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Year 3 - TCD > Case 9 - Congestive Heart Failure > Flashcards

Case 9 - Congestive Heart Failure Flashcards

1
Q

What is the HAS BLED score?

A

Assess 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation.

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2
Q

What is stroke volume?

A

The volume of blood pumped by LV in single heartbeat.

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3
Q

What is ejection fraction?

A

% of blood pumped by LV in each contraction.

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4
Q

What is afterload?

A

The force against which the ventricles contract.

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5
Q

What is preload?

A

How much the heart muscle stretched before systole.

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6
Q

What are the causes of LVHF?

A
  • Arrhythmia: AF
  • Rate related: AF, thyrotoxicosis, anaemia
  • Valvular disease: MR, AS, AS
  • HTN
  • MI
  • Congenital defects: VSD, ASD
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7
Q

What is BNP?

A

Ventricular myocyte released in response to ventricular stretching.

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8
Q

What are the signs and symptoms of LV HF?

A
  • Dyspnoea
  • Orthopnoea
  • Pulmonary odeama
  • Bilateral basila rales
  • Paroxysmal nocturnal dyspnoea
  • Nocturnal cough (pink frothy sputum)
  • Cardiac asthma (wheeze)
  • Cardiomegaly
  • Cool peripheries
  • Nocturia
  • Fatigue
  • S3 gallop
  • Tachycardia
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9
Q

What is the NYHA classification of HF?

A

I - no limitation/sx with normal physical activity
II - slight limitations/sx of normal physical activity
III - marked sx with less than normal physical activity e.g. getting dressed
IV - sx at rest, can’t really do any physical activity

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10
Q

How to diagnose HF?

A
  • BNP >100 ng/L or NT-pro BNP >300 ng/L

- FBC: anaemia/vitamin B12 deficiency

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11
Q

What signs of HF are present on ECG?

A
  • Signs of LV hypertrophy
    • Increased QRS
  • Arrhythmias (AF)
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12
Q

What signs of HF are present on chest X-ray?

A

ABCDE -

  • Alveolar oedema: ‘bat-wing’ shadowing
  • Kerley B lines: leading out towards lung borders
  • Cardiomegaly: heart >50% of thorax
  • Dilated upper lobe veins
  • Pleural effusions: blunted costophrenic angles)
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13
Q

What is systolic heart failure?

A

Inability of the ventricle to contract properly with ejection fraction <40%

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14
Q

What is diastolic heart failure?

A

Inability of the ventricle to relax and fill normally causing increased filling pressures but ejection fraction >50%.

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15
Q

What can be seen on an echocardiogram for HF?

A
  • Transthoracic echo
  • Used to see ejection fraction
  • Can differentiate between systolic and diastolic HF
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16
Q

What is congestive heart failure?

A

LV HF and RV HF

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17
Q

What are the causes of RV HF?

A
  • Left HF
  • COPD
  • Pulmonary hypertension - due to arterioles constricting
  • Tricuspid regurgitation
  • Atrial septal defect
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18
Q

What are he signs and symptoms of RV HF?

A
  • Peripheral pitting oedema: upto sacrum, thighs
  • RaisedJVP with hepatojugular reflex
  • Hepatosplenomegaly
  • Ascites
  • RV heave: due to pulmonary hypertension
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19
Q

How conservatively treat HF?

A
  • Salt restriction
  • Fluid restriction
  • Weight loss + exercise
  • Alcohol and smoking cessation
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20
Q

What drugs improve mortality and are used in HF with EF not preserved?

A
  • ACEi/ARBs
  • Beta blockers
  • Spironolactone (ldosterone antagonist)
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21
Q

What drugs are used for symptomatic relief in HF and EF preserved HF?

A
  • Diuretics

- Digoxin

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22
Q

What can be fitted in patients with electrical desynchrony?

A
  • Implantable cardiac defibrillators (ICD)

- In patients with EF <35%

23
Q

What is acute decompensated HF?

What causes Acute decomp HF?

A
  • Exacerbation of HF

- Pneumonia, anaemia, volume overload, noncompliance, MI, myocarditis, AF

24
Q

How to treat acute decompensated heart failure?

A

LMNOP -

  • Lasix: IV Furosemide
  • Morphine
  • Nitrates
  • Oxygen 100%
  • Sitting position
25
Q

What are the different risk factors for AF?

A
  • HTN, DM, age, obesity
  • CAD, valvular heart disease.
  • COPD, PE, hyperthyroidism
26
Q

What are the symptoms of AF?

A
  • Most asymptomatic
  • Palpitations
  • Dizziness
  • Fatigue
  • Dyspnoea
  • Syncope
27
Q

What ECG changes are present for AF?

A
  • Irregularly irregular rhythm
  • Narrow QRS
  • Absent P waves
  • Increased rate
28
Q

How to treat paroxysmal AF?

A
  • 24 hr ambulatory

- Flecainide

29
Q

What are rate control drugs for AF stating with the most effective?

A

1st - Beta blockers (propranolol)
2nd - CCB (verapamil)
3rd - Digoxin

30
Q

What are rhythm control drugs for AF starting with the most effective?

A

1st - Cardioversion
2nd - Flecainide
3rd - Amiodarone

31
Q

What drug is given to reduce risk of secondary thromboembolism?

A
  • DOAC

- Warfarin

32
Q

Which 2 scores can you use to assess risk/benefit of starting anticoagulation in AF?

A
  • CHADS-VASc

- HAS-BLED

33
Q

What is CHADS-VASc score used for?

What are the results?

A
  • Assess stroke risk in patients with AF

- Offer anti-coagulation for score ≥2 (>1 for men)

34
Q

How to treat acute AF?

A
  • Make haemodynamically stable
  • Emergency cardioversion: IV amiodarone
  • Stable and AF started <48 hours ago: rate or rhythm control (rhythm more preferred)
  • Stable and AF started >48 hours ago: RATE control
35
Q

If AF has been present for >48 hours or an unknown duration, how long would you ideally anticoagulate before cardioversion?

A

3 weeks

36
Q

What is pericarditis?

A

Inflammation of the pericardium that is most commonly caused by infection

37
Q
  • What are the causes of pericarditis?

- Who is more likely to get it?

A
  • Most commonly viral (Coxsackie)
  • Autoimmune (SLE/RA)
  • Post MI (Dresselers syndrome)
  • Trauma/surgery
  • Uraemia
  • TB
  • Mainly young people get it
38
Q

What are the symptoms of pericarditis?

A
  • Low grade, intermittent fever
  • Tachypnoea, dyspnoea, cough
  • Pleuritic chest pain – sharp, pleuritic, improves on sitting and leaning forward
  • Ongoing for a few days to weeks
  • Pericardial friction rub
39
Q

What are the ECG/troponin changes for pericarditis?

A
  • PR depression in every lead
  • ST elevation (saddle shaped) in all leads (depression in aVR + V1)
  • Elevated troponin rise
40
Q

How to treat pericarditis?

A
  • Often self-limiting and resolves in 2-6 weeks
  • Treat underlying cause
  • NSAIDs
  • Restrict physical activity
41
Q

What is infective endocarditis?

A

Infectious (bacterial) inflammation of the endocardium that affects the heart valves

42
Q

What should be considered if new murmur and fever of unknown origin develops?

A

Infective endocarditis

43
Q

What are the risk factors for infective endocarditis?

A
  • Dental procedures
  • Surgery
  • Distant primary infections
  • Non-sterile injections
  • Prosthetic valves
  • IVDU
  • Male
44
Q

What are the symptoms of infective endocarditis?

A
  • Fever and chills
  • Tachycardia
  • General malaise
  • Weakness
  • Night sweats
  • Weight loss
  • Dyspnoea
  • Cough
  • Pleuritic chest pain
  • Arthralgia (joint pain)
  • Myalgia (muscle pain)
  • Headache
45
Q

What signs are seen in infective endocarditis due to bacteria?

A

FROM JANE

  • Fever
  • Roths spots
  • Oslers nodes
  • Murmur
  • Janeway lesions
  • Anaemia
  • Nail bed haemorrhage
  • Emboli
46
Q

What is used to diagnose infective endocarditis?

A

Modified Duke Criteria:

  • 2 major
  • 1 major and 3 minor criteria
  • 5 minor criteria
47
Q

How to treat infective endocarditis?

A
  • Empirical IV Abx
  • Staphylococcus: flucloxacillin and rifampicin
  • Streptococcus: benzlypenicillin, gentamicin
48
Q

What is Duke criteria?

A 
Major:
- Blood culture +ve from 2 sep sites 
- Echo: valvular problems 
Minor: 
- >38 degrees
- Underlying heart disease  or IVDU
- Immunological phenomena (Oslers nodes)
49
Q

What is the investigation for infective endocarditis?

A
  • Blood culture from 2 sep sites

- Echo: valvular problems

50
Q

What are the symptoms of myocarditis?

A
  • Viral syndrome -
  • Chest pain
  • Acute decompensated congestive heart failure
51
Q
  • What the 2 different ways infective endocarditis presents?

- Which bacteria is more likely to present that way?

A
  • Acute: Staphylococcus aureus

- Subacute: Streptococcus Viridans

52
Q

Who is more likely to get infective endocarditis due to staphylococcus aureus (more common cause)?

A
  • Prosthetic valves after 2 months
  • Patients with no PMH
  • IVDUs who present acutely
53
Q

Who is more likely to get infective endocarditis due to streptococcus viridans?

A
  • Prosthetic heart valves
  • Poor dental health
  • After a dental procedure
54
Q

Which valve is more likely to be affected in infective endocarditis?

A

Tricuspid

Year 3 - TCD (17 decks)

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