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
What is meant by congestive heart failure
RHF resulting from pre-existing LHF
Maladaptive neurohormonal adaptations occurring in heart failure
Reduced CO –> activates SNS + RAAS
RAAS –> VC + Na/H2O retention –> Incr BP + cardiac work
SNS –> myocyte aptptosis and necrosis
What is ANP released in response to
Atrial stretch
What does ANP antagonise
Fluid conserving effects of aldosterone
Benefit of adrenergic remodelling signal
Contractility
Hypertrophy
Harm of adrenergic remodelling signal
Myocyte apoptosis
Myocyte toxicity
Benefit of A-II remodelling signal
Hypertrophy
Harm of A-II remodelling signal
Changed expression of contractile proteins
Benefit of TNF-a remodelling signal
Hypertrophy
Harm of TNF-a remodelling signal
Remodelling of matrix
Dilatation
Early warning of CCF (FACES)
Fatigue Activity mod Congestion Edema SOB
Causes LVF (6)
HTN (longstanding) Cardiomyopathies Congenital heart disease MI and IHD Acute ventricular dysrhythmias (VF) Valve disease
PS LVF (5)
Fatigue Exertional dyspnoea/orthopnoea Cardiomegaly + displaced apex beat 3rd HS + gallop rhythm Bibasal crackles
Causes RHF
LVF
Acute- massive PE
Cor pulmonale
Valve disease
Sx RVF (4)
fatigue
breathless
A=N
Swollen ankles
Signs RVF (5)
Jugular venous distention Hepatomegaly Dependent pitting oedema Pleural effusions Cardiomegaly, gallop rhythm
What is cardiac cachexia
Life threatening weight loss due to combination of Hmegaly and increased metabolic demands
NY heart association of HF - stage 1
Disease present, no undue dyspnoea from normal activity
NY heart association of HF - stage 2
Dyspnoea present on normal activities
NY heart association of HF - stage 3
Less than ordinary activity causes dypsnoea which = limiting
NY heart association of HF - stage 4
Dyspnoea present at rest, any activity causes discomfort
Ix HF - bloods (6)
FBC `LFT U+e TFT Cardiac enzymes BNP
What is the gold standard Ix for HF
Echo
What numerical value is diagnostic on echo for HF
Ejection % <45
Mx HF
Lifestyle advice
ACEi + b-blocker
Diuretic (if Sx)
2nd line Mx HF
Spironolactone/ATRA/hydralazine + nitrate
3rd line Mx HF
digoxin
Lifestyle advice HF
Pt education Obesity control Dietary mod Endurance activity recommended Vaccines - pneumococcal and influenza No viagra
What electrolyte imbalance can diuretics and ACEi –>
hyperkalaemia
SE ACEi
Renal - monitor urea/creatinine/ K+ + before Tx
C/I ACEi
PARK Preg Allergy/angiodema Renal aa stenosis K+ hyper
Who are thiazide diuretics used in
Mild failure
Elderly pt w/ massive diuresis
Who are loop diuretics used in
pulm oedema
what metabolic disturbance do diuretics cause
hypokalaemia
digoxin mode of action
+ve inotrope + -ve chronotrope
hence increase force of contraction and decreasing hR
Inhibits Na/K pump
Impairs AVN conduction, incr vagal stim
C/I digoxin
Concurrent heart block
BradyC
Indicators digoxin toxicity
Anorexia
Nausea
visual disturbance
diarrhoea
how is digoxin’s dosage modified
according to eGFR
