HF Flashcards
How do you diagnose a HF
it is diagnosed when the pat have a significant heart disease and develop the s/s of low co, systemic congestion , pulmonary congestion.
what are the most common causes of RV failure?
chronic lung disease
pulmonary embolism
pulmonary valve stenosis.
mention the causes of HF.
1_reduce v contractility: MI, Myocarditis, cardiomyopathy.
2_v outflow obstruction: oartic, pulmonary stenosis, HTN, pulmonary hypertension.
3v inflow obstruction: mitral, tricuspid stenosis.
4 v volume overload: MR, AR, ASD, VSD, increase metabolic demand.
5_arrythmias: tachycardia, AF, Completer heart block.
6_diastolic dysfunction: LV hypertrophy and fibrosis, constrictive pericarditis, restrictive cardiomyopathy, cardia tamponade.
what are the adverse effects of prolonged SNS activation?
myocardia apoptosis, necrosis, hypertrophy.
vasoconstriction
predispose to arrythmias.
what substances cause sodium and water retention?
aldosterone, endothelin1,vasopressin
Mention the causes of high out put HF
Severe anemia, beri beri, thyrotoxicosis.
large arteriovenous shunt.
how acute HF occur and what arre the S/S of it?
1_when any minor event occurs on compensated heart failure (those with impaired cardia function but adaptive changes had prevent the development of overt HF.)
2_in decompensation episoide on back ground of chronic heart failure (acute on chronic).
sudden onset of dyspnea at rest, progress to Acute respa distress, orthopnea, prostration.
pat appears agitated, pale, clammy, cold limbs, repid pulse usually, high bp except in cardiogenic shock.
inc JVP, apex is not displaced, gallop rythm with S3 is heard early, systolic murmur in MR, VSD.
lung criptations, expiratory wheeze.
additional features of chronic HF.
Mention the factors which may precipitate heart failure in preexicting disease.
1_intercurrent illness
2_pulmonary embolism
3_increase metabolic demand
4_MI
5_Arrhythmias
6inappropriate reduction of therapy
7 drugs with negative inotropic or fluid retention property (b blocker, NSAID, glucocorticoids)
8_IV fluid overload.
what is the differential diagnosis of peripheral odema
1_HF
2_hypoalbunemia: nephrotic syn, liver dis, protein lossing enteropathy,
3_idiopathic
4_chronic venous insufficiency
5_chronic lymphatic obstruction
6_drugs:
sodium retention: fludrocortisone, NSAID.
increase cappilary permability: dihydropyridine.
Mention the S/S of chronic HF.
1_S of low co: fatigue poor effort tolerance, cold, low bp, oliguria, uremia, muscle atrophy, cardiac cachexia.
2_S of PO: dyspnea, inspiratiory creptations
3_S of Systemic congestion: raised JVP, peripheral odema, ascites, hepatic congestion, pleural effusion, anorexia
Mention the complications of HF
1_renal failure: poor supply, Exacerbate by diuertic therapy ACE, ARBS.
2_impaired liver function: poor supply, venous congestion leads to mild jaundice, low clotting factors.
3_hyperkalemia:combination of ACE,ARBS, k sparing diuertic +renal impairment
4_hypokalemia: diuertics, hyoerladosteronism, impaired aldosterone metabolism in liver congestion.
5_hyponatremia: in severe heart failure, caused by diuertics, high ADH, Failure of cell mem ion pump.
6_thromboembolism: DVT, pulmonary embolism, systemic emboli caused by AF, Intracardiac thrombus complicating MS, LV aneurysm
7_Arrythmias related to electrolytechanges,SNS, Undelying cause, common,: AF in 20%, V ectopic beats and non sustaind tachycardia
8_sudden death in half pat mainly due to VF.
what are the investigations helps in HF and their findings?
1_CXR in all cases: prominent vascularity of lung, distension of upper lobe pulmonary veins, R&L pulmonary artries dilation, karely B lines, hazy opacification on hilar region, plueral effusion.
2_ECHO: eitology, identify pat will benefit from long term drug therapy
3_serum urea, creatinine, electrolyte
4_HB
5_thyroid function test
6_BNP
How to manage a pat with acute PO?
1_sit the patient up
2_give high flow oxygen
3_ensure continous possitive air way pressure by tight fitting mask.
4_morphine for distress
5_furosamide 50-100 mg IV.
6_Nitrate:
IV 10-200micro gram/min
oral 2-5 mg.
7_if no effect, give inotropic agents like dobutamine.
8_intraoartic balloon pump
what is the general managment of HF
1_education
2’diet
3_alcohol
4_smoking stop
5_excersice regular with limit of symptoms
6_vaccination of infeluenza
