Pulmonary Edema Flashcards
What is the Killip classification used for
Acute myocardial infarction
Outline the Killip classification
Killip I: no clinical signs of heart failure,
Killip II: crackles in the lungs, third heart sound (S3), and elevated jugular venous pressure
Killip III: acute pulmonary oedema
Killip IV: cardiogenic shock or arterial hypotension (measured as systolic blood pressure < 90 mmHg), and evidence of peripheral vasoconstriction (oliguria, cyanosis, and diaphoresis)
What blood tests would you order in AMI
ABG
FBC -anaemia &anaemia
U&E
Troponin
Which drugs improve LV contractility
Inotropes
Options include adrenalin, dopamine, dobutamine,
Which drugs are more effective for Preload reduction
Nitrates are more effective and safer than morphine or furosemide for preload reduction
How does nitrate reduce preload
It dilated peripheral vessels which reduces preload after load thereby lowering myocardial oxygen consumption.
Also has a direct relaxant effect on vascular smooth muscles and Teheran dilatation of coronary vessels improves oxygen supply to myocardium.
Which drugs reduce after load
Ace inhibitors
Combined with nitrates exceeds benefit of either drug used on its own.
Rapid reduction in preload and afterload
Decrease need for intubation
What is the mechanism of ace inhibitors in pulmonary oedema
Dilates arteries and veins by blocking angiotensin 2 and bradykinin metabolism.
Vasodilation reduces arterial pressure, preload and afterload
Two types of CHF
Right or left sided
Systolic and diastolic
(Left sided is from systolic dysfunction, decreased ejection fraction from ischemic heart disease -MI or dilated cardiomyopathy. Diastolic on left side can be due to tachycardia, valvular disease)
(systolic is when myocardium can’t pump adequately and diastolic is when muscles are stiff and don’t relax to fill properly)
Complications of CHF
PE- decreases oxygenation and ventilation
Cardiac death
End organ failure
Most common presentation of heart failure
Fatigue and effort intolerance
Presentation of LHF
SOB
PND +Orthopnea
Effort intolerance
Resp distress
Pink frothy sputum
Tachycardia, tachypnea, hypoxia
Presentations of RHF
Pitting oedema
Weight gain
Risk factors for CHF
HPT
DM
Prev MI
Hx of cardiomyopathy
Triggers (new cardiac event, change in meds, increase in salt intake)
What do you expect to find in examination of lungs in LHF (3)
Crackles
Rales
Decreased breath sound
