Shortness of Breath

Question 1

What is orthopnea?

Answer 1

Dyspnea when supine. Describe it by how many pillows they need. See with CHF, asthma, COPD

Question 2

What is Paroxysmal Nocturnal Dyspnea?

Answer 2

Waking up at night short of breath. CHF, COPD

Question 3

What is trepopnea?

Answer 3

Dyspnea when laying on side. Happens with CHF and he said its probably trivial info

Question 4

What is pathophys of shortness of breath?

Answer 4

Chemoreceptor, stretch receptor and intrathoracic receptors are stimulated. Otherwise, exact mechanism is uncertain.

Question 5

What is CHF according to Dr. Johns?

Answer 5

Syndrome of dyspnea on exertion, edema of lungs/extremities and fluid retension from cardiac issues

Question 6

Left ventricular failure most commonly is from what?

Answer 6

CAD is most common. Also valve issue, hypertension…

Question 7

What are 5 causes of right sided failure?

Answer 7

Most common is Left failure. Tricuspid regurg, mitral stenosis, infarct, PE can do it too.

Question 8

What is high output failure? What can cause it?

Answer 8

Persistant high CO results in dysfunction. Anemia, beriberi, thyrotoxicosis, pregnancy, AV fistula

Question 9

What is systolic dysfucntion?

Answer 9

LV can’t contract well. CAD, hypertension, dilated congestive cardiomyopathy (viral, booze, drugs…)

Question 10

What is diastolic diysfunction?

Answer 10

Doesnt fill well, newly described. Turns out things like prolonged ventricular reaction or poor calcium efflux or other things make it so heart wont relax easily.

Question 11

What is super helpful for differentiating CHF from other dyspnea causes?

Answer 11

BNP

Question 12

Which sided of heart failure causes Dyspnea?

Answer 12

L

Question 13

Which sided of heart failure causes orthopnea?

Answer 13

Left

Question 14

Which sided of heart failure causes Parodoxysmal Nocturnal Dyspnea?

Answer 14

L (all the dyspneas are L, duh)

Question 15

Which sided of heart failure causes fatigue?

Answer 15

Left and right

Question 16

Which sided of heart failure causes weakness?

Answer 16

L and R

Question 17

Which sided of heart failure causes edema nd abdominal fullness?

Answer 17

R (think about the symptoms have to be upstream of the problem)

Question 18

Physical findings with CHF?

Answer 18

Duh, stuff with fluid accumulation or appropriate murmurs. Crackles in lungs with dullness of percussion to lung base (effusion), JVD, Hepatojugular Reflex (MORE SPECIFIC than JVD), S3 mitral regurg could be possible, edema, hepatomegaly, ascites

Question 19

New York Heart Association Functional Classification

Answer 19

Class I: no limitation of physical activity.

Class II slight limitation of activity, rest is comfy.

Class III marked limitation with activity, rest is comfy

Class IV: everything sucks especially the Vikings

Question 20

How do you Dx CHF?

Answer 20

Px, CXR (cardiomegaly, pulmonary venous congestion, effusion), ECG to rule out MI, Echo shows decreased function, Stress test or angiograph if CAD is a concern

Question 21

Meds for CHF and why you give them:

Answer 21

Diuretic and venous dilators to reduce PRELOAD

Contractility: beta blockersonly reduces morbidity if on diuretics and ACE in inhibitors

Afterload: ACE inhibitors or Angioreceptor II blockers

Neurohumeral treatment: spironolactone, carvedilol, nesiritide (info about these on other cards)

Question 22

What is apresoline?

Answer 22

Arterial vasodilator to reduce afterload

Question 23

What is Losartan?

Answer 23

Angiotensin II receptor blocker to reduce afterload

Question 24

What is Spironolactone?

Answer 24

Aldosterone antagonist and neurohumeral treatment to improve survival in severe CHF

Question 25

What is carvedilol?

Answer 25

Selective beta blocker to decrease catecholamines and improve survival

Question 26

How do you treat diastolic dysfunction?

Answer 26

Diuretics and vasodilators are contraindicated b/c need volume to fill. Beta blockers are good b/c slow heart and allow more ventricular filling time.

Question 27

4 edema mechanisms

Answer 27

More capillary pressure, reduced lymph clearance, decreased oncotic pressure, increased capillary permeability