CDM Heart Disease Exam

Cardiac output equation - Correct Ans-heart rate x stroke volume Define heart failure - Correct Ans-Syndrome where the heart fails to pump enough blood with oxygen and nutrients to tissues. Ejection fraction equation - Correct Ans-stroke volume/ total volume Normal ejection fraction % - Correct Ans-55-70% Heart failure with reduced ejection fraction - Correct Ans-Systolic heart failure - failure of ventricle to pump out blood effectively during systolic contraction Causes of HErEF / systolic heart failure (4) - Correct Ans-MI Hypertension Coronary heart disease Cardiomyopathy Left sided heart failure symptoms (6) - Correct Ans-dyspnoea orthopnoea paroxysmal noctural dyspnoea cough cardiac wheeze Pathophysiology of left sided heart failure - Correct Ans-Congestion in the lungs, causing pulmonary oedem Heart failure with a preserved ejection fraction (HFpEF): define - Correct Ans-Diastolic heart failure - failure of ventricles to fill proverly Causes of heart failure with a preserved ejection fraction / diastolic heart failure (3) - Correct Ans-Hypertension Coronary artery disease Diabetes Pathophysiology of right sided heart failure - Correct Ans-Congestion in the body, causing oedema and raised venous pressure. The fluid is affected by gravity, so will collect in the ankles for a mobile patient, or the sacrum in someone lying flat. Causes of right sided heart failure (2) - Correct Ans-Left sided heart failure Pulmonary hypertension (cor pulmonale) NT-Pro-BNP suggestive of heart failure: value - Correct Ans- 400 Imaging to diagnose heart failure - Correct Ans-Echocardiogram NYHA grading of Heart Failure (4) - Correct Ans-I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnoea (shortness of breath). II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnoea (shortness of breath). III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnoea. IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. Medical management of heart failure (4) - Correct Ans-1 - ACE i.e. lisinopril (can consider ARB) 2 - beta blocker - i.e. bisoprolol 3 - Can add mineralocorticoid receptor i.e. spironolactone if symptoms are not fully controlled. 4 - nitrates - reduce vasoconstriction and therefore afterload Treatment to minimise sudden cardiac death in heart failure and indication - Correct Ans-implanted cardiac defibrillator (ICD) Indicted if ejection fraction is under 35 When is cardiac resynchronisation therapy (CRT) indiacted? - Correct Ans-a prolonged QRS due to a left bundle branch block (LBBB Causes of heart failure (7) - Correct Ans-Causes: Acute coronary syndrome (e.g. myocardial infarction) Tachyarrhythmia (e.g. atrial fibrillation) Pulmonary embolism Severe hypertension Infection Drugs e.g. NSAIDs, steroids Renal insufficiency Warm and dry heart failure - Correct Ans-best prognosis perfused and not congested compensated optimise medications and triggers Warm and wet heart failure - Correct Ans-Most common type perfused but congested Fluid overloaded Give diuretics and vasodilators Cold and dry heart failure - Correct Ans-Least common Poorly profused but not congested Hypovoleamic shock Consider fluid bolus May need inotropes Cold and Wet Heart Failure - Correct Ans-Worst prognosis Poorly profused and congested Cardiogenic shock Consider diurectices if BP 90