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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

A
24
Q

Acute heart failure

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

A
25
Q

Acute heart failure

Nitrates
- Indications
- Contraindications
- MoA
- Forms
- S/E

A
26
Q

Acute heart failure

Inotropes
- Indications
- Contraindications
- MoA
- Forms

A
27
Q

Summary of inotrope effects on heart rate and contractility

A
28
Q

Chronic HFrEF

Treatment options

A

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
Q

Chronic HFrEF

ACEI/ ARB
- Indication
- MoA
- Drug choices

A
30
Q

Chronic HFrEF
B-blockers
- Timing of initiation
- Indications
- MoA
- Drug choices

A
31
Q

Chronic HFrEF

Diuretics
- Indication
- MoA
- Monitoring
- Drug choices

A
32
Q

Chronic HFrEF additional therapy
ARNi

  • Timing
  • Indication
  • MoA
  • Drug choices
A
33
Q

Chronic HFrEF additional therapy
MRA

  • Prerequisite
  • Indications
  • MoA
  • Drug choices
A
34
Q

Chronic HFrEF additional therapy
Ivabradine

  • Prerequisite
  • Indications
  • MoA
A
35
Q

Chronic HFrEF additional therapy
Hydralazine + Nitrate

Indication
MoA

A
36
Q

Chronic HFrEF additional therapy

Digoxin
Indication

A
37
Q

HFrEF additional therapy options

A

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
Q

Criteria for severity of LV dysfunction

A
39
Q

Biomarker for heart failure

A

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
Q

Cardiac causes of high BNP

A
41
Q

Confounding non-cardiac causes of high BNP

A
42
Q

Surgical Treatment options for HF

A

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
Q

Clinical course of HF

A
44
Q

Treatment of different hemodynamic profiles of heart failure

A

Congestion (both left or right heart) (Yes or No)&raquo_space; S3, peripheral edema, orthopnea and PND, high JVP, Pulmonary edema

Perfusion (Adequate or poor)&raquo_space; 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
Q

Chronic HFpEF

Treatment options

A

SGLT-2 inhibitor + ACEi/ ARB = major drugs

Additional:
* Slow HR, BP control: BB, CCB
* Diuretics for volume overload
* CAD - coronary revascularization

46
Q

Pulmonary edema

Types
Pathophysiology

A
47
Q

Cardiogenic pulmonary edema

Risk factors

A
48
Q

Cardiogenic pulmonary edema

Precipitating factors

A
49
Q

Non-cardiogenic pulmonary edema

Causes

A
50
Q

Pulmonary edema

Ix, Dx

A
51
Q

Acute pulmonary edema

Treatment flowchart

A

MBBS VI - SpC - Medicine (80 decks)

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