Heart Failiure Flashcards
Explain 3 compensatory mechanisms when BP falls ?
Activation of baroreceptors
Activation of RAAS
Non osmotic ADH secretion
Symptoms of RHF
JVP increase Tender hepatomegaly Ascites Bipedal edema Interstitial edema Splenomegaly Nocturia Pathological S3 \+ Hepatojugular reflex Weight gain
Symptoms of LHF
Pulmonary wedge pressure increases Pulmonary congestion and edema Rales and crepitus on PE Pathological S3 Quadruple rhythm in severe cases PND Orthopnea Coughing due to pulmonary congestion
How to check if dyspnea on patient is cardiac or pulmonary in origin?
PND is only present of dyspnea is of cardiac origin
What criteria is used in diagnosis of HF?
Framingham criteria
2 major/ 1 major + 2 minor
What are the major criteria of Framingham criteria?
JVP increase(neck vein distention) Acute pulmonary edema Rales and crepitus S3 gallop Reflex (HPJ) + Venous pressure (>16mmHg) PND Circulation time(>25sec) Cardiomyopathy
Minor criteria of Framingham criteria?
Tachycardia, hepatomegaly Night coughs Pleural effusion Pleural edema Vital capacity 1/3 of normal
Most common Etiology of RHF?
Left heart failure
Most common Etiology of acute RHF?
Massive pulmonary embolism
Most common Etiology of Chronic RHF?
COPD
List all the etiology of RHF
COPD Massive pulmonary embolism Left heart failure Pulmonary stenosis Pulmonary regurgitation Tricuspid stenosis Tricuspid regurgitation Congenital heart disease
What are the 2 major types of etiology of LHF
Decreased ejection fraction type(<50%)
Preserved ejection fraction type(>50%)
Chagas disease is caused by what organism?
American trypanosoma
List etiology of LHF(reduced EF type)
Angina, myocardial infarction Hypertension and aortic stenosis Mitral regurgitation, aortic regurgitation ASD, VSD Dilated cardiomyopathy Parasitic infection(Chagas disease)
What parasite can cause reduced EF type of LHF
American trypanosoma(Chagas disease)
List Etiology for LHF(preserved EF type)
Hypertrophic cardiomyopathy, restrictive cardiomyopathy
Fibrosis, aging
Endomyocardial disorders
Pulmonary disorders
Give the etiology of systolic LHF
Angina, myocardial infarction Dilated cardiomyopathy Chagas disease ASD, VSD Hypertension, aortic stenosis Aortic regurgitation, mitral regurgitation
Etiology of diastolic LHF
Aging and fibrosis
Hypertrophic and restrictive cardiomyopathy
Endomyocardial disorders
Pulmonary disorders like cor pulmonale
What are investigations you do for Heart failure?
CXR
biomarkers (BNP, ANP, endothelin, adrenomedulin)
2D echo
ECG
Give CXR findings and their interpretation in order of appearance.
Upper lobe vein distention (vascular redistribution)
Kerley B lines(interstitial edema)
Alveolar opacity &batwing appearance (alveolar edema
Mediastinal shift(pleural effusion)
Most sensitive biomarker for heart failure
NT-BNP
Which biomarker correlate best with pulmonary vascular resistance in patients with heart failure?
Endothelin 1/ET 1
Which biomarker helps to differentiate between HF of cardiac or pulmonary origin
If BNP increases then its of cardiac origin
Which cardiac biomarker is an independent mortality predictor?
BNP
What is the normal value of NTproBNP
<300 Pg/ml
Which drug has no role in Treating acute pulmonary edema?
Digoxin(it’s onset takes time)
What 5 measure to be takes in case of acute pulmonary edema?
Ventilation support
Morphine(decrease anxiety)
Vasodilators
Loop Diuretics(furosemide, bumetinde, torsemide)
Ionotropic drugs(to increase myocardial contractility)
What ionotropic agents are used in acute pulmonary edema?
Dopamine
Dobutamine
Levosimendan
Phosphodiesterase inhibitors (Milron and inamnitrone)
Which drug category is not indicated in Heart failure?
Calcium channel blockers
What category of drugs are used to treat symptoms of heart failure
Loop diuretics Thiazide diuretics Ionotropic agents Vasodilators Vasoconstrictors(to increase blood pressure)
Which ionotropic agents can be given in heart failure but not in acute pulmonary edema?
Digoxin
What drugs are used to reverse the heart failure?
ARBs and ACE inhibitors
Beta blockers
Aldosterone antagonist(spironolactone and eprinolone)
Which drug combination can be given in systolic heart failure?
Beta blockers and ACE inhibitors
Which drugs class is not indicated in NYHA class 4?
Beta blockers
