Heart Failure, Stroke , PE,DVT, Afib,MI And Emerging Diseases Flashcards
What is heart failure
Clinical syndrome that develops when the heart cannot maintain adequate output, or can do so only at the expense of elevated ventricular filling pressure.
Which group of people commonly get HF and which year group is it prevalent
Prognosis is
•Poor if untreated true or false
•Common in the elderly •Prevalence •1% : 50 – 59 •10% : 80 – 89 •
True
What is the pathophysiology of heart failure which causes a viscous cycle in the progression of heart failure
When there is increased blood pressure and cardiac work there is myocyte loss and myocardial fibrosis
This causes heart failure due to reduced cardiac output
This leads to neurohormonal activation (sympathetic nervous system,RAAS,vasopressin,endothelin system) this causes vasoconstriction and increased afterload and thus causes increased bp and cardiac work or the neurohormonal activation causes sodium and water retention leading to increased intravascular volume and increased bp and cardiac work
Types of heart failure and explain em
Left Heart Failure
•Reduction in left ventricular output and an increase in left atrial and pulmonary venous pressure
•
Right Heart Failure
•Reduction in right atrial pressure and an increase in right atrial and systemic venous pressure
•
Biventricular
•Failure of the left and right heart may develop because of a disease process
Name the other types of heart failure and explain
Systolic Dysfunction
•Heart failure as a result of impaired myocardial contraction
- Diastolic Dysfunction
- Heart failure as a result of poor ventricular filling and high filling pressures as a result of abnormal ventricular relaxation
And name the other other types of heart failure and explain
Acute Heart Failure
•Heart failure that develops suddenly
- Chronic Heart Failure
- There is gradual impairment of cardiac function with several compensation
What factors precipitate or aggravate heart failure in pre existing heart disease
Myocardial ischemia or infarction
Intercurrent illness example-infection
Arrhythmia example-atrial fibrillation
Inappropriate reduction of therapy
Administration of a drug with negative inotropic (beta blockers) or fluid retaining properties (NSAIDS,corticosteroids)
Pulmonary embolism
IV fluid overload example post operative IV infusion
Conditions associated with increased metabolic demand example anemia,pregnancy,thyrotoxicosis
What are the four clinical features each of left and right heart failure
( failure to thrive and difficulty feeding in kids )
Left heart failure- Pulmonary edema Raised JVP Pleural effusions Pitting edema Orthopnea
Right- raised JVP Hepatomegaly Ascites which causes decreased preload and cardiac output Peripheral pitting edema
What are the differentials for peripheral edema
Cardiac failure -right or combined left and right heart failure,pericardial constriction,cardiomyopathy
Chronic venous insufficiency-varicose veins
Hypoalbuminaemia- nephrotic syndrome,liver disease,protein losing enteropathy ;often widespread,can affect arms and face
Drugs;
Sodium retention;fludrocortisone,NSAIDS
Increasing capillary permeability;nifedipine and amlodipine
Idiopathic;occurs in women more than men
Chronic lymphatic obstruction
What are the six investigations for heart failure
~~~
Chest X-ray
•ECG
FBC ( anemia can precipitate it)
Echocardiogram
•Serum Urea, Creatinine and Electrolytes
•Full Blood Count
•Thyroid Function Test ( thyrotoxicosis can precipitate it)
Lipid profile and cardiac enzymes( MI can precipitate it)
Fasting blood sugar
How is acute heart failure managed
Prop patient up – to relieve pulmonary congestion •Give Oxygen •High flow, high-concentration •Non-invasive positive pressure ventilation •CPAP: 5 – 10mmHg •Give Loop Diuretics •60 – 120mmHg IV Furosemide •Give Nitrates •IV Glyceryl trinitrate 10-200ug/min
The use of continuous positive airway pressure (CPAP) therapy has been reported to reduce the risk of death and hospitalization in heart failure patients with OSA (4). Moreover, CPAP use ameliorates the cardiac function through mainly decreasing afterload in heart failure patients with
What is the non pharmacological management of heart failure
Educate the person on the disease
Check the persons diet and weight reduction if person is obese
Avoid food with high salt content
Moderate or eliminate alcohol drinking but it should be eliminated in people with alcohol induced cardiomyopathy
Stop smoking
Regular exercise
Prop up in bed
Consider influenza and pneumococcal vaccination
Pharmacological management of Hf
If patient comes boom:
ABcs, oxygen, pain meds in there is pain then add the propping up in bed to relive pulmonary congestionthen add these drugs
1.* Diuretic Therapy IV furosemide and
2. Angiotensin-converting enzyme inhibition therapy or Angiotensin Receptor Blocker if ACEi isn’t tolerated
3. Beta-adrenoceptor blocker therapy
Identify and treat precipirating causes ( hpt, infections, anemia, MI, thyrotoxicosis)
Refer when patient is stable ( if in health center so that specialist will identify and treat underlying cause )
Give Digoxin if there’s an AFib
* Used in heart failure and atrial fibrillation
* Vasodilators such as dobutamine given when there’s hypotensionfue to cardiogenic shocks
Give enoxaparin for prophylactic anticoagulant against venous thrombosis
What other devices were used in HF
State the NYHA class of heart failure
Impaired Cardiac defibrillators and resynchronisation therapy
•Coronary revascularisation
•Heart transplantation
•Ventricular assist devices
NYHA class
Class 1- no symptoms or no limitations when performing physical activities or can perform any physical activity without any symptoms
Class II- mild limitation when performing physical activities . Ordinary physical activity results in symptoms and is relived by resting
So for class two, heavy activities will cause the symptoms
Class III- marked limitation of physical activity. symptoms when performing slight physical activities and comfortable by resting but for stage 3 even bathing yourself or any small thing you do will cause the symptoms to come( fatigue palpitations and dyspnea )
Class IV- symptoms even at rest and cannot perform any physical activities at all without discomfort
Name five complications of Hf
Renal failure •Hypokalaemia •Potassium losing diuretics, hyperaldosteronism from RAAS activation •Hyperkalaemia •ACE-Is •Hyponatraemia •Feature of severe heart failure •Poor prognosis
Complications •Impaired liver function •Liver congestion •Thromboembolism •Low cardiac output and impaired mobility •Atrial and ventricular arrhythmias
What’s re the signs of right and left ventricular heart failure? CCF should be distinguished from which disease? Using which signs?(name additional signs of CCF and signs of the other disease)
HEART FAILURE
The signs of right ventricular heart failure are:
1. Raised pulsatile jugular venous pressure.
2. Hepatomegaly which is soft and tender.
3. Sacral and ankle oedema.
The signs of left ventricular failure are:
- Cardiomegaly; apex best is displaced outwards and downwards.
- Bilateral basal crackles which persist after coughing.
If a patient’s symptoms and signs suggest the presence of heart failure it is important to remember that this is a description and not a full diagnosis. Congestive cardiac failure (right heart failure secondary to left heart failure) must be distinguished from cor-pulmonale (right heart failure, secondary to lung disease).
Additional signs in congestive heart failure are basal lung crackles due to pulmonary oedema and pink frothy sputum as well as symptoms and signs suggesting left ventricular disease.
Additional signs of cor-pulmonale are coarse lung crackles as in bronchiestasis or fibrosing alveolitis, sputum which is sticky, white, grey, yellow or green.
There may also be symptoms and signs of chronic lung disease as well as right ventricular hypertrophy.
What are the typical patients of CCF,major signs and symptoms,investigations
Typical patient
Patient with acute myocardial infarction or known left ventricular disease
Major symptoms
Severe dyspnoea and variable circulatory collapse
Major signs
Low-output state (hypotension, oliguria, cold periphery); tachycardia; S3; sweating; crackles at lung bases
Diagnosis
CXR: bilateral air space consolidation with typical perihilar distribution
Echocardiogram: usually confirms left ventricular disease
Additional investigations
ECG: may show evidence of acute or previous myocardial infarction
Blood gas analysis: shows variable hypoxaemia
Comments
Although most cases are caused by acute myocardial infarction or advanced left ventricular disease, it is vital to exclude valvular disease or myxoma, which are potentially correctable by surgery
What are emerging diseases
Emerging infectious diseases are infections that have recently appeared within a population or those whose incidence or geographical range is rapidly increasing or threatens to increase in the near future
In other words, emerging diseases are diseases of infectious origin whose incidence in human has increased within the past decades or threatens to increase in the near future.
State three reasons for emerging diseases
Causes
Emerging diseases can be caused by;
●Previously untreated or unknown infectious agents
●Known agents that have spread to new geographic locations or new populations
●Re-emergence of agents whose incidence of disease had significantly declined in the past, but whose incidence of disease has reappeared. These are usually known as re-emerging diseases.
State five ways emerging diseases are transmitted
oPersonal contact oAir droplet oWater oFomites (tables, door knobs, etc) oZoonosis
State three groups of risk factors that can cause an emerging disease and give examples under each
A•Agents:
•Evolution of pathogen over time
•Resistance by pathogens to medications
c. Environment
•Climate change
b. Host •War •Poverty •International travels •Population growth •Ural-urban migration •Misuse of resources
What is the criteria for classifying a diseases condition as an emerging disease
For an emerging disease to become established, at least two (2) events have to occur;
•The infectious agent has to be introduced into a vulnerable population
•The agent has to have the ability to spread readily from person-to-person and cause disease. The infection also has to be able to sustain itself within the population; that is more and more people continue to be infected.
State six examples of emerging diseases
SARS (Severe Acute Respiratory Syndrome) •MERS-CoV (Middle East Respiratory Syndrome Coronavirus) •Influenza •Ebola •Rift Valley fever •Escherichia coli 0157:H7 (E. coli) •Dengue •Tuberculosis •Zika •COVID-19 •Nipah and henipaviral diseases •HIV/AIDS
What is influenza
What is it common for known as?
What causes it?
The RNA that causes it is highly variable.It is relatively unstable at room temperature. What is it’s half life ?
Why is there a species barrier with this RNA?
Influenza, commonly known as the “the flu” is an illness caused by RNA viruses (has an RNA genome of 8 genes) of the family Orthomyxoviridae; the influenza virus that infect the respiratory tract of many humans.
A few hours
Because of the structure of HA protein or hemagglutinin
