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CRAAB 5 > Johns- Shortness of Breath > Flashcards

Johns- Shortness of Breath Flashcards

1
Q

A patient comes in who has abnormally uncomfortable awareness of their breathing…

A

Dyspnea

can be with or without exertion

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2
Q

What should be on your differential for dyspnea on exertion (DOE)?

A 
CHF
Angina
Obstructive airway disease
anemia
hypothyroid
metabolic acidosis
anxiety and hyperventilation
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3
Q

What should be on your differential for dyspnea NOT related to exertion?

A

Sudden episodes at rest:
PE
Pneumothorax
Anxiety

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4
Q

What is orthopnea

A

Dyspnea when supine

CHF, asthma, COPD

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5
Q

What is PND (paroxysmal nocturanal dyspnea)?

A

Waking at night short of breath

CHF, COPD

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6
Q

What is trepopnea?

A

Dyspnea when lying on side

CHF

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7
Q

What is the pathophysiology of dyspnea?

A

We don’t really know….

Stimulation of chemoreceptors, stretch receptors, intrathoracic receptors—> brainstem respiratory centers

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8
Q

What is CHF?

A
  • Syndrome of dyspnea on exertion
  • Edema of the lungs or extremities
  • fluid retention resulting from cardiac dysfunction
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9
Q

What causes LV failure?

A
  1. CAD
  2. Valvular heart disease
  3. Hypertension
  4. Congenital defects
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10
Q

What causes RV failure?

A

Most commonly:

  1. LV failure
  2. Tricuspid regurgitation

Others: mitral stenosis, primary pulmonary hyptertension, multiple pulmonary emboli, pulmonary valve stenosis, RV infarction

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11
Q

What is high output failure?

A

A persistent high CO that eventually results in ventricular dysfunction

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12
Q

What causes high output failure?

A 
anemia
beriberi
thyrotoxicosis
preganancy
AV fistulas
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13
Q

What is systolic dysfunction and what causes it?

A

Ventricular contractile dysfunction

  1. CAD
  2. Hypertension
  3. Dilated congestive cardiomyopathy
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14
Q

What is diastolic dysfunction? What causes it?

A

Prolonged ventricular relaxation time and resistance to filling (ventricular STIFFNESS)

Hypertension
Age

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15
Q

What is BNP?

A

Neurohormone secreted from the cardiac ventricles in response to volume expansion and pressure overload

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16
Q

Why is BNP useful?

A

It differentiates CHF from other causes of dyspnea

17
Q

What are symptoms of heart failure?

A 
dyspnea L
orthopnea L
PND L
fatigue L and R
Weakness L and R
Leg Edema R
Abdominal Fullness R
18
Q

What physical findings are associated with heart failure?

A 
Lung crackles (rales) L
Dullness to percussion of lung bases (effusion) L
Elevated JVD- positive hepatojugular reflux L or R
S3 L
Mitral insufficiency
ankle edema R
hepatomegaly R
ascites R
19
Q

What is the NYHA functional classification for CHF?

A

I- no limit
II- some limit
III- marked limit
IV- sxs at rest

20
Q

How do you diagnose CHF?

A
  1. Physical Exam
  2. Chest x ray (cardiomegaly, pulmonary venous congestion, pleural effusions)
  3. ECG (r/o) MI
  4. Echocardiography (decreased LV function, diastolic dysfunction)
  5. Stress testing or coronary angiography (if CAD suspected)
21
Q

What can be used to decrease preload in CHF?

A
  1. Diuretics (furosemide, ethacrynic acid)
  2. Vasodilators (isosorbide dinitrate, nitroglycerine)

**by themselves don’t increase survival

22
Q

What can be used to increase myocardial contractility when treating CHF?

A
  1. Digoxin- only commonly used oral med (reduces MORBIDITY in pts also on diuretics and ACE inhibitors)
  2. Dobutamine- given IV only (used in acute CHF in hostpital)
23
Q

What is used to decrease afterload in treating CHF?

A
  1. Arterial vasodilators (apresoline)
  2. ACE inhibitors- dilate arteries and veins (captopril, enalapril)
  3. Angioreceptors II receptor blockers (Losartan)
24
Q

What drugs will reduce mortality in CHF treatment?

A

ACE inhibitors

ARBs

25
Q

What is neurohumeral treatment for CHF?

A
  1. Spironolactone- aldosterone antagonist

2. Carvedilol- selective beta blocker that decreases catecholamines

26
Q

What two drugs increase survival in CHF?

A

Spironolactone (severe CHF)

Carvedilol

27
Q

What drug would you use for stage IV heart failure?

A

Nesiritide (brain natriuretic peptide)

Needs to be infused IV, improves dyspnea

Causes HYPOTENSION

Costs $380/day

28
Q

What drugs can be used to improve diastolic dysfunction?

A
  1. Ace inhibitors

2. Beta blockers slow heart and allow more time for ventricular filling

29
Q

What drugs are contraindicated for diastolic dysfunciton?

A

Diuretics and vasodilators

Pts don’t tolerate decrease in plasma volume or BP

30
Q

What medication should NOT be given with diastolic dysfunction?

A

Furosemide

31
Q

Hepatomegaly can be a sign of?

A

Right heart failure

32
Q

Enalapril is….

A

An afterload reducer–dilates arteries AND veins

CRAAB 5 (9 decks)

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