Shortness of Breath Flashcards
What is orthopnea?
Dyspnea when supine. Describe it by how many pillows they need. See with CHF, asthma, COPD
What is Paroxysmal Nocturnal Dyspnea?
Waking up at night short of breath. CHF, COPD
What is trepopnea?
Dyspnea when laying on side. Happens with CHF and he said its probably trivial info
What is pathophys of shortness of breath?
Chemoreceptor, stretch receptor and intrathoracic receptors are stimulated. Otherwise, exact mechanism is uncertain.
What is CHF according to Dr. Johns?
Syndrome of dyspnea on exertion, edema of lungs/extremities and fluid retension from cardiac issues
Left ventricular failure most commonly is from what?
CAD is most common. Also valve issue, hypertension…
What are 5 causes of right sided failure?
Most common is Left failure. Tricuspid regurg, mitral stenosis, infarct, PE can do it too.
What is high output failure? What can cause it?
Persistant high CO results in dysfunction. Anemia, beriberi, thyrotoxicosis, pregnancy, AV fistula
What is systolic dysfucntion?
LV can’t contract well. CAD, hypertension, dilated congestive cardiomyopathy (viral, booze, drugs…)
What is diastolic diysfunction?
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.
What is super helpful for differentiating CHF from other dyspnea causes?
BNP
Which sided of heart failure causes Dyspnea?
L
Which sided of heart failure causes orthopnea?
Left
Which sided of heart failure causes Parodoxysmal Nocturnal Dyspnea?
L (all the dyspneas are L, duh)
Which sided of heart failure causes fatigue?
Left and right
Which sided of heart failure causes weakness?
L and R
Which sided of heart failure causes edema nd abdominal fullness?
R (think about the symptoms have to be upstream of the problem)
Physical findings with CHF?
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
New York Heart Association Functional Classification
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
How do you Dx CHF?
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
Meds for CHF and why you give them:
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)
What is apresoline?
Arterial vasodilator to reduce afterload
What is Losartan?
Angiotensin II receptor blocker to reduce afterload
What is Spironolactone?
Aldosterone antagonist and neurohumeral treatment to improve survival in severe CHF
What is carvedilol?
Selective beta blocker to decrease catecholamines and improve survival
How do you treat diastolic dysfunction?
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.
4 edema mechanisms
More capillary pressure, reduced lymph clearance, decreased oncotic pressure, increased capillary permeability
