CARDIOLOGY - Heart Failure Flashcards
What is the most common cause of pulmonary oedema?
Left ventricular failure
Clinical features - pulmonary oedema (5)
Dyspnoea Paroxysmal nocturnal dyspnoea Orthopnoea Cough Production pink, frothy, blood stained sputum
How to ask pt about their orthopnoea in pulmonary oedema
How many pillows is the patient using to prop themselves up at night
Ix pulmonary oedema (5)
ABG FBC (U+E, glucose, D-dimer, CRP, trops) CXR ECG Echocardiography
How does the ‘ABG picture’ progress in pulmonary oedema
Intially: T1RF b/c hyperventilation
Later: T2RF b/c impaired gas exchange
CXR pulmonary oedema (5) (A-E)
Alveolar Bat-wing oedema Kerley B lines Cardiomegaly Dilated Upper zone vessels Pleural Effusion
What is Bat wing oedema
Oedema on the frontal chest radiography
Bilateral - perihilar opacities
Assoc w/: Pulmonary oedema
What are Kerley B lines
Septal lines
B/c of lymphatic engorgment/oedema of CT of interlobular septa
Signs pulmonary oedema on ECG (2)
TachyC
Arrhythmia
Causes pulmonary odema - increased capillary pressure (8)
LVF Valve disease Arrythmias VSD cardiomegaly negatively inotropic drugs pulmonary vv obstruction Iatrogenic fl overload
Causes pulmonary oedema - increased cap permeability (4)
ARDS
Infection e.g. pneumonia
DIC
Inhaled toxins
Causes pulmonary oedema - reduced plasma oncotic pressure
Renal /liver failure
Causes pulmonary oedema - lymphatic obstruction
Tumour/parasitic infection
Mx pulmonary oedema
Sit upright 100% O2 IV diamorphine 1.25-5mg IV furosemide 40/80mg GTN x2 puffs
Mx pulmonary oedema if SBP >100
Start IV infusion nitrates
Mx pulmonary oedema SBP <100
Tx as cardiogenic shock –> ICU
May req invasive ventilation
What is cor pulmonale
Enlargement and failure of right ventricle of heart as a response to increased vascular resistance or high BP in lungs
What is acute respiratory distress syndrome
Pulmonary insults –> non-cardiogenic pulmonary oedema
Direct causes ARDS (4)
Aspiration
Smoke/toxin inhal
Pneumonia
Near-drowning
Indirect causes ARDS (6_
Sepsis Multiple trauma Pancreatitis Transfusion reactions Anaphylaxis Drug reactions
Features ARDS (4)
Hypoxaemia
Absence signs RA P
CXR - diffuse bilateral infiltrates
Impaired lung compliance
Mx ARDS (6)
Sit pt up w/ 100% O2 CPAP IV NO3 IV furosemide Morphine + IV metocloperamide Aminophylline (if bronchospasm)
Common causes heart failure (3)
IHD
Dilated cardiomyopathy
HTN
Rarer causes heart failure (ACV = 321)
Anaemia AF/Heart block Alcohol/Dx Cor pulmonale Congenital heart disease Valvular causes