MI complications and HF

Question 1

What is cardiogenic shock

Answer 1

Insufficient tissue perfusion to reach damand due to cardiac causes

Question 2

Causes of oedema

Answer 2

Fluid overload

HF

Question 3

Assessment of oedema - Signs on the A-E assessment

Answer 3

A: Pink sputum
B: Bibasal creps, wheeze, ↓ air entry, CXR: oedema
C: ECG (MI, arrhythmia) HS - murmur S3, JVP
E: Pedel or sacral pitting oedema

Question 4

Mgmt acute pulmonary oedema

Answer 4

OMFG
Sit up, stop fluids
15L O2
Morphine - 2mg IV → reduces work of breathing
Furosemide - 40mg IV, give it 1mL yourself. - can give as infusion after
GTN - 2 puffs every 5 mins → pulmonary vasodilator, can give as infusion but must be on CCU

If not working → CPAP

Daily weighs

Question 5

JVP

What angle, what vein

Answer 5

45 degrees - pulsation of internal jugular vein

Runs up towards ear

Question 6

Name some complications of MI

Answer 6

Death - ventricular wall rupture, arrhythmia
Cardiac Tamponade - fluid in pericardium - reversible cause of cardiac arrest
Arrythmia - Tachy or Brady
Murmur - Mitral regurg - ischaemia to pupillary muscles - pan systolic
Stroke
Pericarditis - Dresslers syndrome - ST elevation in all leads - saddle shaped

Question 7

What is Beck’s Triad

Answer 7

Sign of cardiac tamponade
Low BP
Distended neck veins
muffled heart sound

Question 8

Chronic Heart Failure - how to dif from COPD

Answer 8

Orthopnoea, PND

Question 9

Left sided HF signs

Answer 9

SOB, cardiac wheeze, cynosis

Question 10

Right sided HF signs

Answer 10

JVP, pitting oedema, hepatomegaly, ascites, displaced apex beat , gallop rhythm, murmurs (if valvular)

Question 11

Heart failure signs on CXR + blood results

Answer 11

ABCDE
Aveolar oedema 
B line - 
Cardiomeg
Divcersion to upper lobes
Effusion 

Derranged LFT - hepatocongestion

Question 12

HF causes

Answer 12

after MI
Arrhythmia e.g. AF
Valvular heart disease 
cardiomyopathy (alcohol, hereditary)
Uncontrolled hypertension
Myocarditis 
Cor pulmonale - pulmonary artery hypertension 
Congenital

Question 13

How do you classify heart failure

Answer 13

New York Heart Association 
Class 1 - Normal activity 
Class 2 - ordinary exertion
Class 3 - less than ordinary exertion
Class 4 - at rest

Question 14

Diagnosis of HF

Answer 14

Have they had MI

Yes - urgent 2 week ECHO + specialist

No - measure BNP, if > 400 → ECHO, 100-400 → 6 week referral

Question 15

Mgmt HF

Answer 15

• ACEi, BB •

Diuretics only for symptomatic relief - furosemide

Options 
• Switch ACEi to ARB Class 2-3
• Recent MI - spironolactone 
• Caribbean - Hydralazine + nitrate
Then if still fucked 
• Digoxin, cardiac transplant, resynchronisation therapy

Question 16

What is resynchronisation therapy

Answer 16

Bi ventricular pacemaker - 3 leads (RA, RV, LV)

To get need LVEF <35%

Question 17

Additional mgmt

Answer 17

MDT, specialist nurse
flu jab
smoking/alcohol 
Depression/anxiety 
Exercise based structured cardiac rehab
Education programmes/support groups
Early discussion of end of life issues/palliative care

Question 18

What murmur does mitral regurg causes

Answer 18

Pan systolic murmur

Question 19

Cor pulmonale is what sided HF

Answer 19

RIGHT sided HF → Leg swelling etc

Question 20

Pleural effusion secondary to HF are: bilateral/unilateral, transudate/exudate

Answer 20

Bilateral transudate

Question 21

Someone dies of acute pulmonary oedema what do you write on death certificate

Answer 21

1a) acute pulmonary oedema
b) Ischaemic heart disease

NB: you cannot write heart failure on any part of the death certificate.