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Cardio > Cardio - Cor Pulmonale, HF, Aortic Dissection, Acute and Constrictive Pericarditis > Flashcards

Cardio - Cor Pulmonale, HF, Aortic Dissection, Acute and Constrictive Pericarditis Flashcards

Cor Pulmonale, HF, aortic dissection

1
Q

Cor Pulmonale - what is it?

A

Right sided heart failure due to respiratory disease

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2
Q

Cor Pulmonale - what is the pathophysiology behind it?

A
  1. Increased pressure and resistance in pulmonary arteries (pulmonary HTN)
  2. Then RV unable to pump blood out of RV and into pulmonary arteries
  3. Leads to back pressure of blood eventually into RA, vena cava and systemic venous system
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3
Q

Cor Pulmonale - what are the respiratory causes?

A 
COPD - MOST COMMON
CF
Primary Pulmonary HTN
Pulmonary embolism
Interstitial lung disease
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4
Q

Cor Pulmonale - presentation

A

Early cor pulmonale - asymptomatic

  1. Shortness of breath
  2. Peripheral oedema
  3. Increased breathlessness on exertion
  4. Syncope
  5. Chest pain
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5
Q

Cor Pulmonale - what are the signs to look for on examination?

A

Raised JVP - due to backlog of blood in the jugular veins

Hepatomegaly

Cyanosis

Hypoxia

Murmurs

Peripheral oedema

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6
Q

Cor Pulmonale - management

A

Treat symptoms and underlying cause

Long term O2 therapy

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7
Q

Chronic Heart Failure - what is it?

A

Chronic version of acute HF

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8
Q

Chronic Heart Failure - causes (pathophysiology)

A

Caused by either:
1. Impaired LV contraction (systolic HF)

  1. Impaired LV relaxation (diastolic HF)

Impaired LV function - results in chronic back pressure of blood trying to flow into and through Left Side of heart

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9
Q

Chronic Heart Failure - presentation features

A

Breathlessness - worse on exertion

Peripheral oedema

Orthopnoea - SOB when lying flat

Paroxysmal Nocturnal Dyspnoea

Cough - frothy white/pink sputum

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10
Q

Chronic Heart Failure - Diagnosis

A

Clinical Presentation

ECG

Echo

BNP blood test

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11
Q

Chronic Heart Failure - causes of HF

A

HTN
Valvular heart disease - commonly aortic stenosis
AF
IHD

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12
Q

Chronic Heart Failure - first line medical management

A

ABAL

A - ACE Inhibitor (Ramipril)
B - Beta Blocker (Bisoprolol)
A - Aldosterone antagonist when symptoms not controlled with A and B (Spironolactone)
L - Loop diuretics, improves symptoms (furosemide)

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13
Q

Chronic Heart Failure - what should HF patients be monitored for whilst on medical management

A

U&Es

Diuretics, ACEi, aldosterone antagonists, all cause electrolyte disturbances

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14
Q

Aortic Dissection - what is it

A

Serious cause of chest pain that radiates to the back, due to the tearing of the TUNICA INTIMA in the wall of the aorta

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15
Q

Aortic Dissection - pathophysiology

A
  1. Tearing of tunica intima
  2. High pressure blood flowing through aorta begins to tunnel between the tunica intima and tunica media
  3. Separates the two layers
  4. Blood starts to pool between two layers, increasing diameter of blood vessel
  5. Area where blood collects called false lumen
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16
Q

Aortic Dissection - causes

A

Chronic HTN

Pregnancy - due to increased blood volume circulating

Collagen disorders - Marfans

Hx of aneurysms

Trauma

17
Q

Aortic Dissection - complications

A

Related to where the blood in false lumen flows

  1. Blood could flow back up aorta into heart and enter pericardial space, filling it with blood and causing CARDIAC TAMPONADE
  2. Hole could break through tunica externa, bleed into mediastium, dead quickly
  3. Blood could tunnel through until it reaches another aortic branch e.g. renal artery lower down, blood puts pressure on artery decreasing blood flow to the aortic branches supplying area
18
Q

Aortic Dissection - symptoms and signs

A

Sharp chest pain, radiating to back

Weak pulse in downstream arteries

Variation in BP in each arm

19
Q

Aortic Dissection - diagnosis (imaging)

A

CT angiography - Ix of choice

Chest X-Ray

Transoesphageal Echocardiogram

Patients may present acutely and unstable - need to take into account

20
Q

Aortic Dissection - Stanford Classification

A

Type A - ascending aorta, 2/3 of cases

Type B - descending aorta, 1/3 of cases

21
Q

Aortic Dissection - management

A

Type A - surgical, removal of dissected aorta, and wall reconstructed with synthetic graft

Type B- Treated with IV labetalol, conservative management

IV labetalol used because relaxes the heart, slowing it down. Less blood leaves the heart, so leaves with less force

22
Q

Acute Pericarditis - what is it?

A

Inflammation of the pericardium

23
Q

Acute Pericarditis - what are the causes?

A

Viral infections - Coxsackie, influenza (Most common)

Post MI

TB

Malignancy

24
Q

Acute Pericarditis - what are the clinical features?

A

Sharp, retrosternal chest pain - relieved by leaning forwards

Pericardial friction rub - audible medical sign used in Dx

Dyspnoea

25
Q

Acute Pericarditis - what are the investigations?

A

ECG

Bloods - FBC, ESR, U+Es, cardiac enzymes

CXR

26
Q

Acute Pericarditis - what do you see on ECG

A

Changes are widespread, not defined to specific ‘territories’

  1. Saddle shaped ST ELEVATION elevation across all leads
  2. PR depression - most specific ECG for Pericarditis
27
Q

Acute Pericarditis - what do you see on CXR?

A

Cardiomegaly due to pericardial effusion

28
Q

Acute Pericarditis - if you suspect AP in a patient what investigation should you follow up with?

A

Transthoracic echocardiography

29
Q

Acute Pericarditis - what is the management?

A

Treat the underlying cause

1st line - NSAIDs (analgesia) and Colchicine

30
Q

Constrictive Pericarditis - what is it?

A

It is a condition characterised by the heart being encased in a thickened, fibrotic pericardium, which prevents the diastolic filling of the ventricles, so heart can’t work properly

31
Q

Constrictive Pericarditis - when does it develop?

A

It develops if the pericardium has been inflamed for a long period of time

32
Q

Constrictive Pericarditis - what are the clinical features?

A

Can lead to RIGHT SIDED HEART FAILURE, so raised JVP, oedema, hepatomegaly, ascites

Dyspnoea

Kussmaul’s sign is +ve

33
Q

Constrictive Pericarditis - what is Kussmaul’s sign?

A

Paradoxical rise of JVP on inspiration OR

Failure in the appropriate fall of the JVP during inspiration

34
Q

Constrictive Pericarditis - what investigation do you do and what do you see?

A

CXR - pericardial calcification

35
Q

Constrictive Pericarditis - what is the treatment?

A

Surgical excision of the pericardium - pericardiectomy

Cardio (10 decks)

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