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CP3 Medicine > CARDIOLOGY - Heart Failure > Flashcards

CARDIOLOGY - Heart Failure Flashcards

1
Q

What is the most common cause of pulmonary oedema?

A

Left ventricular failure

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2
Q

Clinical features - pulmonary oedema (5)

A 
Dyspnoea 
Paroxysmal nocturnal dyspnoea 
Orthopnoea 
Cough 
Production pink, frothy, blood stained sputum
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3
Q

How to ask pt about their orthopnoea in pulmonary oedema

A

How many pillows is the patient using to prop themselves up at night

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4
Q

Ix pulmonary oedema (5)

A 
ABG
FBC (U+E, glucose, D-dimer, CRP, trops) 
CXR
ECG
Echocardiography
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5
Q

How does the ‘ABG picture’ progress in pulmonary oedema

A

Intially: T1RF b/c hyperventilation
Later: T2RF b/c impaired gas exchange

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6
Q

CXR pulmonary oedema (5) (A-E)

A 
Alveolar Bat-wing oedema
Kerley B lines 
Cardiomegaly 
Dilated Upper zone vessels 
Pleural Effusion
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7
Q

What is Bat wing oedema

A

Oedema on the frontal chest radiography
Bilateral - perihilar opacities
Assoc w/: Pulmonary oedema

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8
Q

What are Kerley B lines

A

Septal lines

B/c of lymphatic engorgment/oedema of CT of interlobular septa

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9
Q

Signs pulmonary oedema on ECG (2)

A

TachyC

Arrhythmia

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10
Q

Causes pulmonary odema - increased capillary pressure (8)

A 
LVF
Valve disease 
Arrythmias 
VSD
cardiomegaly 
negatively inotropic drugs 
pulmonary vv obstruction
Iatrogenic fl overload
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11
Q

Causes pulmonary oedema - increased cap permeability (4)

A

ARDS
Infection e.g. pneumonia
DIC
Inhaled toxins

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12
Q

Causes pulmonary oedema - reduced plasma oncotic pressure

A

Renal /liver failure

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13
Q

Causes pulmonary oedema - lymphatic obstruction

A

Tumour/parasitic infection

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14
Q

Mx pulmonary oedema

A 
Sit upright 
100% O2 
IV diamorphine 1.25-5mg
IV furosemide 40/80mg 
GTN x2 puffs
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15
Q

Mx pulmonary oedema if SBP >100

A

Start IV infusion nitrates

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16
Q

Mx pulmonary oedema SBP <100

A

Tx as cardiogenic shock –> ICU

May req invasive ventilation

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17
Q

What is cor pulmonale

A

Enlargement and failure of right ventricle of heart as a response to increased vascular resistance or high BP in lungs

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18
Q

What is acute respiratory distress syndrome

A

Pulmonary insults –> non-cardiogenic pulmonary oedema

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19
Q

Direct causes ARDS (4)

A

Aspiration
Smoke/toxin inhal
Pneumonia
Near-drowning

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20
Q

Indirect causes ARDS (6_

A 
Sepsis 
Multiple trauma 
Pancreatitis 
Transfusion reactions 
Anaphylaxis 
Drug reactions
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21
Q

Features ARDS (4)

A

Hypoxaemia
Absence signs RA P
CXR - diffuse bilateral infiltrates
Impaired lung compliance

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22
Q

Mx ARDS (6)

A 
Sit pt up w/ 100% O2
CPAP 
IV NO3 
IV furosemide 
Morphine + IV metocloperamide 
Aminophylline (if bronchospasm)
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23
Q

Common causes heart failure (3)

A

IHD
Dilated cardiomyopathy
HTN

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24
Q

Rarer causes heart failure (ACV = 321)

A 
Anaemia 
AF/Heart block 
Alcohol/Dx 
Cor pulmonale 
Congenital heart disease 
Valvular causes
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25
Q

What is meant by congestive heart failure

A

RHF resulting from pre-existing LHF

26
Q

Maladaptive neurohormonal adaptations occurring in heart failure

A

Reduced CO –> activates SNS + RAAS
RAAS –> VC + Na/H2O retention –> Incr BP + cardiac work
SNS –> myocyte aptptosis and necrosis

27
Q

What is ANP released in response to

A

Atrial stretch

28
Q

What does ANP antagonise

A

Fluid conserving effects of aldosterone

29
Q

Benefit of adrenergic remodelling signal

A

Contractility

Hypertrophy

30
Q

Harm of adrenergic remodelling signal

A

Myocyte apoptosis

Myocyte toxicity

31
Q

Benefit of A-II remodelling signal

A

Hypertrophy

32
Q

Harm of A-II remodelling signal

A

Changed expression of contractile proteins

33
Q

Benefit of TNF-a remodelling signal

A

Hypertrophy

34
Q

Harm of TNF-a remodelling signal

A

Remodelling of matrix

Dilatation

35
Q

Early warning of CCF (FACES)

A 
Fatigue 
Activity mod 
Congestion 
Edema
SOB
36
Q

Causes LVF (6)

A 
HTN (longstanding)
Cardiomyopathies 
Congenital heart disease 
MI and IHD
Acute ventricular dysrhythmias (VF) 
Valve disease
37
Q

PS LVF (5)

A 
Fatigue 
Exertional dyspnoea/orthopnoea 
Cardiomegaly + displaced apex beat 
3rd HS + gallop rhythm 
Bibasal crackles
38
Q

Causes RHF

A

LVF
Acute- massive PE
Cor pulmonale
Valve disease

39
Q

Sx RVF (4)

A

fatigue
breathless
A=N
Swollen ankles

40
Q

Signs RVF (5)

A 
Jugular venous distention
Hepatomegaly 
Dependent pitting oedema 
Pleural effusions 
Cardiomegaly, gallop rhythm
41
Q

What is cardiac cachexia

A

Life threatening weight loss due to combination of Hmegaly and increased metabolic demands

42
Q

NY heart association of HF - stage 1

A

Disease present, no undue dyspnoea from normal activity

43
Q

NY heart association of HF - stage 2

A

Dyspnoea present on normal activities

44
Q

NY heart association of HF - stage 3

A

Less than ordinary activity causes dypsnoea which = limiting

45
Q

NY heart association of HF - stage 4

A

Dyspnoea present at rest, any activity causes discomfort

46
Q

Ix HF - bloods (6)

A 
FBC
`LFT
U+e 
TFT
Cardiac enzymes 
BNP
47
Q

What is the gold standard Ix for HF

A

Echo

48
Q

What numerical value is diagnostic on echo for HF

A

Ejection % <45

49
Q

Mx HF

A

Lifestyle advice
ACEi + b-blocker
Diuretic (if Sx)

50
Q

2nd line Mx HF

A

Spironolactone/ATRA/hydralazine + nitrate

51
Q

3rd line Mx HF

A

digoxin

52
Q

Lifestyle advice HF

A 
Pt education
Obesity control 
Dietary mod 
Endurance activity recommended 
Vaccines - pneumococcal and influenza
No viagra
53
Q

What electrolyte imbalance can diuretics and ACEi –>

A

hyperkalaemia

54
Q

SE ACEi

A

Renal - monitor urea/creatinine/ K+ + before Tx

55
Q

C/I ACEi

A 
PARK
Preg
Allergy/angiodema
Renal aa stenosis 
K+ hyper
56
Q

Who are thiazide diuretics used in

A

Mild failure

Elderly pt w/ massive diuresis

57
Q

Who are loop diuretics used in

A

pulm oedema

58
Q

what metabolic disturbance do diuretics cause

A

hypokalaemia

59
Q

digoxin mode of action

A

+ve inotrope + -ve chronotrope
hence increase force of contraction and decreasing hR
Inhibits Na/K pump
Impairs AVN conduction, incr vagal stim

60
Q

C/I digoxin

A

Concurrent heart block

BradyC

61
Q

Indicators digoxin toxicity

A

Anorexia
Nausea
visual disturbance
diarrhoea

62
Q

how is digoxin’s dosage modified

A

according to eGFR

CP3 Medicine (29 decks)

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