Cardio 1 Flashcards
What is the difference between low and high output Heart Failure?
Low Output:
- Reduced Cardiac Output
- Fails to increase with exertion
High Output:
- Increased needs (Pregnancy, hyperthyroidism)
- Normal Cardiac Output
What are the main causes of Chronic Left-Sided Heart Failure?
Valvular
Heart Muscle
Systemic
What are the valvular causes of Chronic Left-Sided Heart Failure?
Aortic Stenosis (Increased Afterload)
Aortic Regurgitation (Increased pressure in the LV)
Mitral Regurgitation (Increases Preload)
*All these lead to remodelling and hypertrophy of the LV
What are the muscular causes of Chronic Left-Sided Heart Failure?
Ischaemic Heart Disease
Cardiomyopathy
Myocarditis
Arrhythmias
What are the systemic causes of Chronic Left-Sided Heart Failure?
Hypertension
Amyloidosis
Drugs:
- Alcohol
- Cocaine
- Chemotherapeutics (eg. doxorubicin)
What are the causes of Chronic Right-Sided Heart Failure?
Left Heart Failure (Congestive)
Pulmonary Hypertension
Pulmonary Embolism
Chronic Lung Disease (Interstitial, fibrosis, CF)
Tricuspid Regurgitation
Pulmonary Valve Disease
What are the main causes of High-Output Heart Failure?
NAP MEALS
Nutritional Deficiency (Thiamine)
Anaemia
Pregnancy
Malignancy
Endocrine (Hyperthyroidism)
AV Malformations
Liver Cirrhosis
Sepsis
What are the main presenting symptoms of Left Heart Failure?
Exertional Dyspnoea
Orthopnoea
Nocturnal Dyspnoea
Fatigue
Nocturnal Cough (Pink, frothy sputum)
Wheeze
Which signs would you observe on a patient with Left Heart Failure?
Pulsus Alternans
AF (Co-existent with Mitral Regurgitation)
Displaced Apex Beat
S3 Gallop Rhythm
S4 in severe HF
Murmur (due to underlying cause)
Fine end-insiratory crackles at lung bases
Wheeze
What are the main presenting symptoms of Right Heart Failure?
Swelling (Pitting Ankle Oedema, ascites etc)
Weight Gain
Fatigue
Reduced exercise tolerance
Anorexia
Nausea
Nocturia
What are the main signs you may observe on a patient with Right Heart Failure?
Face Swelling
Raised JVP
Tricuspid Regurgitation murmur
Ascites
Hepatomegaly
Pitting Oedema in ankles and sacrum
What is Cor Pulmonale?
RHF due to increased Pulmonary Pressure
How would you investigate suspected Heart Failure?
ECG
FBC, U&Es, LFTs, TFTs, BNP (used to exclude HF)
CXR
Transthoracic Echo with Doppler - Diagnostic
How would you manage a case of Heart Failure?
Treat the Cause
Lifestyle advice
Ace Inhibitors
Beta Blockers
Diuretics
Digoxin
How does Acute HF differ from Chronic HF?
Rapid onset/worsening of symptoms of Heart Failure.
Either due to:
Acute worsening of existing Heart failure Symptoms
or
New-onset symptoms, often due to ACS
How would you manage a case of Acute Heart Failure?
ABC
Sit patient up
High flow O2
Furosemide IV
What are the main complications of Heart Failure?
Pleural Effusion
Renal Failure
Acute Exacerbations
Death
What is the prognosis for Heart Failure?
50% of severe cases die within 2 years.
2-20% mortality in acute cases
How is Cardiomyopathy defined?
A group of disease in which the myocardium becomes structurally and fucntionally abnormal.
How does Cardiomyopathy typically present?
Symptoms of HF may occur (Dizziness, SOB on exertion)
Collapse
Sudden Death
FHx
Which signs on examination could point towards a diagnosis of Cardiomyopathy?
Signs of HF (resp. crackels, increased JVP)
Murmurs
S3
S4
How would you investigate suspected Cardiomyopathy?
Bloods
BNP
CXR
ECG
Stress testing
Echo
Cardiac Catheterisation
What is Dilated Cardiomyopathy?
Enlarged Ventricles become dilated and weaken, preventing effective contraction.
What may cause Dilated Cardiomyopathy?
Alcohol
Viral Illness
Autoimmune conditions
Haemochromatosis
Hereditary
How would you investigate suspected Dilated Cardiomyopathy?
CXR - Globular Heart
Echo - Dilated Ventricle
Signs/Symptoms of Tricuspid and Mitral Regurgitation
What is Hypertrophic Cardiomyopathy (HOCM)?
The heart muscle thickens inwards, eventually blocking blood flow out of the ventricle.
In SBAs - Tends to be Young Athletes having Syncopal Episodes with FHx of Sudden Cardiac Death
Describe the inheritance pattern of HOCM.
Autosomal Dominant
50% of cases are Familial
How would you investigate suspected Hypertrophic Cardiomyopathy?
ECG
Q waves
LAD
LVH signs
Echo
Ventricular Hypertrophy
How would Left Ventricular Hypertrophy appear on an ECG?
Deep S in V1/V2
Tall R in V5/6
S in V1 + R in V5 or V6
What is Restrictive Cardiomyopathy
Ventricles become abnormally Rigid.
This means they progressively lack the flexibility to expand as the ventricles fill with blood.
What is Kussmaul’s Sign?
Paradoxical rise in JVP in inspiration.
Due to restricted filling of the Ventricles.
Seen in restrictive Cardiomyopathy.
What is Arrhythmogenic Right Ventricular Cardiomyopathy?
Progressive fatty and fibrous replacement of the Ventricular Myocardium.
What is Constrictive Pericarditis?
Chronic Inflammation of the Pericardium, leading to thickening and scarring.
What may cause Constrictive Pericarditis?
Idiopathic
Infectious (TB, Bacterial, Viral)
May be acute
Cardiac Surgery and Radiation
How does Constrictive Pericarditis present?
Resembles Restrictive Cardiomyopathy
Kussmaul’s Sign
How would you investigate a suspected case of Constrictive Pericarditis?
CXR - Pericardial Calcification
Echo - Increased Pericardial Thickness
Cardiac CT/MRI (Usually before surgical management)
What is Myocarditis and what causes it?
Inflamation of the Myocardium in the absence of ischaemia
Causes include:
Infection
Drugs (Cocaine, penicillins, cephalosporins, digoxin, anticonvulsants)
Radiation
How does Myocarditis typically present?
Symptoms
Flu-like symptoms
Positional Chest Pain (Worse when lying)
SOB Palpitations
Signs
Pericardial Rub
Arrhythmias
How would you investigate a suspected case of Myocarditis?
ECG (Non-specific ST changes, T-Wave abnormalities)
CK & Troponin (Mild rise, not seen in pericarditis)
Endomyocardial Biopsy (Diagnostic, not routinely performed)
Which murmur would likely be heard in a patient with HOCM?
Ejection Systolic
HOCM leads to Aortic Stenosis
