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Stage 3: EJR - LTC > Chronic Heart disease (heart failure, angina) > Flashcards

Chronic Heart disease (heart failure, angina) Flashcards

1
Q

What is cardiac asthma

A

type of coughing or wheezing that occurs with left heart failure

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2
Q

What 2 differentials should one consider for post-MI cardiogenic shock

A
  1. Free ventricular wall rupture

2. Rupture of papillary muscles

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3
Q

Signs of heart failure (both sides)

A
  • tachycardia, weak pulse
  • pale, clammy
  • lower CRT
  • displaced apex, heaves
  • dull percussion
  • reduced resonance
  • reduced breath sounds/ no sounds (pleural effusion)
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4
Q

Normal output causes of heart failure

A
  • Hyperthyroidism
  • Anaemia
  • Alcohol (causing cardiomyopathy)
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5
Q

Signs of R sided heart failure

A
  • Peripheral oedema

- Raised JVP

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6
Q

Signs of L sided heart failure

A
  • Orthopnoea, PND
  • Cardiac asthma
  • Pink frothy sputum
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7
Q

Bedside tests for heart failure

A

ECG

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8
Q

Blood test for heart failure

A 
BNP
FBC
LFTs
TFTs
U n Es
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9
Q

Imaging for heart failure

A

CXR

ECHO

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10
Q

What is considered a raised BNP

A

> 400

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11
Q

Causes of raised BNP

A 
"	Any cardiac disease eg arrhythmias
"	COPD
"	Renal impairment
"	Liver failure
"	Diabetes
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12
Q

Signs of heart failure on CXR

A
  • Alveolar oedema (batwings)
  • Kerley B lines
  • Cardiomegaly
  • Dilated upper lobe vessels
  • Pleural effusion
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13
Q

Drugs that improve heart failure symptoms

A
  • diuretics
  • morphine
  • digoxin
  • nitrates
  • oxygen
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14
Q

MoA of digoxin

A

Inhibits Na/K ATPase

Increases heart contractility + decreases heart rate

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15
Q

Drugs that improve prognosis of heart failure pts

A

ANTIHYPERTENSIVES

  • ACE inhibitors
  • Beta blockers
  • Angiotensin receptor blockers
  • Aldosterone antagonists
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16
Q

What imaging test is used to diagnose angina

A

CT coronary angiography

17
Q

What 3 drugs are first line treatment for angina

A
  • GTN (for angina episodes)
  • Beta blocker
  • CCB
18
Q

What drugs are given to angina patients for secondary prevention of cardiovascular disease

A
  • Aspirin (for stable angina)

- ACE inhibitors (for stable angina + diabetes)

19
Q

What interventions may be offered to patients with angina

A
  • CABG

- PCI

20
Q

What drugs are given to pts who have had an acute coronary event (MI)

A
  • Morphine
  • Oxygen
  • Nitrate
  • Aspirin
  • Clopidogrel
21
Q

How long after MI will it take for troponin levels to be raised

A

8-12h after onset of chest pain

Peaks at 24-48h after chest pain onset

22
Q

First line hypertensive drug for white person <55

A

ACE inhibitor

23
Q

First line hypertensive drug for black person of any age/ white person >55

A

CCB

24
Q

Second line combination of hypertensive drugs

A

ACE inhibitor/ ARB
+
CCB

25
Q

Describe pathophysiology of transudative pleural effusions

A

LOW PROTEIN CONTENT

Fluid leaks into to pleural space due to low protein + increased pressure in blood vessels

eg due to congestive heart failure

26
Q

Describe pathophysiology of exudative pleural effusions

A

HIGH PROTEIN CONTENT

Fluid leaks due to inflammation/ blocked lymph or blood vessels

eg due to pneumonia, PE

27
Q

Reduced output causes of heart failure

A
  • arrythmias
  • valvular disease
  • alcohol
  • ischaemic heart disease
  • hypertension
  • cor pulmonale
28
Q

According to the Framingham criteria, what is required for the diagnosis of heart failure

A

2 major criteria OR

1 major + 2 minor criteria

29
Q

Major Framingham criteria for HF

A
  • PND
  • raised JVP
  • hepatojugular reflux
  • pulmonary oedema (crepitations)
  • Cardiomegaly
  • S3 gallop
  • Increased central venous pressure
  • Weight loss in response to tx
30
Q

Minor Framingham criteria for HF

A
  • Nocturnal cough
  • Dyspnoea on ordinary exertion
  • Tachycardia (>120)
  • Decreased vital capacity
  • Hepatomegaly
  • Pleural effusion
  • Bilateral ankle oedema
31
Q

MoA of hydralazine

A

Direct-acting smooth muscle relaxant

32
Q

Is raised JVP a sign of R or L sided heart failure

A

R HF

33
Q

In L heart failure, does pleural effusion or pulmonary oedema occur first

A

Pulmonary oedema

34
Q

Signs of pulmonary oedema

A

Bibasal crepitations
Upper lobe blood diversion
Kerley B lines

Stage 3: EJR - LTC (14 decks)

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