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Year 3 - Cardio > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Differentiate between diastolic and systolic sided heart failure

A

Diastolic heart failure - problem with actually loading the heart with blood
Hence the normal ejection fraction

Systolic heart failure - problem with getting the blood out of the heart

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2
Q

Give some causes of systolic heart failure

A

Ischemic heart disease incl. atherosclerosis
Chronic HTN
Dilated cardiomyopathy

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3
Q

Give causes of diastolic heart failure

A

Aortic stenosis

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4
Q

Name a drug that can cause heart failure if started too quickly at a high dose

A

Levothyroxine

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5
Q

How can you classify heart failure?

A

Acute and chronic

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6
Q

Epidemiology

A

1-3% general population
10% of elderly
50% mortality
Worse in south of london

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7
Q

Causes of HF

A 
Cardiomyopathy 
Congential defects 
MI
Arrhthymia 
HTN
Valve disease 
Lung fibrosis
Pulmonary atresia 
Vessel stenosis
PE (acute HF)
Myocarditis
Diabetes (HTN, HF)
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8
Q

What is pulmonary atresia?

A

Narrowing pulmonary artery/trunk

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9
Q

What are the consequences of

A

Heart works harder, hence HTN

pumps faster, hence tachycardia

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10
Q

Why do you get pulmonary oedema?

A

The fluid from the pulmonary artery and vein (backflow from mitral regurg) goes into the lungs !!

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11
Q

What is a consequence of right hypertrophy?

A

induced tricuspid regurg

and therefore blood goes back via IVC into LEGS

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12
Q

Why do you get cachexia and atrophy?

A

The muscles aren’t used as a result of reduced perfusion due to HF, so the muscles waste away

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13
Q

Nocturnal cough can be caused by?

A

Asthma

HF

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14
Q

Is the nocturnal cough productive or non productive in HF?

A

Productive - pink and frothy because of pulmonary oedema

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15
Q

Signs of LHF?

A 
Cyanosis 
Poor exercise tolerance
Angina
Noctural cough
Orthopnoea 
Dyspnoea 
Displaced apex
Pulmonary oedema
Weight loss
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16
Q

Signs of CHF

A

Narrow pulse pressure

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17
Q

What could cause thrills?

A

Pulmonary

aortic valve failure

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18
Q

What would be causing a heave?

A

RHF so heart is throbbing against

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19
Q

What do you call enlargement of the heart

A

Cardiomegaly

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20
Q

What do you call both RHF and LHF together?

A

Congestive heart failure

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21
Q

Investigations

A

BP
CXR
Trans thoracic echo (gold standard)

22
Q

Investigations

A

BP
CXR
ECG
U and E

Trans thoracic echo (gold standard)
BNF

23
Q

What are the five signs of HF on a CXR (ABCDE)

A 
A - alveolar oedema 
B - curly B lines
C - cardiomegaly 
D - dilated upper lobe
E - pleural effusion
24
Q

What are the five signs of HF on a CXR (ABCDE)

A 
A - alveolar oedema 
B - curly B lines
C - cardiomegaly 
D - dilated upper lobe
E - pleural effusion (hazy lines)
25
Q

Where is BNP released from?

A

Atria, released during heart strain

26
Q

Drugs prescribed?

A

Frusemide

27
Q

What kind of diuretic is frusemide?

A

Loop diuretic

28
Q

What lifestyle modifications would you advise for someone with HF?

A

Cut smoking
Lose weight
Diabetes management

29
Q

What drugs would these patients have to avoid?

A

NSAIDS
Negative inotropes
Flu and pneumoccoal vaccinces

30
Q

Drugs for HF

A 
ACEi
Beta blockers
Mineralocorticoid receptor antagonists
Digoxin
Vasolidators e.g. GTN and hydralazine
31
Q

Which of these actually improve mortality?

A

Mineralocorticoid receptor antagonist

32
Q

Example of mineralocorticoid receptor antagonist

A

Spironolactone

33
Q

What you should be careful about with hydralazine?

A

Renal failure

34
Q

Other options?

A

Transplant (but v risky with HF patients)

palliation

35
Q

How do you manage chronic diseases, in order?

A

CONSERVATIVE
MEDICAL
SURGICAL

36
Q

How do you treat an acute disease?

A 
ABCDE approach 
Airway
Breathing
Circulation 
Disability 
Exposure
37
Q

How do you open someone’s airway?

A

Head tilt

Chin lift

38
Q

When do you do a jaw thrust?

A

if they have a cervical spine trauma

39
Q

What would you do with breathing looking for?

A

Pulse oximeter

ABGs

40
Q

When do you give oxygen?

A

If sats are lower than 96%, give 15l of oxygen in a non rebreathe mask

41
Q

What do you do if you’ve had to intervene at some point during ABCDE?

A

Always recheck from A to E again if you intervened, e.g. if you gave oxygen at some point

42
Q

What would you do for circulation

A 
Blood pressure
Pulse 
Active bleeding 
Cyanosis 
Warm peripheries 
Heart monitor (3/12 lead ECG)
Cannulate
43
Q

If someone doesn’t have a radial pulse, what do you know?

A

That the bp is above 80mmHg

44
Q

What does the D stand for?

A

Disability
also:
DEFG
Don’t ever forget glucose

45
Q

Mnemonic for GCS scoring?

A

AV PU (have a poo)

Alert (ask pt to squeeze hand)
Voice
Pain
Unresponsive

46
Q

How do you check whether someone is alert?

A

Push down on nails

Push down above eyes

47
Q

What does E stand for?

A

exposure

48
Q

What do you do when looking for exposure?

A 
Trauma
Stab wounds
Rash (meningitis)
Oedema 
Pulsation
49
Q

Acute management of HF

A 
Sit patient upright
Give high flow oxygen 
IV access
ECG 
Morphine
Furesmide 
GTN spray if blood pressure is above 90
Assess reversible causes
50
Q

Complications of HF

A 
Reduced lung function 
Chronic anaemia 
Impaired kidney disease (due to HTN)
Syncope 
Wheeze and cough
Cachexia
MI

Year 3 - Cardio (19 decks)

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