Heart Failiure Flashcards

1
Q

Explain 3 compensatory mechanisms when BP falls ?

A

Activation of baroreceptors
Activation of RAAS
Non osmotic ADH secretion

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2
Q

Symptoms of RHF

A
JVP increase
Tender hepatomegaly
Ascites
Bipedal edema
Interstitial edema
Splenomegaly
Nocturia
Pathological S3
\+ Hepatojugular reflex
Weight gain
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3
Q

Symptoms of LHF

A
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
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4
Q

How to check if dyspnea on patient is cardiac or pulmonary in origin?

A

PND is only present of dyspnea is of cardiac origin

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5
Q

What criteria is used in diagnosis of HF?

A

Framingham criteria

2 major/ 1 major + 2 minor

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6
Q

What are the major criteria of Framingham criteria?

A
JVP increase(neck vein distention)
Acute pulmonary edema
Rales and crepitus
S3 gallop
Reflex (HPJ) +
Venous pressure (>16mmHg)
PND
Circulation time(>25sec)
Cardiomyopathy
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7
Q

Minor criteria of Framingham criteria?

A
Tachycardia, hepatomegaly
Night coughs
Pleural effusion
Pleural edema
Vital capacity 1/3 of normal
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8
Q

Most common Etiology of RHF?

A

Left heart failure

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9
Q

Most common Etiology of acute RHF?

A

Massive pulmonary embolism

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10
Q

Most common Etiology of Chronic RHF?

A

COPD

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11
Q

List all the etiology of RHF

A
COPD
Massive pulmonary embolism
Left heart failure
Pulmonary stenosis
Pulmonary regurgitation
Tricuspid stenosis
Tricuspid regurgitation
Congenital heart disease
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12
Q

What are the 2 major types of etiology of LHF

A

Decreased ejection fraction type(<50%)

Preserved ejection fraction type(>50%)

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13
Q

Chagas disease is caused by what organism?

A

American trypanosoma

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14
Q

List etiology of LHF(reduced EF type)

A
Angina, myocardial infarction
Hypertension and aortic stenosis
Mitral regurgitation, aortic regurgitation
ASD, VSD
Dilated cardiomyopathy
Parasitic infection(Chagas disease)
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15
Q

What parasite can cause reduced EF type of LHF

A

American trypanosoma(Chagas disease)

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16
Q

List Etiology for LHF(preserved EF type)

A

Hypertrophic cardiomyopathy, restrictive cardiomyopathy
Fibrosis, aging
Endomyocardial disorders
Pulmonary disorders

17
Q

Give the etiology of systolic LHF

A
Angina, myocardial infarction
Dilated cardiomyopathy
Chagas disease
ASD, VSD
Hypertension, aortic stenosis
Aortic regurgitation, mitral regurgitation
18
Q

Etiology of diastolic LHF

A

Aging and fibrosis
Hypertrophic and restrictive cardiomyopathy
Endomyocardial disorders
Pulmonary disorders like cor pulmonale

19
Q

What are investigations you do for Heart failure?

A

CXR
biomarkers (BNP, ANP, endothelin, adrenomedulin)
2D echo
ECG

20
Q

Give CXR findings and their interpretation in order of appearance.

A

Upper lobe vein distention (vascular redistribution)
Kerley B lines(interstitial edema)
Alveolar opacity &batwing appearance (alveolar edema
Mediastinal shift(pleural effusion)

21
Q

Most sensitive biomarker for heart failure

A

NT-BNP

22
Q

Which biomarker correlate best with pulmonary vascular resistance in patients with heart failure?

A

Endothelin 1/ET 1

23
Q

Which biomarker helps to differentiate between HF of cardiac or pulmonary origin

A

If BNP increases then its of cardiac origin

24
Q

Which cardiac biomarker is an independent mortality predictor?

A

BNP

25
Q

What is the normal value of NTproBNP

A

<300 Pg/ml

26
Q

Which drug has no role in Treating acute pulmonary edema?

A

Digoxin(it’s onset takes time)

27
Q

What 5 measure to be takes in case of acute pulmonary edema?

A

Ventilation support
Morphine(decrease anxiety)
Vasodilators
Loop Diuretics(furosemide, bumetinde, torsemide)
Ionotropic drugs(to increase myocardial contractility)

28
Q

What ionotropic agents are used in acute pulmonary edema?

A

Dopamine
Dobutamine
Levosimendan
Phosphodiesterase inhibitors (Milron and inamnitrone)

29
Q

Which drug category is not indicated in Heart failure?

A

Calcium channel blockers

30
Q

What category of drugs are used to treat symptoms of heart failure

A
Loop diuretics
Thiazide diuretics
Ionotropic agents
Vasodilators
Vasoconstrictors(to increase blood pressure)
31
Q

Which ionotropic agents can be given in heart failure but not in acute pulmonary edema?

A

Digoxin

32
Q

What drugs are used to reverse the heart failure?

A

ARBs and ACE inhibitors
Beta blockers
Aldosterone antagonist(spironolactone and eprinolone)

33
Q

Which drug combination can be given in systolic heart failure?

A

Beta blockers and ACE inhibitors

34
Q

Which drugs class is not indicated in NYHA class 4?

A

Beta blockers