Chest X-ray for heart failure Flashcards
Heart failure definition? (this one a bit more detailed)
Heart failure is the pathophysiological state in which the heart, via an abnormality of cardiac function, fails to pump blood at a rate that fulfils requirements of the metabolising tissues,
or is able to do so only with an elevated diastolic filling pressure.
Stages of Congestive Heart Failure
Stage 1 = \_\_\_\_\_\_\_\_\_\_\_ [ PCWP = 13-18 mmHg ] (PCWP is \_\_\_ \_\_\_\_ \_\_\_\_\_\_ estimate, 6-12mmHg is normal) - \_\_\_\_\_\_\_\_\_\_ to pulmonary vessels - cardiomegaly
Stage 2 = ________ ______ [ PCWP = 18-25 mmHg ]
- _____ lines
- peribronchial cuffing
- ____ vessel contours
- thickened interlobular fissures
Stages 3 = \_\_\_\_\_\_ \_\_\_\_\_\_ [ PCWP = >25 mmHG ] - c\_\_\_\_\_\_\_\_\_ - air bronchogram - \_\_\_\_\_\_\_\_ appearance - pleural effusions
Stages of Congestive Heart Failure
Stage 1 = Redistribution [ PCWP = 13-18 mmHg ] (PCWP is left atrial pressure estimate, 6-12mmHg is normal) - redistribution to pulmonary vessels - cardiomegaly
Stage 2 = Interstitial oedema [ PCWP = 18-25 mmHg ]
- Kerley lines
- peribronchial cuffing
- hazy vessel contours
- thickened interlobular fissures
Stages 3 = Alveolar oedmea [ PCWP = >25 mmHG ] - consolidation - air bronchogram - cottonwool appearance - pleural effusions
Stage 1 heart failure = Redistribution
- in normal CXR vessels in lower zones are ____ than the upper
- If upper zone vessels are _____ __ or ______ than lower zone vessels, elevation of pulmonary venous pressure should be considered
- artery to bronchus ratio also changes,
pulmonary artery:bronchus is 0.85 in _____ and 1.34 in _____. In left ventricular failure (type of heart failure) ratios reverse = _____ becomes 1.5 and _____ is 0.87
- cardiomegaly (X-ray suff for this in pics)
Stage 1 = Redistribution
- in normal CXR vessels in lower zones are larger than the upper
- If upper zone vessels are equal to or greater than lower zone vessels, elevation of pulmonary venous pressure should be considered
- artery to bronchus ratio also changes,
artery: bronchus is 0.85 in upper and 1.34 in lower. In left ventricular failure (type of heart failure) ratios reverse = upper becomes 1.5 and lower is 0.87 - cardiomegaly (X-ray suff for this in pics)
Stage 2 heart failure = Interstitial oedema
- more breathless, activity more limited
- ____ ____ (discussed on other card)
- ________ _____: form of interstital oedema, where fluid collects around bronchi
- ___ contours of vessels
- _______ ________ _____
Stage 2 = Interstitial oedema
- more breathless, activity more limited
- Kerley lines (discussed on other card)
- Peribronchial cuffing: form of interstital oedema, where fluid collects around bronchi
- Hazy contours of vessels
- thickened interlobular fissures
Kerley Lines (in interstitial odeoma = stage 2)
- Kerley _ seen way more often that _ and _
- 1-2cm horizontal lines on CXR which extend right to _____ ______
- Kerley _ lines = septal lines, due to fluid leakage into _______ ____. Seen at ____ ____ and indicate interstitial pulmonary oedema.
- Kerley _ lines = distension of channels between peripheral and central _______, oblique and longer than Kerley _s
- Kerley _ lines = reticular opacities as lung bases
Kerley Lines (in interstitial odeoma = stage 2)
- Kerley B seen way more often that A and C
- 1-2cm horizontal lines on CXR which extend right to pleural surface
- Kerley B lines = septal lines, due to fluid leakage into interlobular septa. Seen at lung bases and indicate interstitial pulmonary oedema.
- Kerley A lines = distension of channels between peripheral and central lymphatics, oblique and longer than Kerley Bs
- Kerley C lines = reticular opacities as lung bases
Peribronchial cuffing (in interstitial oedema = stage 2)
- normally walls of bronchi are ______
- when fluid collects in peribronchial interstitial space the bronchial walls become ______
Peribronchial cuffing (in interstitial oedema = stage 2)
- normally walls of bronchi are invisible
- when fluid collects in peribronchial interstitial space the bronchial walls become visible
Hazy contours of vessels (in interstital oedema = stage 2)
- vessels _____ but lose _____ ____ due to surrounding ______
- consistent finding
- requires previous examinations
Hazy contours of vessels (in interstital oedema = stage 2)
- vessels enlarge but lose defined margin due to surrounding oedema
- consistent finding
- requires previous examinations
Subpleural pulmonary oedema (in interstitial oedema = stage 2)
- fluid can accumulate in the ____ _______ tissue beneath _____ ____
- seen as sharply defined band of increased intensity
- if adjacent to fissure can make fissure look _____
Subpleural pulmonary oedema (in interstitial oedema = stage 2)
- fluid can accumulate in the loose connective tissue beneath visceral pleura
- seen as sharply defined band on increased intenstity
- if adjacent to fissure can make fissure look thick
Stage 3 heart failure = Alveolar oedema
- high LV pressure
- very b______
- hypoxic
- clammy
- airspaces and p_____ e______
- stage 2 -> stage 3, fluid in interstitium has nowhere to go so spills into ______
- usually [[ bilateral or unilateral ]]
- if _______, usually ___ lung
- ‘___ ____’ distribution: perihilar shadowing that is mostly central then fades out (pic in folder)
- rapid change
Stage 3 heart failure = Alveolar oedema
- high LV pressure
- very breathless
- hypoxic
- clammy
- airspaces and pleural effusion
- stage 2 -> stage 3, fluid in interstitium has nowhere to go so spills into alveoli
- usually bilateral
- if unilateral, usually right lung
- ‘Bat’s wing’ distribution: perihilar shadowing that is mostly central then fades out (pic in folder)
- rapid change
Pleural effusion (in alveolar oedema = stage 3)
- pleural effusions (fluid in potential space between _____ and _____ layers)
- usually co-exists with alveolar oedema
- divided into _______ (___ protein) and ______ (____ protein)
Pleural effusion (in alveolar oedema = stage 3)
- pleural effusions (fluid in potential space between parietal and visceral layers)
- usually co-exists with alveolar oedema
- divided into transudates (low protein) and exudates (high protein)
Transudates vs Exudates (different types of pleural effusion)
Transudates
- Common: L__, c_____
- Uncommon: P_______ e______, s_______
Exudates
- Common: P_______ e______, b_______ i_____
- Uncommon: f____/v___ infection, l_______
Transudates vs Exudates (different types of pleural effusion)
Transudates
- Common: LVF, cirrhosis
- Uncommon: Pulmonary embolism, sarcoidosis
Exudates
- Common: Pulmonary embolism, bacterial infection
- Uncommon: fungal/viral infection, lymphoma
Subpulmonic effusion (in alveolar oedema stage = stage 3 HF)
- fluid can accumulate in subpulmonic location (bottom of lungs)
- pic in folder of it
- can be difficult to detect as upper edge of fluid mimics contour of _______
- costophrenic angle is ______
Subpulmonic effusion (in alveolar oedema stage = stage 3 HF)
- fluid can accumulate in subpulmonic location
- pic in folder of it
- can be difficult to detect as upper edge of fluid mimics contour of diaphragm
- costophrenic angle is blunted
Acute vs Chronic HF
AHF: new acute onset or decompensation of CHF characterised by signs of pulmonary and/or peripheral oedema
CHF:
- symptoms of hf
- objective evidence of cardiac dysfunction
Pretty pointless flashcard, but should talk about ‘decompensation’
This is when something happens to damage heart but it is still able to compensate. After another event, eg maybe another MI or infection, the damage is so that the heart cannot continue normal function. This is decompensation.
