Cardiac SOB Flashcards
Causes of SOB general?
Not enough O2 reaching lungs = asthma, COPD, anaphylaxis
V/Q mismatch = PE, pulmonary oedema, pulmonary fibrosis
Not enough O2 reaching rest of bodies = heart issues or anaemia, shock
General breakdowns of HF?
Acute or chronic
Left or right (both = CHF)
High output state or low output state
Def: the failure of te heart to maintain teh CO required to meet the bodys demands
Acute HF features?
Rapid onsent severe symptoms, causes by ACS or decompensation of chronic HF
Categories of left HF?
Valvular = AS, AR or MR
Muscular = IHD, cardiomyopathy, myocarditis and arryhthmias
Systemic: HTN, amyloidosis, drugs e.g. chemo,cocaine
Categories of right HF?
Lungs: pulmonary HTN (cor pulmonale), PE, chronic lung disease e.g. CF, IPF
Valvular: TR, Pulmonary valve disease
LHF -> CHF
Conditions that require higher CO?
NAP MEALS Nutrional (B1/thiamine) Anaemia Pregnancy Malignancy Endocrine AV malformations Liver Cirrhosis Sepsis
What happens if fluid is congested back?
LHF: fluid backs up pulmonary vein and accumulates in lungs -> respiratory symptoms
RHF: Fluid bacs up vena cava = accumulates in peripheries = swelling
LHF symptoms?
Dyspnoea (PND = paroxysmal nocturnal dysponoea, exertional dysponoea, orthopnoea)
Nocturma cough +/- pink frothy sputum
Fatigue
Crackles and wheeze
Cyanosis, fatigue, confusion and restlessness
Heart signs of LHF?
Increased HR, increased RR, irregularly irregular heartbeat, pulsus alternans, displaced apex beat
S3 gallop rhythm
S4 severe HF
Murmur = AS,MR,AR
Lung signs of LHF?
Fine end-inspiratory crackles at lung bases (pulmonary oedema)
Wheeze (cardiac asthma)
symptoms of RHF?
Symptoms: fatigue, reduced exercise tolerance, anorexia, nausea and NOCTURIA
Signs of RHF?
Face swelling, increased JVP, TR murmur, increased HR and RR
Ascites and hepatomegaly, ankle and sacral pitting oedema
Ix for HF?
ECG
Bloods: FBC, U&E, LFTs, TFTS, BNP is key
Imaging: CXR, TransThoracicEcho
If BNP is low, HF unlikely
If BNP high -> TTE
TTE with doppler is diagnostic
How to use TTE for EF?
EF <40% indicates ventricular inability to contract normally
EF>50% indicates ventricle inability to relax and fill normally
CXR for HF assessment?
ABCDE Alveolar oedema B-lines (Kerley) Cardiomegaly Dilated upper lobe vessels + diverted upper lobe Effusion (transudative pleural effusion)
What is used for HF diagnosis?
Framingham criteria
2+ major or 1 major and 2 minors
Chronic HF Mx?
1) treat the underlying cause
2) treat the eacerbating factors
3) lifestyle modifications
4) Drugs ABD: Acei, Beta, diuretics
What drugs are given for HF?
ACEi: for all patients with LV dysfunction e.g. enalapril, preindopril, ramipril
beta bloceker to reduce O2 demand of heart e.g. bisoprolol, carvedilol
Duresemide (loop) or aldosterone antagonist (spirinolactone)
Hydralazine + nitrates - considered in afro-carribean patients
Digoxin
Acute HF management>
Sit patient up 60-100% O2 IV diamorophine 2.5-5mg GTN infusion IV fureosemide 40-80mgs
DMONS
Diuretics, morphine, oxygen, nitrates, sit up
Complications of HF?
Respiratory failure, renal failure (hypoperfusions), acute exacerbations and death
Very poor prognosis
Cardiomyopathy definition?
A group of diseases in which the myocardium becomes structurally and functionally abnormal. In the absenee of coronary artery disease, valvular disease and congenital heart disease.
It can affect young people
Primary: confined to myocardium
Secondary: part of systemic disease
General types of cardiomyopathy?
Normal, dilated, hypertrophic and restrictive
Presentation of cardiomyopathy?
Symptoms of HF: SOBOE< fainting, fatigue
Suddent death adn Fhx
Ask above young deaths in family
Pathophysiology of dilated cardiomyopathy?
Ventricles enlarge and become dilated so walls thinner and weaker. therefore LAw of Laplace: increased radius = reduced ventricular pressure
RFs for dilated cardiomyopathy?
ALCOHOL, post viral, haemochromotosis, genetic
PC for Dilated CM?
Signs and symtoms of HF, displaced apex beat,
TR/MR murmur, S3`
Ix for dilated CM?
Globular heart on CXR and dilated ventricle in ECHO
Pathophysiology of hypertrophic CM (HCM)?
Increased stiffness affects pumping and disrupts electrical conduction = arrhythmia
HOCM = affected outflow
50% is familial (autosomnal dominant)
PC of HCM?
usually asymptomatc, sudden cardiac death
Angina, dyspnoea, palpitations and syncope
Signs of HCM?
Ejection systolic murmur, jerky carotid pulse, double apex beat but NOT DISPLACE
S4`
Ix for HCM?
ECG: q waves, left axis deviation and signs of LVH
ECHO: ventricular ypertophy
LVH by voltage criteria?
Deep s in V1/2
Tall R in V5/6
S in V1 + R in V5 or V6 >7 large squares
Restrictive cardiomyopathy pathophysiology?
R is for rigid as loses flexibility so impaired ventricular filling during diastole
Causes of restrictive cardiomyopathy?
OSIS: sarcoidosis, amyloidosis, haemochromotosis
Familial and idiopathic
Rarer than other two types
Symptoms and signs of RCM?
Asx or HR symptoms
RHF signs: raised JVP, S3, ascites and oedema, hepatomegaly
Kussmauls signs = paradoxical rise in JVP during inspiration
What are the other cardiomyopathies?
Arrhythmoemc right ventricular cardiomyopathy: progressive fatty and fibrous replacement of the ventricular myocardium (autosomnal dominant)
Takotsubo cardiomyopathy = broken heart syndrome
Causes of constrictive pericarditis?
idiopathic, infectious e.g. TB, bacteriale.g. strep, staph and pneumococcus, viral
Acute pericarditis causes
cardiac surgery and radiation
Signs and symptoms of restrictive pericarditis?
Similar to restrictive cardiomyopathy
RHF presentation (raised JVP, oedema) Jussmauls signs
Ix for constricitve pericarditis?
CXR: pericardial calcification
ECHO: increased pericardial thickness (to differentiate to RCM)
Cardiac CT/MRI
Mx for constrictive pericarditis?
Pericardectomy
What is and causes of myocarditis?
Inflammation of the myocardium
Infectious, drugs e.g. cocaine, metals and radiation
Coxsackie B most common cause in europe
Signs and symptoms of myocarditis?
Flu-like prodome
Chest pain (worse lying down)
SOB
Palpitations
investigations for Myocarditis?
ECG: non-specific ST and T wave changes
Cardiac biomarkers: CK and troponin
Endomyocardial biopsy: diagnostic but not routinely preferred
