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Cardio-resp > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Signs of right sided Heart Failure

A
  • increased JVP
  • Cardiomegaly
  • Hepatomegaly
  • Ascites
  • Pitting Oedema
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2
Q

Causes of Right sided Heart Failure

A
  1. Chronic Lung Disease (cor pulmonale)
  2. PE/ Pulmonary HTN
  3. Tricuspid/Pulmonary valve disease
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3
Q

Diagnosis of Heart Failure

A

Transthorasic Doppler 2D echo-cardiomyopathy

Serum nauteric peptide (w/o previous MI), BNP >100ng/L

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4
Q

NYHA Classification of Heart Failure

A
  1. No limitation of activity
  2. Slight limitation (mild HF)
  3. Marked limitation (moderate)
  4. Symptoms at rest (Severe)
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5
Q

Framingham CCF criteria (Major)- 8

A

2 Major or 1 major and 2 minor

  • PND
  • Crepitations
  • S3 gallop
  • Cardiomegaly
  • Acute Pulmonary Oedema
  • Hepatojugular reflex
  • increased CVP (>16mmHg at RA)
  • Weight decrease with treatment (>4.5kg in 5d)
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6
Q

Framingham CCF criteria (Minor)- 7

A

1 major + 2 minor

  • B/L ankle oedema
  • exertional SOB
  • tachycardia
  • decreased VC of max
  • nocturnal cough
  • hepatomegaly
  • pleural effusion
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7
Q

Signs of left sided Heart Failure

A
  • displaced apex beat
  • S3 gallop
  • Mitral regurgitation
  • basal cracles
  • pitting oedema (RAAS activation)
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8
Q

Causes of left sided Heart Failure

A
  1. IHD
  2. Non-ischaemic dilated cardiomyopathy
  3. HTN
  4. Mitral/Aortic valve disease
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9
Q

CXR changes of Heart failure

A 
A- alveolar oedema
B- Kerley B lines
C- cardiomegaly
D- dilated/ diverted upper lobe vessels
E- effusion
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10
Q

Pharmacological management of Heart Failure

A 
Diuretics (Frusemide) 
ACE inhibitor
B- blockers (in stable chronic HF)
Spironolactone 
Inotrophic agents (dopamine/cobutamine or digoxin)
Nitrates 
Anticoagulation
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11
Q

Acute severe pulmonary oedema: managmeent

A

100 O2 (unless theres lung disease)
ECG (Arrhythmias,) CXR, troponin, ABG, U&Es, plasma BNP)
Diamorphine 1.25mg-5mg IV
Furosemide 40-80mg IV
GTN or nitrate infusion (isosorbide dinitrate if BP low)

if no improvement: furosemide again, incr. nitrate infusion,CPAP

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12
Q

Infective endocarditis: empirical treatment

A

benzylpanicilin and gentamicin

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13
Q

Pericarditis: commonest cause

A

viral- coxsackie viruses

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14
Q

Pericarditis: causes

A 
Viral (coxsackie viruses)
Idiopathic
TB 
Bacterial
CVS disease (MI, Dresslers syndrome)
Neoplasms (lung tumours, metastatic disease)
CKD 
Inflammatory (RA, Sarcoidosis, SLE)
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15
Q

Pericarditis: symptoms

A

Pleuresy like symp.: sharp, worse on inspiration
Angina-like: cenral CP, radiating to lt shoulder
specific: eased by sitting forward
+/- dyspnoea (esp in tamponade)
+/- fever

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16
Q

Pericarditis: signs

A 
pericardial friction rub (lt lower sternal edge)
pericatdial knick (loud high pitched S3)
17
Q

Constrictive pericarditis: signs

A

rt heart fauiler: Inc. JVP, ascites, hepatomegaly, Kussmaul’s sign (increased JVP with inspiration)
Hypotension
Pulsus paradoxus

18
Q

Pericarditis: ECG changes

A

1: saddle shaped ST elevation
2. ST normalises, T wave flattening (Several days later)
3. T wave inversion (may persist)
4. normal/ baseline ECG (withing weeks to months)

19
Q

Pericarditis: management

A 
bed rest and oral NSAIDS (not if post-MI) 
-high dose aspirin or ibuprofen 
corticosteroids if no rapid improvement 
pericardial window 
pericardiectomy
20
Q

Cardiac tamponade: define

A

pericardial effusion leading to heamodynamically significant cardiac compression

  • > venous return to the heart inhibited
  • > reduced CO, BP and shock
21
Q

Pericardial effusion: acute causes

A

trauma
iatrogenic (cardiac surgery, catheterisation, anticoag)
aortic disection
spontaneous bleed (uraemia, thrombocytopenia)
cardiac rupture post-MI

22
Q

Pericardial effusion: subacute causes

A 
malignancy 
idiopathic pericarditis
uraemia
infection (inc. TB)
radiation
23
Q

Pericardial effusion: presentation

A 
variable on speed of accummulation 
cardiac arrest 
hypotension, shock 
confusion 
slowly developing: SOB, cough, hiccups, dysphagia
24
Q

Pericardial effusion: signs

A

Beck’s triad: increased JVP, decreased BP, muffled heart sounds
tachycardia
Kassmaul’s sign-> increased JVP with inspiration
Pulsus paradoxus (reduction in pulse volume with inspiration)

25
Q

Pericardial effusion/tamponade management

A

ABC, IV fluids, ECG, Bloods
Senior help
Pericardiocentesis (level of xiphisternum, aim for tip of scapula)- blind in emergency (5-50% complication risk) or USS guided
Pericardial fluid for microbiology and cytology
+/- drain

Cardio-resp (5 decks)

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