Heart Failure Flashcards
Signs of right sided Heart Failure
- increased JVP
- Cardiomegaly
- Hepatomegaly
- Ascites
- Pitting Oedema
Causes of Right sided Heart Failure
- Chronic Lung Disease (cor pulmonale)
- PE/ Pulmonary HTN
- Tricuspid/Pulmonary valve disease
Diagnosis of Heart Failure
Transthorasic Doppler 2D echo-cardiomyopathy
Serum nauteric peptide (w/o previous MI), BNP >100ng/L
NYHA Classification of Heart Failure
- No limitation of activity
- Slight limitation (mild HF)
- Marked limitation (moderate)
- Symptoms at rest (Severe)
Framingham CCF criteria (Major)- 8
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)
Framingham CCF criteria (Minor)- 7
1 major + 2 minor
- B/L ankle oedema
- exertional SOB
- tachycardia
- decreased VC of max
- nocturnal cough
- hepatomegaly
- pleural effusion
Signs of left sided Heart Failure
- displaced apex beat
- S3 gallop
- Mitral regurgitation
- basal cracles
- pitting oedema (RAAS activation)
Causes of left sided Heart Failure
- IHD
- Non-ischaemic dilated cardiomyopathy
- HTN
- Mitral/Aortic valve disease
CXR changes of Heart failure
A- alveolar oedema B- Kerley B lines C- cardiomegaly D- dilated/ diverted upper lobe vessels E- effusion
Pharmacological management of Heart Failure
Diuretics (Frusemide) ACE inhibitor B- blockers (in stable chronic HF) Spironolactone Inotrophic agents (dopamine/cobutamine or digoxin) Nitrates Anticoagulation
Acute severe pulmonary oedema: managmeent
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
Infective endocarditis: empirical treatment
benzylpanicilin and gentamicin
Pericarditis: commonest cause
viral- coxsackie viruses
Pericarditis: causes
Viral (coxsackie viruses) Idiopathic TB Bacterial CVS disease (MI, Dresslers syndrome) Neoplasms (lung tumours, metastatic disease) CKD Inflammatory (RA, Sarcoidosis, SLE)
Pericarditis: symptoms
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
Pericarditis: signs
pericardial friction rub (lt lower sternal edge) pericatdial knick (loud high pitched S3)
Constrictive pericarditis: signs
rt heart fauiler: Inc. JVP, ascites, hepatomegaly, Kussmaul’s sign (increased JVP with inspiration)
Hypotension
Pulsus paradoxus
Pericarditis: ECG changes
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)
Pericarditis: management
bed rest and oral NSAIDS (not if post-MI) -high dose aspirin or ibuprofen corticosteroids if no rapid improvement pericardial window pericardiectomy
Cardiac tamponade: define
pericardial effusion leading to heamodynamically significant cardiac compression
- > venous return to the heart inhibited
- > reduced CO, BP and shock
Pericardial effusion: acute causes
trauma
iatrogenic (cardiac surgery, catheterisation, anticoag)
aortic disection
spontaneous bleed (uraemia, thrombocytopenia)
cardiac rupture post-MI
Pericardial effusion: subacute causes
malignancy idiopathic pericarditis uraemia infection (inc. TB) radiation
Pericardial effusion: presentation
variable on speed of accummulation cardiac arrest hypotension, shock confusion slowly developing: SOB, cough, hiccups, dysphagia
Pericardial effusion: signs
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)
Pericardial effusion/tamponade management
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
