Cardio2 Flashcards
Cardiac SOB
What is heart failure?
Failure for the heart to maintain the cardiac output required by the body to function
How do you calculate cardiac output?
Heart rate x stroke volume
What are the risk factors for a left-sided heart failure?
Aortic valve disease (AS, AR) Mitral regurgitation IHD/MI Cardiomyopathy (HOCM, dilated, restrictive) Myocarditis Arrhythmias (AF) Hypertension Amyloidosis Alcohol/cocaine
What are the risk factors for a right-sided heart failure?
Left-sided HF PE Pulmonary HTN Chronic lung disease (ILD, fibrosis, CF) Tricuspid regurg/pulmonary valve disease
What is cor pulmonale?
Enlargement and failure of RV
Secondary to vascular resistance (pulmonic stenosis)
OR pulmonary HTN
What is a high-output heart failure?
Higher than normal cardiac output due to increased peripheral demand
What are the causes of a high-output heart failure?
NAPMEALS Nutritional (B1- thiamine) Anaemia Pregnancy Malignancy (multiple myeloma) Endocrine (hyperthyroidism) AV malformations Liver cirrhosis Sepsis
What are the risk factors for heart failure?
Older men PMHx/FHx of heart disease Diabetes Dyslipidaemia Drug abuse
What is the epidemiology of heart failure?
10% of >65yrs
1-3% of general population
What are the common symptoms of LHF?
Exertional dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Fatigue Nocturnal cough (+- pink frothy sputum) Wheeze (cardiac asthma)
What are the common signs of LHF?
Raised HR and RR AF Displaced apex beat HS 1+2+3 Murmur (AS MR) Bibasal crackles
What are the common symptoms of RHF?
Fatigue Weight gain (due to oedema) Reduced exercise tolerance Anorexia Nausea Nocturia
What are the common signs of RHF?
Raised HR and RR Raised JVP Oedema (ankle, face, ascites) Parasternal heave TR murmur Hepatomegaly
What investigations would you do for HF?
ECG FBC/U+E/LFT/TFT/glucose Brain natriuretic peptide Trans-thoracic echocardiogram CXR
Why would you do and FBC for HF?
Anaemia is a cause of HF
Why would you do LFTs for HF?
To rule out other causes of abdominal congestion
Why would you measure glucose for HF?
To assess for diabetes
Why would you do TFTs for HF?
To assess for hypo/hyperthyroidism
Why would you measure the BNP for HF?
If it is not elevated, you can rule out HF
How do you calculate the ejection fraction?
Stroke volume/end diastolic volume
What is a normal ejection fraction?
50-70%
What is the ejection fraction of systolic HF and why?
<40%
Due to a decreased stroke volume and force of contraction
What is the ejection fraction of HF with preserved ejection fraction and why?
> 50%
There is also an abnormal diastolic function hence the ratio may appear normal
What are the findings of HF seen on an X-ray?
Hint: ABCDE
Alveolar oedema B-lines (Kerley) Cardiomegaly Dilated upper lobe vessels Effusion (plural [in late stage])
Describe the main investigations done to diagnose HF.
BNP (raised in HF)
Echo (determine ejection fraction)
CXR for ABCDE changes
What is the conservative management for chronic HF?
Smoking cessation Weight loss (exercise) Dietary changes (reduce salt and fat)
What are the main medical management options for chronic HF?
ACE inhibitors (enalapril, ramipril) Beta blockers (bisoprolol, carvedilol) Diuretics (spironolactone, frusemide, hydrochlorthiazide)
What are the alternate medical management options for chronic HF?
Hydralazine and nitrates (for Afro-Caribbeans)
Digoxin (improves inotropy, no impact on survival)
Cardiac resync therapy
Aspirin
What is the management for acute HF?
Sit the Pt up O2 sats to 94-98% Frusemide IV Treat the underlying cause (SOFT)
The following are no longer included in the guidelines:
Vasodilator (GTN spray 2 puffs sub-lingual)
Analgesia (morphine 2.5mg)
What are the complications for HF?
Pleural effusion
Renal failure
Acute exacerbations
Death
What is the prognosis for severe HF?
50% mortality in 2 years
A 78-year-old woman is admitted with heart failure. The underlying cause is determined to be aortic stenosis. What will you hear in the lungs?
Bi-basal crepitations
A 60-year-old man presents to his GP with gradually increasing fatigue and some exertional dyspnoea. Blood pressure is 118/74mmHg and pulse rate is 81/minute. There are no abnormal physical findings and on echocardiography the ejection fraction is 0.47. However, the clinical impression remains one of early heart failure. Which biomarker would lend support to that conclusion?
Brain natriuretic peptide
A 55-year-old male presents with increasing exertional dyspnoea, fatigue, weight loss and bone pain. Blood results reveal elevated calcium levels and normocytic anaemia. He is treated for heart failure. What is the underlying cause for his heart failure?
Multiple myeloma
What are the signs of a multiple myeloma?
CRAB C- hypercalcaemia R- renal failure A- anaemia B- bony lesions
A 74 year old male with a 30 pack year smoking history is admitted to AMU. He has had 2 myocardial infarctions in the last 5 years. On examination he is producing frothy pink sputum, he has bilateral pitting oedema, bibasal crackles and oxygen saturations of 89%. Which of the following is most likely to be identified by auscultating the chest?
A. Third heart sound
B. Carotid bruit
C. Pericardial rub
D. Fourth heart sound
A. Third heart sound
B. presents in carotid stenosis
C. presents in pericarditis
D. can occur but only after a third HS
A 74 year old man presents to AMU with a history of fatigue and breathlessness. On examination, he has an oedematous ankles, a raised JVP, and finger clubbing. When you ask about work, he says he used to work as a ship builder. He is diagnosed with acute heart failure. What is the most likely cause of his heart failure?
A. Smoking B. Rheumatic heart disease C. Interstitial lung disease D. Aortic stenosis E. Aortic regurgitation
C. Interstitial lung disease
A. never mentioned
B. no other features
D. lack of end-systolic murmur
E. lack of diastolic murmur
A 85 year old woman is seen in heart failure clinic for a review of her long term condition. She is currently taking enalapril and bisoprolol. Which other drug can be added to help control her symptoms?
A. Spironolactone B. Amlodipine C. Salbutamol D. Morphine E. Omeprazole
A. Spironolactone
B. CCB used for HTN
C. B-agonist would worsen symptoms
D. analgesic is used for acute management
E. PPI used for GORD
Regarding the management of acute HF, which statement is not true?
A. The patient should be given a diuretic, such as IV frusemide.
B. High-oxygen is not always recommended
C. Opiate analgesia is always recommended
D. A vasodilator, such as nitrates, can be given
E. An ECG may not show an arrythmia
C. Opiate analgesia is always recommended
A. manages oedema
B. O2 may already be adequate
D. 2 puffs sub-lingual
E. 10% have normal ECGs
Which of these x-ray findings is most likely to be seen on a Chest X-ray of a patient with heart failure?
A. Cardiothoracic ratio <50% B. Blunting of the costophrenic angles C. Air bronchograms D. Dilated lower lobe vessels E. Cannon-ball opacities
B. Blunting of the costophrenic angles
You are at Calais and you see a 10 year old boy who is acutely breathless, fatigued and feels nauseous. His mother tells you he has had several episodes of fevers, elbow pains and difficulty walking for the past 2 years, and has developed a rash. On examination, he has an ejection systolic murmur. He is treated for heart failure. What is the most likely underlying cause of his heart failure?
A. Cor pulmonale B. Cystic fibrosis C. Familial cardiomyopathy D. Rheumatic heart disease E. Congenital heart disease
D. Rheumatic heart disease
A. RHF
B. no other features of CF
C. no mention of FHx
E. no mention of DDx
