CARDIOVASCULAR SYSTEM Flashcards
types of coronary artery disease manifestations
Stable angina Unstable angina Atypical angina (Prinzmenal) MI Atherosclerotic myocardiosclerosis Silent ischemia Sudden cardiac death
markers for heart attack
- troponin and ck (dont really use as much now)
dresslers syndrme
a type of pericarditis believed to occur after a MI- its the bodys immune response to clearing up the debris but soemtimes it goes over board
staging of hypertension
LSO
liable - co increases but normal TPR
stable - co normal but TPR increases
organ damage; compenstaed and decompensated
compenstaions of the body in hypertension
pee a lot
decrease HR
vasodilation
which recepetors in the heart are responsible for tachycardia
b1
most important screening tool for heart failure
BNP
whats BNP
its released in response to the stretching of the myocardium by ventricles
what level of ejection fraction indicates HF
<40%
causes of high output HF
AAPPTT
anemia
Arteriovenous malformation
Paget’s disease
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet Beri-Beri)
physical signs of pulmonary congestion
achypnoea
Bibasal fine crackles on auscultation of the lungs
symptoms of pulmonary cogestion
Shortness of breath on exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough (± pink frothy sputum)
what is high output HF
so this is where CO is normal ( EF) but its the metabolic needs of the individual are increased so essentially still HF
what is diasoltic heart failure and examples
reduced ability of the Ventricles to fill so theres somehting restricting it
Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
causes of heart failure
myocarditis
coranary artery disease
valvular problems - I.e
chronic hypertension
infiltration like hemochromatosis /sarcoidosis
dilated cardiomyopathy
chagas disease in south america
s3
(produced by large amounts of blood striking a compliant left ventricle)
occurs in diastole as the heart is filling
usually assocatied with systolic hF(picture)
s4
picture says its associated with dialstolic HF
systolic vs diastolc HF
s; EF is normal
d: EF not normal
s: s3
D: s4
signs of RH failure
distened JVP
ASCITES
pleaural effusions (transudative)
heaptomegaly - abdominal pain
pitting edema of legs, sacrum
new york HF class 3
marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).
invetsigations for hf
BNP levels
ECHO, ECG , X RAY. (pulmondary markings)
BLOODS-
endocrine(hyperthyroidism), LFTS - heaptomgealy , kidneys values
kerley b
associated with pulmonary edema
the interlobular septae are thickened
x ray findings from HF
Alveolar oedema (with ‘batwing’ perihilar shadowing)
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly (cardiothoracic ratio >0.5)
D: upper lobe blood diversion
E: Pleural effusions (typically bilateral transudates)
F: Fluid in the horizontal fissure
lifestyle modifaction for hF
stop smoking
fluid restriction
salt restriction
drugs used in HF
ACE Inhibitors
BB
digoxin
diuretics loops
spironolactone
hydralazine - vasodilator increases blood flow to CO
dopamine - increases contractility
INITIAL MANAGEMENT OF ACUTE HEART FAILURE (pumonary edema)
Sit the patient up
Oxygen therapy (aiming saturations >94% in normal circumstances)
IV furosemide 40mg or more (with further doses as necessary) and close fluid balance (aiming for a negative balance)
SC morphine - this is contentious with some studies suggesting that it might increase mortality by suppressing respiration
side effects of bb
hypotension
erectile dysfucntion
psyhcological distrubances
bradycardia
ace :(
dry cough
angioedema
HYPERKALEMIA
kindey damage
Name 2 loops
furosemide and bumetanide
usual first line in uk for hF
meds so ace inhibitor and BB
If doesnt work then move to spirancolactone
cor pulmonale
Right sided heart failure secondary to long-standing pulmonary artery hypertension e.g COPD
Which medical device can be used to bridge heart failure patients awaiting a heart transplant?
LVAD
- so end stage hF
normal EF
50 -70
Pulsus alternans
it’s quite rare and is a sign of left ventricular pathology failure, the pulse alternates between being strong and weak
CRT
biventricular pacing) is a procedure for implanting a permanent biventricular pacemaker. This makes your ventricles (lower chambers in your heart) contract together instead of at different times.
how to we classify pulmonary edema
cardiogenic
non cardiogenic - exo + endo
mechanisms of systolic failure
- not enough force to pump
- overburden with volume
3.. overburden with pressure
- hypertension
-pulmonary hypertension
- aortic stenosis
whats very specific in the defintion of heart failure
you have to say that the metabolic demands are not met! (because co could be reduced but patient is fine)
frank starling principle
stroke volume will increases in response to increase volume of blood which will strech out the chamber and cause it to contract more strongly
what is one explanation for the extra fluid in heart faulure
the RAAS gets activated due to poor co and more fluid gets conserved but leaky capillaries
dukes major
- postive blood cultures (more than once)
- postive echo findings (vegetations, regurgitation , abscess)
dukes minor
mb evidence but not fulfilling major
fever
immunological phenomena
risk factors for it
dukes minorj
mb evidence but not fulfilling major
fever
immunological phenomena
risk factors for it
