Heart Failure Flashcards
Define Dyspnoea
Dyspnoea is an overall term used to describe an unpleasant awareness of increased respiratory effort and is used synonymously with ‘breathlessness’
Pathophysiology of Dyspnoea
- The pathophysiology of dyspnoea is poorly understood.
- Normal breathing - respiratory centres - brain stem.
- Intrapulmonary parenchymal stretch receptors
- Carotid body and central medullary chemoreceptors, peripheral vascular receptors and pulmonary artery baroreceptors all contribute to the pathways leading to dyspnoea.
- Stimulation of pulmonary stretch receptors has been shown to influence the intensity of breathlessness
- There is a no direct relationship between the degree of hypoxia and the degree of breathlessness
- PCo2 & Ph. has a casual relationship
List the most common causes of dyspnoea
- Asthma
- Cardiac failure
- COPD
- Pneumonia
- Interstitial lung disease • psychogenic disorder
List four life threatening causes of dyspnoea
Airway obstruction Anaphylaxis Epiglottitis
Severe pulmonary oedema Severe asthma Tension pneumothorax Cardiac tamponade Massive PE
List four urgent but not lifethretetning causes of dyspnoea
Simple pneumothorax Asthma (less severe) Pneumonia Pulmonary oedema COPD Metabolic acidosis Poisoning Valvular heart disease Myocarditis Guillain-Barre Syndrome Pulmonary embolism
List three non-urged causes of dyspoonea
Pleural effusion Neoplasm Pneumonia (less severe)
How does asthma present in ED?
- May have abrupt onset
- Tachypnoea, tachycardia
- Accessory muscle use
- Diffuse expiratory wheeze • Cyanosis, exhaustion
- Low Sats Late sign
How is asthma managed in ED?
- Assesment-Mild/Moderate/Acute Severe/Near fatal Asthma • Salbutamol/Steroids
- Atrovent –Acute severe/Life Threatening
- Magnesium Sulphate 2g-20 minutes
- Aminophylline 5mg/kg-20 minutes • Invasive Ventilation
- BTS Guidelines
How does pneumonia present?
- Progressive & Systemic symptoms • Fever
- May have associated chest pain
- Productive cough Pyrexia
- Tachypnoea, tachycardia
- Coarse / focal crepitations
- Bronchial breath sounds
- Focally reduced breath sounds
Outline CURB 65
- CURB 65 score of 2 • Confusion
- Urea >7
- RR>30
- Low BP <90 • Age >65
How dose a pneumothorax present?
Simple • Sudden onset with Pleuritic pain • Unilateral reduced breath sounds • Hyper resonance to percussion Tension - as simple plus • Collapse • Extreme respiratory distress • Tracheal deviation • Elevated JVP • Cardiovascular collapse: tachycardia, hypotension
How does anxiety present?
- May have abrupt onset
- Previous episodes related to stress
- Tingling/pins and needles,
- Hyperventilation syndrome
- Tachypnoea
- Tachycardia
- Tetany
- No other abnormal physical findings
List the causes of pulmonary oedema
- MI/IHD
- Arrhythmias
- Prosthetic Valve Failure
- Cardiomyopathy
- Exacerbation of HTN/Valve disease
How does pulmonary oedema present?
- Usually progressive,may be abrupt in onset
- Previous myocardial infarction (MI)
- Risk factors for ischaemic heart disease (IHD) • Dyspnoea, tachypnoea
- Elevated JVP if associated with CCF
- Bilateral inspiratory crepitations
- Gallop rhythm
How is pulmonary oedema managed in ED?
- GTN Spray plus GTN Infusion (10mcg/min)
- Frusemide 50 mg iv
- Opiod iv
- NIV (CPAP/BiPaP)
- Invasive Ventilation
