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Phase1c Medicine > Shortness of Breath > Flashcards

Shortness of Breath Flashcards

1
Q

What are the three categories for shortness of breath?

A
  1. Not enough oxygen reaching the lungs (Asthma, anaphylaxis, COPD)
  2. Not enough oxygen getting into the blood - V/Q Mismatch
  3. Not enough oxygen reaching the rest of the body (Anaemia, shock).
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2
Q

What are the common causes of a V/Q mismatch?

A

Pulmonary embolism
Pulmonary oedema
Pulmonary fibrosis

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3
Q

What are the four common cardiac causes for shortness of breath?

A

Heart failure
Constrictive pericarditis
Myocarditis
Cardiomyopathy

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4
Q

A pansystolic murmur on auscultation of the right sternal border is suggestive of what pathology?

A

Tricuspid regurgitation

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5
Q

What is the definition of heart failure?

A

The failure of the heart to maintain the cardiac output required to meet the physiological demands

-not enough oxygen reaching the rest of the body

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6
Q

What are the two types of anatomical heart failure?

A

Right and left-sided heart failure

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7
Q

What can are the cardiac complications of left-sided heart failure?

A

Congestive heart failure increased backflow pressure into the pulmonary veins.

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8
Q

What is the definition of a low-output state?

A

The heart fails to pump in response to normal exertion -There is low cardiac output.

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9
Q

What is the definition of a high output state?

A

The cardiac output is normal, however, there is increased metabolic demand (pregnancy, anaemia, hyperthyroidism).

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10
Q

What are the valvular causes of left-sided heart failure?

A

Aortic stenosis
Aortic regurgitation
Mitral regurgitation

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11
Q

What are the muscular causes of left-sided heart failure?

A

Ischaemia (IHD)
Cardiomyopathy
Myocarditis
Arrhythmias (AF)

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12
Q

What are the systemic causes of left-sided heart failure?

A

Hypertension
Amyloidosis
Drugs (cocaine, chemo)

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13
Q

What are the chronic causes of right-sided heart failure?

A

Pulmonary hypertension (Cor Pulmonale)

Pulmonary embolism

Chronic lung disease (interstitial lung disease, cystic fibrosis)

Tricuspid regurgitation
Pulmonary valve disease

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14
Q

What are the causes of high-output heart failure (NAP Meals)?

A 
Nutritional (B1/Thiamine deficiency)
Anaemia
Pregnancy
Malignancy
Endocrine (Hyperthyriodism increases the BMR). 
AV malformations 
Liver cirrhosis 
Sepsis
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15
Q

What are the signs of left-sided heart failure?

A

Fluid accumulates in the lungs - respiratory symptoms

Dyspnoea - Paroxysmal nocturnal dyspnoea (PND) - Episodic at night

Orthopnoea - SOB when lying flat

Exertional dyspnoea

Nocturnal cough (Pink frothy sputum)

Fatigue

Pulsus alternans
Displaced apex beat
S3 gallop
S4 in severe heart failure
Murmur (AS,MR, AR)

Pulmonary oedema - Crackles at lung bases

Wheeze - cardiac asthma

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16
Q

What are the signs of right-sided heart failure?

A

Fluid accumulates in the peripheries - Swelling signs, raised JVP, Dyspnoea, ankle oedema, sacral oedema

Ascites

Hepatomegaly

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17
Q

Which abnormal heart sounds are associated with LHF?

A

S3 ventricular gallop

S4 in severe HF

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18
Q

What are the symptoms of RHF?

A 
Fatigue
Reduced exercise tolerance
Anorexia
Nausea
Nocturia
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19
Q

Which cardiac biomarker is raised in heart failure?

A

NT-pro-BNP

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20
Q

A raised NT-Pro-BNP in a patient with suspected HF, indicates which investigation to confirm the diagnosis?

A

Trans-thoracic echocardiogram (TTE)

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21
Q

What is the diagnostic investigation to confirm heart failure?

A

Trans-thoracic echocardiogram (TTE) coupled with doppler

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22
Q

What does a TTE with doppler visualise?

A

Visualises the structure and function of the heart

Calculates ejection fraction (EF): % of blood present in the left ventricle that gets pumped during systole.

EF = SV/EDV x 100

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23
Q

What is a normal ejection fraction?

A

50-70%

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24
Q

What ejection fraction value is suggestive of reduced ejection fraction heart failure?

A

<40%

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25
Q

What does reduced ejection fraction heart failure suggest?- Systolic

A

Indicates an inability of the ventricle to contract normally

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26
Q

Which value suggests a preserved ejection fraction heart failure? - Diastolic

A

> 50% - indicates an inability of the ventricle to relax and fill normally.

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27
Q

What chest X-ray findings are evident in heart failure?

A 
A: Alveolar odema
B-lines - kerley
Cardiomegaly 
Dilated upper lobe vessels
Diverted upper lobe
Effusion (Transudative pleural effusion).
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28
Q

Which criteria is used for the clinical diagnosis of Heart failure?

A

Framingham Criteria

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29
Q

What are the major symptoms of the Framingham criteria?

A 
Paroxysmal noctural dyspnoea
bibasal crepitations 
S3 gallop
Cardiomegaly 
Increased central venous pressure
Weight loss
Neck vein distension 
Acute pulmonary oedema 
Hepatojugular reflux
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30
Q

What are the minor signs and symptoms of the Framingham criteria?

A 
Bilateral ankle oedema
Dyspnoea 
Tachycardia
Decrease in vital capacity by 1/3
Nocturnal cough
Hepatomegaly 
Pleural effusion
31
Q

Which drugs are used for the treatment of heart failure?

A

ABD
Ace inhibitors
Beta blockers
Diuretics

32
Q

Which ace inhibitors are prescribed for the management of left ventricular dysfunction?

A

Enalipril, perindopril, ramipril

33
Q

Which beta-blockers are indicated in reducing oxygen demand on the heart?

A

Bisoprolol

Carvedilol

34
Q

How do ace inhibitors manage heart failure?

A

Reduce afterload and hypertension - supports left ventricular failure

A low CO , activates the RAS, and sympathetic nervous system which makes HF worse

35
Q

Which beta-blockers are indicated in reducing oxygen demand on the heart?

A

Bisoprolol

Carvedilol

36
Q

How do ace inhibitors manage heart failure?

A

Reduce afterload and hypertension

37
Q

Which diuretics are commonly used in the management of heart failure?

A

Loop diuretics - furosemide

Aldosterone antagonists - Spironolactone

38
Q

What is digoxin?

A

Positive inotrope that improves symptoms not mortality

39
Q

What is the acute management for heat failure?

A 
DMONS
Diuretics
Morphine (IV diamorphine 2.5-5mg) 
Oxygen (60-100%)
Nitrates (GTN infusion) 
Sit-up

IV furosemide 40-80mg

40
Q

Which diuretic and dose is given to a patient with an acute HF?

A

IV furosemide 40-80 mg

41
Q

Once oxygen and the patient is sat upright which drug should be administered in a patient presenting with acute HF?

A

IV diamorphine 2.5-5mg

42
Q

What are the complications of heart failure?

A

Respiratory failure
Renal failure due to hypoperfusion
Acute exacerabtions
Death

43
Q

In cardiomegaly what comment can be made for the cardio-thoracic ratio on a chest radiograph?

A

There is an increased ratio

44
Q

Which lung lobes are diverted in heart failure?

A

Upper lobes

45
Q

What are the two types of cardiomyopathy?

A

Dilated- Dilated ventricle, thin walls, reduced ventricular pressure - systolic

Hypertrophic - Muscle wall hypertrophies inwards, more rigid, obstruction (HOCM) - Diastolic

Restrictive - Same amount of muscle but rigid - does not pump well (Systolic)

46
Q

What is cardiomyopathy?

A

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

-In the absence of CAD

47
Q

What is the pathophysiology of dilated cardiomyopathy?

A

Ventricles enlarge and become dilated

Walls thin and weaken - Cannot contract effectively

Law of Laplace - An increase in radius = reduced ventricular pressure

48
Q

What are the risk factors of dilated cardiomyopathy?

A

Alcohol,
Post viral,
Haemochromatosis,
Genetic

49
Q

What is the presentation of dilated cardiomyopathy

A

Displaced apex beat
Signs and symptoms of heart failure
TR/MR murmur
S3 sound

50
Q

On a CXR, how does dilated cardiomyopathy represent?

A

Globular heart

51
Q

What is the pathophysiology of hypertrophic cardiomyopathy?

A

Thickened myocardium internally

Increased stiffness of the muscle affects pumping

Disrupts electrical conduction and causes arrythmias

HOCUM- Obstructs the outflow of blood

52
Q

What is the familial inheritance pattern for HOCM?

A

Autosomal dominant

53
Q

What is the presentation of HOCM?

A

Sudden cardiac death

Angina, dyspnoea on exertion, palpitations, syncope

54
Q

What are the signs of HOCM?

A

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

55
Q

LVH by voltage criteria?

A

Deep S wave in V1 and V2

Tall R wave in V5/V6

S in V1 + R in V5 or V6 > 7 large squares

56
Q

What are the ECG findings for HOCM?

A

Q waves, left axis deviation, signs of left ventricular hypertrophy

57
Q

What is the pathophysiology of restrictive cardiomyopathy?

A

Ventricles become abnormally rigid and lose flexibility

Impaired ventricular filling during diastole

Reduced preload –> Reduced blood flow + backing up of blood.

58
Q

What are the causes of restrictive cardiomyopathy?

A

Sarcoidosis, amyloidosis
Haemocrhomatosis
Familial
Idiopathic

59
Q

What is constrictive pericarditis?

A

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

60
Q

What are the causes of constrictive pericarditis?

A

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

61
Q

What are the signs and symptoms of constrictive pericarditis?

A

Right heart failure presentation (Raised JVP, oedema)

Kussmaul’s sign

62
Q

What is myocarditis?

A

Inflammation of the myocardium

63
Q

Which virus is associated with myocarditis?

A

Coxsackie B virus

64
Q

What are the signs and symptoms of myocarditis?

A

Flu-like prodrome
Chest pain
SOB
Palpitations

65
Q

What are the diagnostic investigations of myocarditis?

A

Endomyocardial biopsy

66
Q

What are the main causes of valvular disease?

A

Infective endocarditis
Rheumatic fever
Calcification
Myocardial infarction

67
Q

What murmur is associated with tricuspid regurgitation?

A

Pansystolic

68
Q

What murmur is associated with tricuspid stenosis?

A

Mid-late diastolic

69
Q

What mumur is associated with pulmonary regurgtiation?

A

Early diastolic

70
Q

Murmur with aortic regurtitation?

A

Early diastolic

71
Q

Aortic stenosis murmur?

A

Ejection systolic

72
Q

Mitral regurgitation murmur?

A

Pansystolic

73
Q

Mitral stenosis murmur

A

Mid-late diastolic

Phase1c Medicine (11 decks)

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