small group

Question 1

what are crackles at the base a sign of

Answer 1

heart failure

Question 2

what does “Dullness to percussion 1⁄4 up bilateral lung fields “ mean

Answer 2

Lung is normally resonant • Thickened pleura or fluid in the pleural cavity cause dullness and flatness to percussion • Dullness in the lower lung indicates pleural effusion or thickening, as well as possible elevation of the diaphragm • Dullness in the upper lung would indicate neoplasm, atelectasis, or consolidation

Question 3

what produces the crackle sound

Answer 3

Likely mechanism of crackle generation is sudden airway closing at expiration and sudden reopening at inspiration

Question 4

what does ““Decreased air movement symmetrically in the bilateral bases”” mean

Answer 4

• Decrease in intensity of breath sounds indicates a decrease in ability to move air through the airway or a decrease in the transmission of the sounds • Decrease in ability to move air o Airway disease o Issue with diaphragm o Obstruction • Decrease in transmission of sounds o Pleural effusion o Pleural thickening o pneumothorax

Question 5

treatment for systolic heart failure

Answer 5

Beta-blockers - RAAS system inhibitors (ACE-I, ARBs, Aldosterone block) - Neprilysin Inhibitors - ARNIs - Diuretics

Question 6

treatment for diastolic heart failure

Answer 6

Control fluid overload and pulmonary congestion (diuretics) - Control comorbidities (hypertension, diabetes, arrhythmias)

Question 7

what is the early tx for hf

Answer 7

• Begin supplemental oxygen (if needed) - Identify/manage immediately life-threatening conditions (ex: arrhythmia) - Alleviate symptoms o Often a diuretic + ACE inhibitor with early addition of a beta-blocker (symptomatic systolic heart failure)

Question 8

differential for edema

Answer 8

Question 9

meain effect of ACEI

Answer 9

In patients treated with ACE-inhibitors,there is an improvement in afterload reflected in a reduction in end-systolic volume. There is also a mortality benefit from this therapy as well.

Question 10

what kind of HF is b blocker used for

Answer 10

systolic

Question 11

do loop diuretics help the heart

Answer 11

no just decrease congestion

Question 12

how does aldosterone and RAS blockage help

Answer 12

aldosterone blockage –> spirolactone –> prevents na and water reabsorption through ENAC as well as K and H excretion

RAS blockage reduce vasoconstriction

Question 13

what are the 3 contributions to ventricular filling

Answer 13

1. Early rapid filling
   - Active myocardial relaxation
   - Ventricular elastic properties
2. Diastasis
3. Atrial systole

Question 14

HFpEF is associated with what comorbidities

Answer 14

•Seen mostly in

–Elderly (> 65 yo)

–Females (2:1)

–Those with:

•Hypertension

–60-80% of HFpEFpopulation

–Mostprevalent modifiable risk factor

• Ischemic heart disease
• Diabetes

Question 15

sexual dimorphisms in cardiac function and structure

Answer 15

•LV chamber size and mass initially 15-40% lower in women

–Myocardium loss of 1g/yrin men

–Women protected by effect of estrogen on cell survival

–

•LV structural stress response

–Women - concentric remodeling

–Men - eccentric LV remodeling

•Arterial stiffness occurs with increased age

–Young girls have stiffer vessels than young boys

–Difference lost at puberty

–Age-dependent increase in arterial stiffness is much greater in women after menopause than in age-matched men

Question 16

what does BNP correlate with

Answer 16

LV systolic disfunction

lower in HFpEF (possible with obesity and due to the hypertrophic response tow all stress)