Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CRRAB I Final > Shortness of Breath - Johns > Flashcards

Shortness of Breath - Johns Flashcards

1
Q

What is Dyspnea?

A

“Abnormally uncomfortable awareness of breathing”

-Can be related to exertion or not related to exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is in the differential for dyspnea on exertion (DOE)?

A
  • CHF
  • Angina (anginal equivalent)
  • Obstructive airway disease
  • Anemia
  • Hypothyroid
  • Metabolic acidosis
  • Anxiety and hyperventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is in the differential for dyspnea not related to exertion?

A

Sudden episodes at rest - pulmonary emboli, pneumothorax, anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is orthopnea?

A

Dyspnea when supine

-CHF, asthma, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is paroxysmal nocturnal dyspnea (PND)?

A

Waking at night short of breath (CHF, COPD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Trepopnea?

A

Dyspnea when lying on side (CHF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pathophysiology of dyspnea?

A
  • Exact mechanisms not known
  • Stimulation of brainstem respiratory centers
  • Receptors:
  • -chemoreceptors
  • -stretch receptors
  • -intrathoracic receptors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do chemoreceptors detect?

A

Peripheral afferents sense:

  • -Inc. PaCO2
  • -Dec. PaO2
  • -Dec. pH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a Grade II/VI holosystolic murmur heard best at the apex that radiates to the axilla?

A

Mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why would someone with CHF have mitral regurgitation?

A

Chronic left ventricular dilation stretches annulus and causes dilation of the valve hole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What symptom does Left heart failure usually cause?

A

Lung edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What symptom does right heart failure usually cause?

A

Extremity edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is CHF?

A

A syndrome of dyspnea on exertion, edema of the lungs or extremities and fluid retention resulting from cardiac dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes left ventricular (LV) failure?

A

Coronary artery disease, valvular heart disease, hypertension, and congenital defects (e.g. ventricular septal defect, patent ductus arteriosus with large shunts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where is cardiogenic shock on the cardiac output curve?

A

Below heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is right ventricular (RV) failure caused by?

A

Most commonly caused by prior LV failure or tricuspid regurgitation.
-Other causes - mitral stenosis, primary pulmonary hypertension, multiple pulmonary emboli, pulmonary valve stenosis, RV infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is High Output Failure?

A

A persistent high CO that eventually results in ventricular dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the cause of high output failure?

A

Anemia, beriberi, thyrotoxicosis, pregnancy and A-V fistulas (from dialysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is an AV fistula?

A

Connection between artery and vein – makes pressure between artery and vein pressure for dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is systolic function?

A

Ventricular contractile function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What causes systolic dysfunction?

A

Coronary artery disease, HTN, dilated congestive cardiomyopathy (viral, alcohol, beta-blockers, Ca blockers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is diastolic function?

A

Prolonged ventricular relaxation time and resistance to filling (ventricular stiffness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What causes diastolic dysfunction?

A

HTN, age related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is BNP?

A

B-type (brain) natriuretic peptide

-Neurohormone secreted from the cardiac ventricles in response to volume expansion and pressure overload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is BNP used for?

A

Differentiates CHF (BNP should be increased due to ventricular stretching) from other causes of dyspnea

26
Q

What are symptoms of left heart failure?

A

Dyspnea, Orthopnea, PND (paroxymal nocturnal dyspnea), Fatigue, Weakness

27
Q

What are symptoms of right heart failure?

A

Fatigue, Weakness, Leg edema, Abdominal fullness

28
Q

What are physical findings of CHF?

A
  • Lung crackles
  • Dullness to percussion of lung bases
  • Elevated JVD
  • Positive hepatojugular reflex
  • S3, mitral insufficiency
  • Ankle edema
  • Hepatomegaly, ascites
29
Q

What is NYHA functional classification Class I?

A

No limitation of physical activity.

30
Q

What is NYHA functional classification Class II?

A

Slight limitation. Comfortable at rest, dyspnea or fatigue with activity.

31
Q

What is NYHA functional classification Class III?

A

Marked limitation with physical activity, comfortable at rest.

32
Q

What is NYHA functional classification Class IV?

A

Symptoms at rest, unable to carry on any physical activity without symptoms

33
Q

How do diagnose CHF with chest x-ray?

A
  • Cardiomegaly
  • Pulmonary venous congestion
  • Pleural effusions
34
Q

How do you diagnose CHF with ECG?

A
  • r/o MI

- Look for a-fib

35
Q

How do you diagnose CHF with ECHO?

A

-Decreased LV function, diastolic dysfunction

36
Q

What are other ways to diagnose CHF?

A
  • Physical Exam

- Stress testing or coronary angiography (if coronary artery disease is suspected!!)

37
Q

What does an irregular rhythm and no p waves indicate on ECG?

A

Atrial fibrillation

38
Q

What happens on an ECG with lateral ischemia?

A

Inverted T waves at Lead I, aVL and V6.

39
Q

What shows ischemia on ECG?

A

ST depression (subendocardial), T wave inversion

40
Q

What shows MI on ECG?

A

ST elevation (transmural)

41
Q

What shows on ECG for old MI?

A

ST elevation with Q waves!!

42
Q

What are the inferior leads?

A

Leads II, III, aVF

43
Q

What is the normal size of the heart on chest X-ray?

A

Less than half or half of the diameter of one lung field

44
Q

What might you see on a CHF X-ray?

A
  • No costophrenic angles
  • Bilateral pleural effusion
  • Increased vasculature of lungs
  • Cardiomegaly
45
Q

What is LV ejection fraction in a normal person?

A

50-60%

46
Q

What might a CHF cardiac echo show?

A

Severe LV dysfunction - ejection fraction 20%

47
Q

What factors determine stroke volume?

A
  • Preload
  • Myocardial contractility
  • Afterload
  • Neurohumoral factors also play a role
  • -> increased catecholamines and Na+ and water cause activation of sympathetic and neurohormonal systems (vicious cycle)
48
Q

What drugs can you use to decrease preload on the heart?

A
  • Diuretics (Furosemide, Ethacrynic Acid)
  • Vasodialators (venoselective - Isosorbide Dinitrate, Nitroglycerine - used for angina!!)
  • -> By themselves these do not increase survival!
49
Q

What drugs can you give to increase myocardial contractility?

A
  1. Digoxin - only commonly used oral med. –> reduces morbidity in patients also on diuretics and ACE inhibitors
  2. Dobutamine - give IV only - used in acute CHF in hospital
50
Q

What drugs can you give to decrease after load in CHF?

A
  1. Arterial vasodilators - Apresoline
  2. ACE inhibitors - dilate arteries and veins - Major Advance! Improves mortality (Captopril, Enalapril)
  3. Angiotensin II receptor blockers - Also reduce mortality (Losartan)
51
Q

What do the drugs that decrease after load in CHF do?

A

Make people LIVE LONGER!

52
Q

What are neurohumeral treatments?

A
  1. Spironolactone

2. Carvedilol

53
Q

What is Spironolactone?

A

Aldosterone antagonist - improves survival in severe CHF

54
Q

What is Carvedilol?

A

Selective beta blocker, decreases catecholamines, improves survival

55
Q

What drug can be used to affect brain natriuretic peptide?

A

Nesiritide (Natrecor)

  • Needs to be infused IV for Stage IV heart failure
  • Improved dyspnea
  • Major side effect of hypotension
  • COST: $380/day
56
Q

What about patients with diastolic dysfunction? What is contraindicated?

A

Diuretics & vasodilators

-Patients do not tolerate decrease in plasma volume or BP

57
Q

What are of value for patients with diastolic dysfunction?

A

ACE Inhibitors

-Use beta blockers to slow heart and allow more time for ventricular filling!!!

58
Q

What do you think of with leg edema?

A
  • Right sided heart failure
  • Obstruction by clot
  • Pregnancy putting pressure on vena cava
  • Lymphatic tumors
59
Q

What medication should be given with diastolic dysfunction?

A

CHF diastolic dysfunction –> beta blocker!

sometimes ACE inhibitors are valuable

60
Q

Hepatomegaly can be a sign of?

A

Right heart failure

61
Q

Enalapril is:

A

ACE inhibitor –> reduces after load

CRRAB I Final (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions