heart failure

History taking questions

A

Symptoms of HF: Dyspnea, orthopnea, edema, PND…

Past history of CAD, PVD, Stroke

Etiologies:
* Risk factors of CVS: Smoking, Metabolic syndrome (HT, DM,HL)
* Valvular diseases: CTD, Rheumatic fever…etc
* Systemic diseases: Thyroid storm, Pheochromocytoma …etc
* Cardiotoxic drugs: Chemo/RT, Substance abuse

Family history:
Sudden death at young age, FHx of myopathies, arrhythmias, premature CVD

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16
Q

Heart failure

P/E

A
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17
Q

Heart failure

Biochemical Ix

A
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18
Q

Heart failure

Radiological Ix

A

+ CXR
+ Coronary angiography
+ Cardiac MRI

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19
Q

Heart failure

CXR findings

A
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20
Q

Heart failure

Indications of coronary angiography and cardiac MRI

A
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21
Q

Heart failure

Acute HF causes
treatment principles

A

Respiratory causes:
* Acute respiratory failure
* Pulmonary embolism

Circulation emergency:
* Cardiogenic shock
* Hypertension emergency/ Malignant hypertension

Cardiac causes:
* Acute Coronary syndrome/ MI
* Arrhythmia
* Acute mechanical cause e.g. VHD, LVOTO

Systemic:
* Anemia
* Endocrine: e.g. thyroid storm, pheochromocytoma
* Adverse drug effects

22
Q

Heart failure

General management

A

General:
* Bed rest
* O2 supplementation: NIV, NI-cPAP, Intubation, Mech. ventilation
* Low salt diet
* Fluid restriction

Monitor:
* Vitals: Orthostatic BP, O2 saturation, HR
* Fluid I/O, Weight
* Clinical: signs of peripheral congestion, symptoms of HF
* Electrolytes and renal function

23
Q

Acute heart failure

Morphine MoA

24
Q

Acute heart failure

Loop diuretics
- Indication
- MoA
- Drug choice
- S/E

25
Acute heart failure Nitrates - Indications - Contraindications - MoA - Forms - S/E
26
Acute heart failure Inotropes - Indications - Contraindications - MoA - Forms
27
Summary of inotrope effects on heart rate and contractility
28
Chronic HFrEF Treatment options
4 main pillars: * ACEi/ ARB + Beta Blocker * Mineralocorticoid receptor antagonist * Angiotensin receptor neprilysin inhibitor (ARNI), Ivabradine * Surgical: e.g. Cardiac resynchronization therapy (CRT) Additional: * Nitrate + Hydralazine if cannot tolerant ACEi and ARB * Diuretics for volume overload * Anti-coagulants, Digoxin, PCI for A-fib * CABG/ PCI for CAD Lifestyle modification  Salt restriction (< 2 g/day)  Fluid restriction (1.5 – 2 L/day)  Avoid smoking and alcohol  Weight monitoring and exercise training in ambulatory patients
29
Chronic HFrEF ACEI/ ARB - Indication - MoA - Drug choices
30
Chronic HFrEF B-blockers - Timing of initiation - Indications - MoA - Drug choices
31
Chronic HFrEF Diuretics - Indication - MoA - Monitoring - Drug choices
32
Chronic HFrEF additional therapy ARNi - Timing - Indication - MoA - Drug choices
33
Chronic HFrEF additional therapy MRA - Prerequisite - Indications - MoA - Drug choices
34
Chronic HFrEF additional therapy Ivabradine - Prerequisite - Indications - MoA
35
Chronic HFrEF additional therapy Hydralazine + Nitrate Indication MoA
36
Chronic HFrEF additional therapy Digoxin Indication
37
HFrEF additional therapy options
Angiotensin receptor neprilysin inhibitors (ARNi) Mineralocorticoid receptor antagonist (MRA) Ivabradine Hydralazine + Nitrates (Isosorbide dinitrate) Digoxin Sodium glucose transporter protein (SGLT-2) inhibitor (Empagliflozin) No effect: Statins have NO benefit in patients with HFrEF with or without coronary artery disease CCBs have NO benefit in patients with HFrEF
38
Criteria for severity of LV dysfunction
39
Biomarker for heart failure
Brain Natriuretic Peptide (BNP) and NT-proBNP Endogenous function: BNP from cardiomyocytes to resist fibrosis and myocardial hypertrophy by decreasing BP, sympathetic tone, RAAS activation
40
Cardiac causes of high BNP
41
Confounding non-cardiac causes of high BNP
42
Surgical Treatment options for HF
Devices: * Cardiac Resynchronization therapy (CRT) (biventricular pacing) * Cardiac assist devices: Pacemaker * Implantable Cardioverter Defibrillator (ICD) Revascularization: * Cardiac Transplant * CABG for ischemic cardiomyopathy * Valvular surgery * Left ventricular assist device (LVAD)
43
Clinical course of HF
44
Treatment of different hemodynamic profiles of heart failure
Congestion (both left or right heart) (Yes or No) >> S3, peripheral edema, orthopnea and PND, high JVP, Pulmonary edema Perfusion (Adequate or poor) >> low peripheral temp and pulse HF with congestion (Wet profile) * Adequate peripheral perfusion - Wet and Warm - Treat hypertension and congestion with Vasodilators, Diuretics * Poor peripheral perfusion - Wet and Cold - Inotropes, Vasopressors, Diuretics for low SBP; Vasodilators, Diuretics for normal SBP HF without congestion (Dry profile) * Adequate peripheral perfusion - Dry and warm - Compensated HF, adjust medication * Poor peripheral perfusion - Dry and cold - treat hypoperfusion with Fluid Challenge, Inotropic agent
45
Chronic HFpEF Treatment options
SGLT-2 inhibitor + ACEi/ ARB = major drugs Additional: * Slow HR, BP control: BB, CCB * Diuretics for volume overload * CAD - coronary revascularization
46
Pulmonary edema Types Pathophysiology
47
Cardiogenic pulmonary edema Risk factors
48
Cardiogenic pulmonary edema Precipitating factors
49
Non-cardiogenic pulmonary edema Causes
50
Pulmonary edema Ix, Dx
51
Acute pulmonary edema Treatment flowchart

MBBS VI - SpC - Medicine (80 decks)

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