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3 Long term conditions EJR > heart > Flashcards

heart Flashcards

1
Q

definition of heart failure

A

failure of the heart to function as a pump in maintaining effective systemic circulation

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2
Q

3 main causes of heart failure

A

MI
cardiomyopathy
hypertension

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3
Q

3 other less common causes of heart failure

A

valvular problems
congenital heart defects
arrhythmias

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4
Q

5 factors in the pathophysiology of heart failure

A 
increased venous return/pressure (preload)
increased outflow resistance (afterload)
myocardial contractility
neurohormonal sympathetic activation
myocardial remodelling
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5
Q

what is the renin-angiotensin-aldosterone-system (RAAS) and how does it relate to heart failure

A

heart failure causes reduced perfusion of the kidneys leading to synthesis of Renin, this activates angiotensin I which is converted to angiotensin II. angiotensin II is a vasoconstrictor and also stimulates aldosterone production. aldosterone inreases sodium retension in the kidneys while increasing potassium excretion.

this leads to a rise in plasma sodium, increased fluid retension and rise in blood pressure

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6
Q

what are the actions of angiotensin II

A 
vasoconstriction
aldosterone production
ADH production
sympathetic stimulation
renal Na and water retension, and K excretion
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7
Q

what are the cardiac enzymes associated with heart failure

A

ANP
BNP
endothelin
ADH

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8
Q

what are the cardiac enzymes associated with myocardium damage

A

troponin T and I
myoglobin
creatine kinase MB
BNP

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9
Q

clinical symptoms of heart failure

A

dyspnea
tiredness
orthopnea
PND

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10
Q

clinical signs of heart failure

A 
raise JVP
peripheral edema
dyspnea
tachycardia
hypotension
enlarged heart/displaced apex beat
heart sounds 3 + 4
bi-basal crackles
pleural effusion
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11
Q

what type of effusion is found in heart failure

A

transudative pleural effusion

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12
Q

what is the classification used for heart failure severity

A

new york heart association classification

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13
Q

what is class IV NYHAC heart failure like

A

HF symptoms at rest and exacerbated by any physical activity

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14
Q

investigations done in HF

A

ECG
echo

bloods

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15
Q

what bloods to do in HF

A 
FBC
LFT
TFT
U&Es
cardiac enzymes
BNP
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16
Q

how to monitor heart failure

A

functional capacity
fluid status
ECG

17
Q

6 types of drugs used in heart failure

A 
ACEI
beta blockerse
diuretics
aldosterone antagonist 
vasodilators
cardiac glycosides
18
Q

non-drug options for heart failure

A

pacemaker
implanted defib
revascularisation
cardiac transplants

19
Q

causes of acute heart failure

A 
MI
hypertension
renal failure
valvular conditions
atrial fibrilation
20
Q

features of hypertensive HF

A

high BP
pulmonary edema
preserved LV function

21
Q

treatment of acute HF

A

IV diuretics e.g. furosemide
oxygen
monitor renal fx, daily weights and fluid balance

22
Q

investigations to do in suspected MI

A

ECG - ST changes

bloods - troponin, myglobin

23
Q

associated features of MI

A 
radiating chest pain
N&V
restlessness
sweating
pallor
breathlessness
24
Q

acute treatment of ACS and NSTEMI

A 
GTN sublingual
analgesia 
oxygen
aspirin
clopidogrel
25
Q

acute treatment for STEMI

A

PCI/revascularisation
fibrinolytics/thrombolytics e.g. alteplase
metoprolol

26
Q

drug chronic management after an MI

A 
ACEI
statin
aspirin
clopidogrel
beta blocker
27
Q

possible complications after MI

A

arrthymias
heart failure
embolism

28
Q

medication commonly used in arrythmias

A

amiodarone

29
Q

how to tell the difference between a MR murmur and a VSD murmur

A

VSD murmur heard loudest over LLSB while MR heard loudest over apex beat and radiates into the axilla

30
Q

how does a tricuspid regurgitation murmur change with inspiration?

A

it gets louder on inspiration

31
Q

what criteria is used in diagnosing infective endocarditis?

A

dukes criteria

32
Q

what does the murmur of Barlow syndrome sound like?

A

click in mid systole followed by late-systolic murmur -> mitral valve prolapse

3 Long term conditions EJR (8 decks)

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