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Respiratory Medicine > Shortness of Breath > Flashcards

Shortness of Breath Flashcards

1
Q

What are the three categories of why someone might be breatheless?

A

Not enough oxygen reaching the lungs
Not enough reaching the blood
Not enough reaching the rest of the body

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2
Q

What are the cardiac causes of breathlessness?

A

Heart Failure
Cardiomyopathy
Constrictive Pericarditis
Myocarditis

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3
Q

Define heart failure

A

The failure of the heart to maintain CO to meet body’s demands

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4
Q

How can HF be classified?

A

Acute or Chronic
Left or Right or Both
High or Low output state

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5
Q

What is HF where both sides of the heart are effect known as?

A

Congestive HF

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6
Q

What is the natural history of Congestive HF?

A

LH to start
Pressure backs up into the pulmonary system
Backs up into RH

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7
Q

What is low output state HF?

A

Heart fails to pump un response to normal exertion

Low CO

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8
Q

What is high output state HF?

A

CO is normal but higher metabolic needs

e.g. pregnancy, anaemia and hyperthyroidism

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9
Q

What are the causes of LHF?

A

Valvular
Muscular
Systme

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10
Q

What are the valvular causes of LHF?

A

Aortic stenosis
Aortic regurg
Mitral regurg

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11
Q

What are the muscular causes of LHF?

A

IHD
Cardiomypopathy
Myocarditis
Arrythmias

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12
Q

What are the systemic causes of LHF?

A

HTN
Amyloidosis
Drugs e.g. cocaine, chemo

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13
Q

What are the causes of RHF?

A

Lungs

Valvular

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14
Q

What are the lung related causes of RHF?

A

Pulmonary HTN
PE
Chronic lung ddisease

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15
Q

What are the valvular causes of RHF?

A

Tricuspid regurg

Pulmonary valve disease

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16
Q

High output heart failure causes?

A

NAP MEALS

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17
Q

Which vein does the LHS of the heart receive blood from?

A

Pulmonary veins

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18
Q

What causes symptoms in LHF?

A

Fluid accumulates in lungs –> respiratory systen

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19
Q

What causes symptoms in RHF?

A

Fluid accumulates in the peripheries –> swelling signs

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20
Q

What are the symptoms of LHF?

A

Dyspnoea
Nocturnal cough (pink, frothy sputum)
Fatigue

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21
Q

What types of dyspnoea can be present in LHF?

A

Paroxysmal nocutrnal
Exertional
Orthopnoea

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22
Q

What cardiac signs are present in HF?

A 
High HR
High RR
Irregulary irregular pulse
Pulsus alternans
Dispaced apex beath
S3 Gallop
S4 in severe HF
Murmur (AS, MR, AR)
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23
Q

Why do we get signs in LHF?

A

Consequence of HF

Because of the underlying cause of the HF

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24
Q

What are some signs of RHF?

A

Face swelling
Raised JVP
Weight gain
Ascites

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25
Q

What investigations should be done for HF?

A

ECg
FBC, U&Es, LFTs, TFTs, BNP
CXR, TTE

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26
Q

Why do a CXR for HF?

A

Rule out MI

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27
Q

What is a TTE?

A

Trans-thoracic echocardiography

Gold standard for HF

28
Q

What is BNP? When is it raised?

A

Released when heart muscle stretches

29
Q

What is the issue with BNP?

A

Sensitive but not specific

If high need to do TTE to confirm

30
Q

What does TTE allow us to do?

A

Visualise the structure and function of the heart

Calculate the EF

31
Q

What are the CXR signs for HF?

A 
Alveolar oedema
B-lines
Cardiomegaly
Dilated upper lobe vessels
Diverted upper lobe
Effusion
32
Q

What is the criteria for HF diagnosis clinically?

A

Framingham criteria

33
Q

What are the major framingham criteria?

A

Paroxysmal nocturnal dyspnea
Weight loss of 4.5 kg in 5 days in response to treatment
Neck vein distention
Rales
Acute pulmonary edema
Hepatojugular reflux
S 3 gallop
Central venous pressure greater than 16 cm water
Circulation time of 25 seconds or longer
Radiographic cardiomegaly
Pulmonary edema, visceral congestion, or cardiomegaly at autopsy

34
Q

What are the minor framingham criteria?

A

Ankle edema, night cough, dyspnea on exertion, hepatomegaly, tachycardia and weight loss

35
Q

What is the management for Chronic HF?

A

Treat underlying cause
Treat the exacerbating factors
Lifestyle modification
Drugs

36
Q

What are the drugs for HF?

A

ABD Villiers

ACE inhibitors
Beta Blockers
Diuretics

37
Q

In which HF patients should ACE inhibitors be given?

A

Anyone with LV dysfunction

38
Q

Why are beta blockers used?

A

To reduce O2 demand

39
Q

What can be used in place of ACEi if not tolerated?

A

ARB

Sometimes get cough with ACEi

40
Q

When are diuretics used?

A

Evidence of fluid retention

41
Q

What are some ACEi?

42
Q

What are some Beta blockers?

43
Q

What are some diuretics?

A

Furosemide

44
Q

Define cardiomyopathy

A

A group of diseases in which the myocardium becomes structurally and functionally abnormal

  • in the absence of CAD, valvular disease and congenital heart disease
45
Q

What are the types of cardiomyopathy?

A

Dilated
Hypertrophic
Restrictive

46
Q

What are the types of cardiomyopathy?

A

Dilated
Hypertrophic
Restrictive (less compliant muscle)

47
Q

How might cardiomyopathy present?

A

HF symptoms
SOB on exertion
Fainting
Fatigue

Ask about FH
Esp. sudden death

48
Q

Signs of cardiomyopathy on examination?

A

Respiratory crackles

Murmurs S3, S4

49
Q

Describe the pathophysiology of dilated cardiomyopathy?

A

Ventricles enlarge and become dilated
Walls thin and weaken, cannot contract well
Law of LaPlace

50
Q

What are the RFs for dilated cardiomyopathy?

A

Alcohol
Post-viral
Haemochromatosis
Genetic

51
Q

What are the signs of dilated cardiomyopathy?

A

Displaced apex beat
TR/MR murmur
SM

52
Q

What will you see on investigation in dilated cardiomyopathy?

A

Globular heart CXR

53
Q

What is the pathophysiology for HOCM

A

H for hench
Muscle thickens inward
Increased stiffness
Thickened muscle disrupts electrical conduction

54
Q

What are the symptoms of HOCM?

A 
Usually asympto
Sudden cardiac death
Angina
Dyspnoea on exertion
Palpitations 
Syncope
55
Q

What are the signs of HOCM?

A

Ejection systolic murmur
Jerky carotid pulse
Double apex beat NOT DISPLACED (muscles grows inwards)
S4

56
Q

What is the pathophysiology of restrictive cardiomyopathy?

A

R for rigid

Ventricles become abnormally rigid and lose flexibility
Impaired ventricular filling
Reduced preload
Reduced blood flow and backing up of blood

57
Q

What are some causes of restrictive cardiomyopathy?

A

Sarcoidosis
Amyloidosis
Famililal
Idiopathic

58
Q

What does HOCM stand for?

A

Hypertrophic cardiomyopathy

59
Q

What are the causes of constrictive endocarditis?

A

Idiopathic
Infectious (TB, ba
Acute pericarditis
Cardiac surgery and radations

60
Q

What are the signs/symptoms of constrictive pericarditis?

A

Similar to restrictive cardiomyopathy
RHF presentation
Kussmaul’s

61
Q

What are the investigations for constrictive pericarditis?

A

CXR - pericardial calcification

Echo - increased pericardial thickness

62
Q

What are the causes of constrictive endocarditis?

A

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

63
Q

What are the causes of myocarditis?

A 
Infectious 
Drugs
Metals
Radiation 
Coxsackie B virus
64
Q

What are the signs and symptoms of myocarditis?

A

Flu-like prdome
Chest pain
SOB
Palp

65
Q

Define myocarditis

A

Inflammation of the myocardium

66
Q

What are the signs and symptoms of myocarditis?

A

Flu-like prodome
Chest pain
SOB
Palpitations

Respiratory Medicine (12 decks)

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