SOB

Question 1

What is the DDx for the 68 years old gentlemen presented to you with SOB

Answer 1

Cardiac- acute pulmonary Edema secondary to congestive heart failure
Respiratory
Obstructive lung disease such as the acute exacerbation of bronchial asthma and COPD
restrictive lung disease such as pulmonary fibrosis
Others such as pneumothorax, PE and pneumonia.
Liver- decompensated liver failure
Renal- chronic renal failure
Others- anemia

Question 2

Definition of heart failure

Answer 2

Due to structural or functional abnormalities of the heart that result in reduced cardiac output which cause imbalance between the supply and demand

Question 3

How do you classify the heart failure

Answer 3

Can be classify into 3
Heart failure with reduced ejection fraction (<40%)
Heart failure with midrange ejection fraction (40-49%)
Heart failure with preserved ejection fraction (>50%)
This classification is based on echo

Question 4

How do you classify the patient clinically

Answer 4

New HF- new onset of the unknown HF
Chronic HF- already dx HF for sometime
Stable HF- HF without symptoms for more than 1 month
Decompensated- chronic stable HF have symptoms
Congestive HF- HF with congestion either in acute or chronic stage
Advanced HF- chronic and recurrent decompensation, severe cardiac dysfunction HF

Question 5

Symptom of HF

Answer 5

SOB normally is exertional sob
Orthopnea
Paroxysmal nocturnal dyspnea
Reduced effort tolerance
Nocturnal cough with pink frothy sputum
Wheeze (cardiac asthma)
Cold peripheries
Pedal Edema
Ascites

Question 6

For the sob, you must use the NYHA classification. NYHA is to know the severity of heart failure symptoms and exercise tolerance and help to monitor the progress of tx given

Answer 6

Level 1 is normal
level 2 is limited in physical activity
level 3 is limited in ordinary activity
level 4 is symptom at rest

Question 7

What are signs of right sided and left sided heart failure

Answer 7

Right sided- elevated JVP, hepatojugular reflex, parasternal heave due to right ventricle hypertrophy
Left sided- third heart sound, displaces apex beat.
hepatojugular reflex is the distension of neck vein when pressure applied over the abdomen.

Question 8

What is congestive heart failure

Answer 8

When both left and right ventricular failure

Question 9

Causes of heart failure
Systolic and diastolic

Answer 9

Systolic heart failure- inability of ventricle to contract and result in reduce cardiac output
- MI
- ischemic heart disease
- hypertension that cause the heart fatigue
- valvular heart disease like regurgitation that make heart pump harder
- myocarditis and cardiomyopathy.
Diastolic heart failure due to ventricle unable to relax that cause the pressure inside the ventricle so high that filling of blood is reduced
- cardiac temponade
- constrictive pericarditis
- restrictive cardiomyopathy
- hypertension

Question 10

Complication of heart failure

Answer 10

• Arrhythmias cuz the HF will result in hypertrophy that make the heart cannot contract and relax at the same time, result in AF which can result in clot formation and result in stroke
• Secondary regurgitation
• liver dysfunction due to poor hepatic perfusion and congestion
• renal failure due to poor perfusion due to low cardiac output
• hypoxia and lactic acidosis