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EOR Family med > CHF > Flashcards

CHF Flashcards

1
Q

what is the MC cause of CHF

A

coronary artery disease

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2
Q

left-sided failure

A

increased pulmonary venous pressure from fluid backing up into lungs

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3
Q

sx for left-sided failure

A

pulmonary sx - progressive dyspnea MC, cough, rales, pink frothy sputum (surfactant), wheezing, pleural effusion, Cheyne’s stokes breathing

Think L for left sided and lungs

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4
Q

what is cheyne stoke’s breathing

A

deeper faster breathing w gradual decrease and periods of apnea

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5
Q

right-sided failure

A

due to increased systemic venous pressure –> signs of systemic fluid retention; causes systemic vascular congestion

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6
Q

sx right-sided failure

A

peripheral edema
JVD
GI/hepatic congestion
anorexia
N/V due to GI
hepatosplenomegaly
hepatojugular reflex

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7
Q

systolic HF

A

decreased EF associated w S3 (filling of dilated ventricles)

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8
Q

diastolic HF

A

normal/increased EF associated w S4 (atrial contraction into stiff ventricle)

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9
Q

Class 1 HF

A

no limitation to physical activity
ordinary physical activity does not cause undue fatigue, dyspnea, or anginal pain

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10
Q

class 2 HF

A

slight limitation of physical activity, ordinary physical activity results in symptoms

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11
Q

class 3 HF

A

marked limitation of physical activity
comfortable at rest
less than ordinary activity causes sx

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12
Q

Class 4 HF

A

unable to engage in any physical activity without discomfort
sx may be present even at rest

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13
Q

what will you see on CXR for CHF

A

Kerley b lines
butterfly/bat wing appearance - bilateral perihilar alveolar edema
cephalization of vessels
cardiomegaly
pleural effusions
pulmonary edema (bilateral interstitial markings)

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14
Q

what is the most useful imaging to assess size and function in heart failure

A

echocardiography

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15
Q

what will echo show for systolic HF

A

decreased EF
thin ventricular walls
dilated LV chamber
S3

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16
Q

what will echo show for diastolic HF

A

normal/increased HF
thick ventricular walls
small LV chamber
S4

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17
Q

BNP and N-terminal proBNP levels that indicate HF is likely

A

BNP > 100
N-terminal proBNP > 125

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18
Q

BNP levels increase with

A

age
renal insufficiency
may be decreased on chronic tx

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19
Q

what is indicated if atherosclerosis is suspected in the presence of HF

A

cardiac cath

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20
Q

what are the cornerstone agents in treating coronary disease

A

Anti-platelet agents (Aspirin)

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21
Q

what valve is MC affected in endocarditis

A

Mitral valve (M > A > T > P)

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22
Q

what valve is most commonly affected in endocarditis in IV drug users

A

tricuspid valve

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23
Q

RF for endocarditis

A

increased age (> 60)
rheumatic heart disease
IV drug use
immunosuppression
prosthetic heart valves
congenital heart disease

24
Q

sx endocarditis

A

fever
EKG conduction abnormalities
anorexia
wt loss
Janeway lesions
roth spots
osler nodes
splinter hemorrhages of proximal nail bed
clubbing
hepatosplenomegaly
petechiae
septic emboli: CNS, kidneys, spleen, joints

25
what are Janeway lesions
painless erythematous macules on palms/soles
26
what are Roth spots
retinal hemorrhage w pale center
27
osler nodes
tender nodules on pads of digits
28
staphylococcus aureus and endocarditis
MC cause, including ACUTE infective endocarditis, prosthetic valve infective endocarditis, and IVDA infective endocarditis (especially MRSA)
29
what valves are usually affected in staphylococcus aureus in infective endocarditis
normal valves
30
streptococcus viridans in infective endocarditis
MC cause of SUBACUTE infective endocarditis part of the oral flora; associated w endocarditis from transient bacteremia secondary to gingivitis, poor dentition, dental procedures
31
what valves are usually affected by streptococcus viridans in infective endocarditis
damaged valve
32
staphylococcus epidermis in infective endocarditis
early prosthetic valve endocarditis (especially within 60 days of the procedure) is usually caused by S. aureus or S. epidermidis
33
enterococcus in infective endocarditis
seen especially in men > 50 w a recent history of GI or GU procedure
34
HACEK organisms
haemophilus aphrophilus Actinobacillus Cardiobacterium hominis Eikenella corrodens Kingella kingae gram-negative organisms that are hard to culture
35
when should you suspect HACEK organisms in infective endocarditis
endocarditis + negative blood cultures
36
streptococcus gallolyticus and bovis in infective endocarditis
commensal bacteria of the gut seen w increased incidence in patients w colorectal CA and UC colonoscopy should be performed in these patients to rule out both
37
two most important tests for suspected endocarditis
blood cultures echocardiography
38
blood cultures in infective endocarditis
before antibiotic initiation 3 sets at least 1 hour apart if patient is stable
39
what echocardiogram should be obtained first in infective endocarditis
TTE first TEE if TTE is nondiagnostic TEE is much more sensitive than TTE
40
clinical criteria for infective endocarditis
2 major OR 1 major + 3 minor OR 5 minor
41
major Duke criteria
sustained bacteremia (2 positive blood cultures by organism known to cause endocarditis) endocardial involvement documented by either positive echocardiogram (vegetation, abscess, valve perforation, prosthetic dehiscence) OR clearly established new valvular regurgitation (aortic or mitral regurgitation)
42
minor Duke criteria
predisposing condition (abnormal valves, IVDA, indwelling catheter) fever > 38C/100.4F vascular and embolic phenomena (Janeway lesions, septic arterial or pulmonary emboli, ICH) immunologic phenomena: Osler's nodes, Roth spots, positive rheumatoid factor, acute glomerulonephritis positive blood culture not meeting major criteria echocardiogram not meeting major criteria (worsening of existing murmur)
43
endocarditis prophylaxis indications for cardiac conditions
prosthetic heart valves heart repairs using prosthetic material (not including stents) prior history of endocarditis congenital heart disease cardiac valvulopathy in a transplanted heart
44
what procedures require prophylaxis for infective endocarditis
dental - involving manipulation of gums, roots of teeth, oral mucosa perforation respiratory - surgery on respiratory mucosa, rigid bronchoscopy procedures involving infected skin/MSK tissues (including abscess incision and drainage)
45
prophylactic tx for indicated conditions and procedures
amoxicillin 2g 30-60 main before Clindamycin 600mg if pcn allergy Macrolide or Cephalexin are other options
46
tx for native valve (MSSA) IE
anti-staphylococcal PCN (nafcillin, oxacillin) + either Ceftriaxone of Gentamicin if PCN allergy - Cefazolin; Vancomycin or Daptomycin
47
tx for native valve (MRSA) or unknown IE
Vancomycin plus either Ceftriaxone or Gentamicin Daptomycin if unable to tolerate Vancomycin
48
tx for fungal IE
parenteral antifungal (Amphotericin containing product) with or without combo (Flucytosine)
49
how long is therapy for fungal IE
6 weeks or more
50
how long is therapy for non-fungal IE
4-6 weeks
51
indications for surgery for IE
refractory CHF persistent or refractory infection invasive infection prosthetic valve recurrent systemic emboli fungal infxn
52
acute bacterial endocarditis
infection of normal vales with virulent organism (s aureus)
53
subacute bacterial endocarditis
indolent infection of abnormal valves w less virulent organism (S viridian's)
54
endocarditis w IVDA
MRSA (s aures) pseudomonas candida - esp in HIV patients
55
prosthetic valve endocarditis
early (after 60 days) - staph epidermis = MC
56
initial pharm therapy for reduced ejection fraction HF
ACEI, ARB, or ARNI Diuretic BB
57
BB that have proven beneficial in HF
Carvedilol Metoprolol Bisoprolol

EOR Family med (25 decks)

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