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Year 3 > MedED cardiac SOB > Flashcards

MedED cardiac SOB Flashcards

1
Q

What are some reasons that SOB arises?

A

Not enough oxygen reaching the lungs eg asthama, COPD
Not enough oxygen getting into the blood eg PE, pulmonary oedema and fibrosis
Not enough oxygen reaching the rest of the body eg heart issues, anaemia, shock

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2
Q

What is the definition of heart failure?

A

The failure of the heart to maintain a cardiac output that is reuqired to meet the bodies demands

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3
Q

What are the 3 ways heart failure can be classified?

A

Acute or chronic
Left or right
High output state or low output state

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4
Q

What are the 2 main causes of acute heart failure?

A

Acute coronary syndrome ie massive heart attack causing the heart muscle to fail
Decompensation of chronic heart failure

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5
Q

What is the combination of right and left heart failure called?

A

Congestive heart failure

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6
Q

What is congestive heart failure?

A

Right and left heart failure

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7
Q

In congestive heart failure which side of the heart if affected first?

A

Left

This then progresses to cause right heart failure

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8
Q

What is a low output state in HF?

A

Heart fails to pump in response to normal exertion causing low cardiac output

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9
Q

What is a high output state in HF?

A

Cardiac output is normal but there is increased metabolic demand eg pregnancy, anaemia hyperthyroidism etc

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10
Q

What are valvular causes of chronic left heart failure?

A

Aortic stenosis
Aortic regurg
Mitral regurg

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11
Q

What are muscular causes of chronic left heart failure?

A

Ischaemia
Cardiomypathy
Myocarditis
Arrhythmias (AF)

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12
Q

What is the biggest systemic causes of chronic left heart failure?

A

Hypertension

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13
Q

What are lung causes of chronic right heart failure?

A 
Pulmonary hypetension (cor pulmonale)
Pulmonary embolism
Chronic lung disease eg interstitial, cystic fibrosis
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14
Q

What are valvular causes of chronic right heart failure?

A

Tricuspid regurg

Pulmonary valve disease

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15
Q

What are the 3 main causes of high output heart failure?

A

Hyperthyroidism
Anaemia
Pregnancy

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16
Q

Where does fluid accumulate in left heart failure?

A

Lungs

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17
Q

Where does fluid accumulate in right heart failure?

A

Peripheries

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18
Q

What type of symptoms do you get with left heart failure?

A

respiratory

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19
Q

Where does fluid accumulate in right heart failure?

A

Swelling signs

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20
Q

What are symptoms of left HF?

A

Dyspnoea
Paroxsymal nocturnal dyspnoea
Nocturnal cough
Fatigue

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21
Q

What is a buzz word for left HF?

A

Coughing up pink frothy sputum- due to pulmonary oedema

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22
Q

What might you ask in OSCE when taking a history and you suspect left heart failure?

A

SOB: how far are you able to walk ie how many steps before you need to catch a breath, how many flights of stairs can you climb
Orthopnoea: have you noticed anything makes your sob worse? what about lying down or standing up
PND: do you wake up gasping for air, how many pillows do you need to sleep at night

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23
Q

What are signs for left heart failure?

A 
Heart= high HR and RR, S3 gallop, S4 if severe HF, may be an arrhythmia, murmur (AS, MR, AR) 
Lungs= due to pulmonary oedema fine end inspiratory crackles at lung bases, wheeze due to cardiac asthma
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24
Q

What are signs of right heart failure?

A 
Face: swelling
Neck: raised JVP
Heart/chest: TR murmur, high HR and RR
Abdomen: ascites, hepatomegaly 
Other: ankle and pitting oedema
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25
Q

What are symptoms of heart failure?

A 
Fatigue
Reduced exercise tolerance
Anorexia
Nausea
Nocturia
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26
Q

What is the main difference in symptoms between left and right heart failure?

A 
Left= breathing symptoms
Right= swelling symptoms
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27
Q

What investigations are done for heart failure?

A

Bedside= ECG
Bloods=FBC, U+Es, LFTs, TFTs, BNP
Imaging= CXR, trans thoracic echocardiogram

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28
Q

What blood tests is most important for heart failure?

A

BNP

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29
Q

What is the gold standard imaging for diagnosing HF?

A

Trans thoracic echocardiogram coupled with a doppler

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30
Q

What is the sensitivity and specificity of BNP and what does this mean?

A

It is highly sensitive- this means if its low they arent in heart failure
It is not specific- this means if its high they may be in heart failure but other things also cause a high BNP

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31
Q

When is BNP released?

A

Whenever the ventricles are streched

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32
Q

What does TTE with doppler allow you to see and conclude in heart failure?

A

Allows you to see the structure and function of the heart and may show the cause of HF
Can calc EF

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33
Q

What is a normal EF?

A

50-70%

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34
Q

What occurs in HFrEF?

A

There is systolic dysfunction- the ventricles are unable to contract properly

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35
Q

What occurs in HFpEF?

A

The ventricles are unable to relax and fill normally

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36
Q

What type of HF do you get when systole vs diastole is impaired?

A

Impaired systole= HFrEF

Impaired diastole= HFpEF

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37
Q

What are some chest x ray signs of heart failure?

A

Pleural effusion
Kerley B lines
Increased cardiothoracic ratio

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38
Q

Go through chest x ray A-E for someone with HF?

A

A- lveolar oedema
B- line (Kerley)
C- ardiomegaly
D- ilated upper lobes vessels and diverted upper lobe
E- ffusion (transudative pleural effusion)

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39
Q

What type of effusion do you get in heart failure?

A

Transudative pleural effusion

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40
Q

What criteria is clinically used to diagnose HF?

A

Framingham criteria

41
Q

What score is needed on Framingham’s criteria for diagnosis of HF?

A

2 majors or 1 major and 2 minors

42
Q

What is Framingham’s criteria?

A

It is used to clinically diagnose HF

43
Q

How is chronic HF managed?

A

Treat underlying cause
Treat exacerbating factors
Lifestyle modifications- smoking cessation, diet (reduce salt intake), exercise
Pharmacologically- ABD (ace inhibitors, beta blockers, diuretics)

44
Q

What 3 drugs are given for chronic HF?

A

Ace inhibitor
Beta blocker
Diuretic

45
Q

Why are ace inhibitors used in chronic HF?

A

For left ventricular dysfunction- it reduces hypertension and stops heart failure from getting worse due to the hypertension

46
Q

Why are beta blockers used in HF?

A

To reduce the oxygen demand of the heart muscle itself

47
Q

Why might it seem beta blockers would be contraindiciated in heart failure and why aren’t they?

A

They usually reduce cardiac output and if someone with HF had HFrEF why would you want to further reduce their cardiac output?

But they are given because they reduce the oxygen demand of the heart uscle itself and are therefore therapeutic

48
Q

In heart failure if you have a low cardiac output which 2 systems are upregulated?

A

Sympathetic nervous system and renin angiotensin system

49
Q

What are the 2 main types of diuretic given in heart failure and give an example of each

A

Loop diuretics- furosemide

Aldosterone antagonists- spironolactone

50
Q

What are some medications used in chronic HF? Give an example of each

A 
Ace inhibitors- enalapril, ramipril
Beta blocker- bisoprolol, metoprolol
Diuretics- furosemide, spironolactone 
Hydralazine+ nitrates
Digoxin
Cardiac resynchronisation therapy
51
Q

How is acute HF managed?

A 
Emergency, treat with ABC:
Sit them upright
Give oxygen (60-100%) 
IV diamorphine 2.5-5mg (pain relief)
GTN (especially if due to CHD)
IV furosemide
52
Q

What acronym can be used to remember how to treat acute HF?

A 
DMONS:
Diuretics
Morphine
Oxygen
Nitrates
Sit up

Note: the acronym doesn’t represent what order you should do this all in

53
Q

What is the prognosis of HF?

A

Very poor (worse than most malignancies), if severe most patients will die in 2 years

54
Q

What are complications of heart failure?

A

Respiratory failure
Renal failure (due to hypoperfusion)
Acute exacerbations
Death

55
Q

What happens to cardio thoracic ratio in heart failure?

A

It is increased

56
Q

Which lobes are diverted in heart failure?

A

Upper lobes

57
Q

What is cardiomyopathy?

A

A group of the disease where the myocardium becomes structurally and functionally abnormal

58
Q

What is the difference between primary and secondary cardiomyopathy?

A 
Primary= confined to the myocardium
Secondary= part of a systemic disease
59
Q

What must be absent in cardiomyopathy?

A

CAD
Valvular disease
Congenital heart disease

60
Q

What are the layers of the heart from innermost to outermost?

A

Endocardium
Myocardium
Epicardium

61
Q

What are the types of cardiomyopathy?

A

Dilated
Hypertrophic
Restrictive

62
Q

What happens to muscle in restrictive cardiomyopathy?

A

It doesnt increase or decrease in volume but becomes more rigid eg due to infiltration and also becomes less complaint and effective at pumping

63
Q

How will cardiomyopathy present?

A

Like HF: SOB, fainting, fatigue

Can also present with sudden death: ask about family hx

64
Q

What will you see on examination in cardiomyopathy?

A

S3 and S4 on auscultation

Respiratory crackles

65
Q

What is the best investigation for cardiomyopathy?

A

Echo

Can also do bloods, BNP, stress test, ECG, CXR, cardiac catheterisation

66
Q

What happens in dilated cardiomyopathy?

A

The ventricles enlarge and become dilated

The walls are thing and weak so they cant contract effectively and cardiac output is reduced

67
Q

What are the causes of dilated cardiomyopathy?

A

Alcohol (most common)

Post viral

68
Q

How can you differentiate dilated cardiac myopathy from HF?

A

The apex beat will be displaced (to the left)

69
Q

What happens in hypertrophic cardiomyopathy?

A

The muscle is thicker so it can’t pump effectively

Thick muscle can lead to arrhythmia as it is not as good as conducting electricity

70
Q

What is HOCM?

A

Hypertrophic obstructive cardiomyopathy= thickened ventricle obstructs the outflow of blood

71
Q

What is the most common cause of hypertrophic cardiomyopathy?

A

Inherited (50%)

72
Q

How will someone with hypertrophic cardiomyopathy commonly present and who does it most affect?

A

Usually a young person, who is an athlete and it will present with a sudden collapse out of no where and usually they die
Often patients are asymptomatic but some warning symptoms might be angina, dyspnoea on exertion, palpitations, syncope

73
Q

What are buzz words for HOCM?

A

Ejection systolic murmur
Jerky carotid pulse
Double apex beat which is not displaced
S4

74
Q

What might an ECG show if there is LVH?

A 
Q waves
Left axis deviation
Deep S in V1/V2
Tall R in V5/V6
S in V1 and R in V5 or V6> 7 large squares
75
Q

How do you remember what happens in restrictive cardiomyopathy?

A

R for RHF symptoms

76
Q

What part of the cycle is affected in restrictive cardiomyopathy?

A

Diastole- there is reduced filling of the heart

77
Q

What happens to preload in restrictive cardiomyopathy?

A

It is reduced

78
Q

What are the causes of restrictive cardiomyopathy?

A 
Infiltrative disease (they often end in 'osis') eg amyloidosis, sarcoidosis, haemochromatosis
Can also be familial and idiopathic
79
Q

Which cardiomyopathy is more common?

A

Dilated and hypertrophic are more common than restricitve

80
Q

How will restrictive cardiomyopathy present?

A

Asymptomatic

HF symptoms

81
Q

What are signs of restrictive cardiomyopathy?

A

RHF signs= raised JVP, S3, ascites, oedema, hepatomegaly

Kussmaul’s sign= paradoxical rise in JVP on inspiration

82
Q

What is a buzzword for restrictive cardiomyopathy?

A

Kussmaul’s sign= rise in JVP on inspiration

83
Q

What are buzzwords for HOCM?

A

Jerky carotid pulse, double apex beat that isn’t displaced, S4, ejection systolic murmur

84
Q

What is constrictive pericarditis?

A

Chronic inflammation of the pericardium (outermost sac of the heart) with thickening and scarring

85
Q

What are caused of constrictive pericarditis?

A

Idiopathic
Infectious (TB, bacterial, viral)
Acute pericarditis
Cardiac surgery and radiation

86
Q

What condition will present similarly to restrictive cardiomyopathy?

A

Constrictive pericarditis

87
Q

What investigation is best for constrictive pericarditis?

A

Echo

88
Q

How is constrictive pericarditis treated?

A

Surgical removal of the pericardium can cure the condition

89
Q

How do you differentiate between constrictive pericarditis and restrictive cardiomyopathy?

A

Echo- you can see if there is increased pericardial thickness and also check the thickness of the myocardium

90
Q

How do restrictive cardiomyopathy and constrictive pericarditis differ in terms of management?

A

In constrictive pericarditis you can cure the patient by surgically removing the pericardium
In cardiomyopathy there is no cure, the only way would be to do transplant surgery

91
Q

What is myocarditis?

A

Inflammation of the myocardium

92
Q

What are causes of myocarditis?

A

Infections- coxsackie B virus is the most common cause
Drugs- cocaine
Metals
Radiation

93
Q

What are signs and symptoms of myocarditis?

A

Flu like prodrome
Chest pain (worse when lying down)
SOB
Palpitations

94
Q

What investigations are done for myocarditis? What will they show

A

CK and troponin to rule out other causes of chest pain- they will be raised
ECG- non specific ST and T wave changes
Diagnostic investigation is endomyocardial biopsy but this is not routinely done

95
Q

How can you differentiate myocarditis from thing like restrictive pericarditis etc?

A

The cardiac biomarkers (troponin and CK) will be raised

There will be chest pain and this may be worse when lying down

96
Q

What does endomyocardial biopsy diagnose definitively and when is it used? Why is it used then?

A

It diagnoses myocarditis
It is only used if you have tried to treat myocarditis unsuccessfully to find out what specific agent has caused it
It is only done after initial treatment is unsuccessful because it is very invasive and risky

97
Q

In HOCM what causes sudden death in an asymptomatic patient?

A

Arrhythmia

98
Q

In HOCM what causes sudden death in a patient who has experienced some warning symptoms before hand?

A

Obstruction of blood flow from the heart

Reduced pumping of blood due to stiff myocardium

Year 3 (104 decks)

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