Chronic Heart disease (heart failure, angina) Flashcards
What is cardiac asthma
type of coughing or wheezing that occurs with left heart failure
What 2 differentials should one consider for post-MI cardiogenic shock
- Free ventricular wall rupture
2. Rupture of papillary muscles
Signs of heart failure (both sides)
- tachycardia, weak pulse
- pale, clammy
- lower CRT
- displaced apex, heaves
- dull percussion
- reduced resonance
- reduced breath sounds/ no sounds (pleural effusion)
Normal output causes of heart failure
- Hyperthyroidism
- Anaemia
- Alcohol (causing cardiomyopathy)
Signs of R sided heart failure
- Peripheral oedema
- Raised JVP
Signs of L sided heart failure
- Orthopnoea, PND
- Cardiac asthma
- Pink frothy sputum
Bedside tests for heart failure
ECG
Blood test for heart failure
BNP FBC LFTs TFTs U n Es
Imaging for heart failure
CXR
ECHO
What is considered a raised BNP
> 400
Causes of raised BNP
" Any cardiac disease eg arrhythmias " COPD " Renal impairment " Liver failure " Diabetes
Signs of heart failure on CXR
- Alveolar oedema (batwings)
- Kerley B lines
- Cardiomegaly
- Dilated upper lobe vessels
- Pleural effusion
Drugs that improve heart failure symptoms
- diuretics
- morphine
- digoxin
- nitrates
- oxygen
MoA of digoxin
Inhibits Na/K ATPase
Increases heart contractility + decreases heart rate
Drugs that improve prognosis of heart failure pts
ANTIHYPERTENSIVES
- ACE inhibitors
- Beta blockers
- Angiotensin receptor blockers
- Aldosterone antagonists
What imaging test is used to diagnose angina
CT coronary angiography
What 3 drugs are first line treatment for angina
- GTN (for angina episodes)
- Beta blocker
- CCB
What drugs are given to angina patients for secondary prevention of cardiovascular disease
- Aspirin (for stable angina)
- ACE inhibitors (for stable angina + diabetes)
What interventions may be offered to patients with angina
- CABG
- PCI
What drugs are given to pts who have had an acute coronary event (MI)
- Morphine
- Oxygen
- Nitrate
- Aspirin
- Clopidogrel
How long after MI will it take for troponin levels to be raised
8-12h after onset of chest pain
Peaks at 24-48h after chest pain onset
First line hypertensive drug for white person <55
ACE inhibitor
First line hypertensive drug for black person of any age/ white person >55
CCB
Second line combination of hypertensive drugs
ACE inhibitor/ ARB
+
CCB
Describe pathophysiology of transudative pleural effusions
LOW PROTEIN CONTENT
Fluid leaks into to pleural space due to low protein + increased pressure in blood vessels
eg due to congestive heart failure
Describe pathophysiology of exudative pleural effusions
HIGH PROTEIN CONTENT
Fluid leaks due to inflammation/ blocked lymph or blood vessels
eg due to pneumonia, PE
Reduced output causes of heart failure
- arrythmias
- valvular disease
- alcohol
- ischaemic heart disease
- hypertension
- cor pulmonale
According to the Framingham criteria, what is required for the diagnosis of heart failure
2 major criteria OR
1 major + 2 minor criteria
Major Framingham criteria for HF
- PND
- raised JVP
- hepatojugular reflux
- pulmonary oedema (crepitations)
- Cardiomegaly
- S3 gallop
- Increased central venous pressure
- Weight loss in response to tx
Minor Framingham criteria for HF
- Nocturnal cough
- Dyspnoea on ordinary exertion
- Tachycardia (>120)
- Decreased vital capacity
- Hepatomegaly
- Pleural effusion
- Bilateral ankle oedema
MoA of hydralazine
Direct-acting smooth muscle relaxant
Is raised JVP a sign of R or L sided heart failure
R HF
In L heart failure, does pleural effusion or pulmonary oedema occur first
Pulmonary oedema
Signs of pulmonary oedema
Bibasal crepitations
Upper lobe blood diversion
Kerley B lines
