LOBS Flashcards
what is the immediate management of heart failure?
high flow oxygen
diamorphine
furosemide
GTN spray
what is the point of giving a loop diuretic for heart failure?
Increases sodium and water excretion
reduces preload
vasodilation
what are the side effects of loop diuretics?
hypotension
hypovalaemia
dose related hearing loss
what is the neurohormonal model of heart failure?
decreased CO leads to neurohormonal activation
two pathways of neurohormonal release
1. RAAS activation leading to increased preload and vascular resistance. also leading to aldosterone release causing vasoconstriction and hypertrophy
- sympathetic activation; increased vascular resistance and after load. increased catecholamine release meaning increased workload
why do ACE inhibitors help in heart failure?
Decrease mortality and help prevent RAAS cycle in the neurohormonal model
why do beta blockers help in heart failure?
symptom relief and mortality
prevent renin release due to bet 1 receptors
decrease rate and contractility.
why does spirolactone help in heart failure?
It’s an aldosterone antagonist
increases sodium and water loss decreasing preload
helps mortality
what are causes of aortic stenosis?
- congenital in people born with a bicuspid valve
- calcification associated with smoking and hypertension
- Williams syndrome
- post rheumatic valve
what are problems seen in Williams syndrome?
aortic stenosis hernias dental issues renal issues sensitive hearing retardation low birth weight
what are clinical features of aortic stenosis?
SOB chest pain syncope ejection systolic murmur narrow pulse pressure slow rising pulse
what is the management of aortic stenosis?
observe if there are no symptoms
aortic valve replacement
transcatheter aortic valve implantation
when is an aortic stenosis patient considered for surgery?
Area <1cm
spontaneous symptoms
abnormal LV systolic function
what is aortic regurgitation?
the valve leaflets become incompliant and there is a leakage of blood into the LV during diastole
what are causes of aortic regurgitation?
- congenital due to a bicuspid valve
- aortopathy
- acquired
4 syphilis - acute
what are causes of aortopathy aortic regurg?
collagen disorderes
ehler danlos
osteogenesis imperfect
what are causes of acquired aortic regurgitation?
rheumatic heart disease
dilated aorta
degeneration
giant cell arteritiis
what are signs of aortic regurgitation?
diastolic murmur
widened pulse pressure
displaced apex
what is the management of aortic regurgitation
Surgery
ACE inhibitor/ Ca channel blocker to reduce afterload
what are causes of mitral regurgitation?
- leaflet problems such as myomatous MV disease, rheumatic, endocarditis
- chordae causes
- annulus problems
- papillary muscles
- LV dilation
what are the effects of BNP and ANP?
increased GFR, decreased sodium reabsorption, decreased fluid load
REDUCES PRELOAD
what causes release of ADH?
hypotension nausea increase osmolality angiotensin II adrenaline cortisol nicotine
what is laplaces law?
pressure = 2 x wall tension/ radius
how does laplaces law relate to heart failure?
As the radius of the cardiac chamber increases more tension is needed to create the same pressure
what causes pulsatile hepatomegaly and a 3rd heart sound?
tricuspid insufficiency
what are three types of AF?
paroxysmal: sself terminates in 7 days
persistant: lasts longer than 7 days and needs termination by cardioversion
long standing: over 1 year
what are complications of AF?
loss of atrial contraction reducing CO
thromboembolism
stroke
MI
heart failure
what is the management for acute AF?
direct current cardioversion in haemodynamic instability or when medication fails
what can be given for pharmacological cardioversion for AF?
IV flecainide, IV amiodarone, verapamil
what is the management for stable angina that started under 48 hours ago?
offer rate and rhythm control
start heparin
what can be offered for rate control in AF?
beta blocker and rate limiting calcium channel are first choice
what can be offered for rhythm control in AF?
cardioversion, pacing
who can’t be given beta blockers?
people with ashtma
