Origin Story
What is the leading cause of COPD?
Cigarette Smoking
What is the gold standard for the diagnosis of COPD?
Spirometry w/wo bronchodilation
What are the two main lung diseases that come under the umbrella of COPD?
- Emphysema
- Chronic Bronchitis
What physiological position can help relieve dyspnea in a patient with COPD. Explain how it improves breathing?
The tripod position helps improve chest/ diaphragm expansion, reduces WOB, improves air exchange
What piece of data should be collected and monitored closely every day at home AND in the hospital for poorly controlled CHF patients. (Specially those with marked congestion/fluid overload)
Daily Weights
Describe ALL types of Heart Failure and their respective Ejection Fractions.
HFrEF (reduced): LVEF ≤40% — the systolic dysfunction
HFmrEF (mildly reduced): LVEF 41–49%.
HFpEF (preserved): LVEF ≥50% — a diastolic dysfunction, usually accompanied by other comorbidities (hypertension, obesity, CKD, diabetes)
HFimpEF (improved): >40% — therapy should be continued*
Right-sided HF : Often secondary to L sided failure or lung disease
Persistent/worsening cough, increased mucous production, worsening SOB/DOE
What is the main goal of treatment of hospitalized CHF patients?
Reduce congestion
What receptors does albuterol work on and how does it work?
Beta-2 adrenergic agonist, relaxes airway smooth muscles by stimulating beta-2 receptors, leading to rapid bronchodilation
short acting
What arterial blood gas findings are typically seen in chronic compensated COPD?
Elevated CO2, elevated bicarbonate, and near-normal or slightly low pH.
What are 7 major risk factors for Heart Failure
HTN, CAD, Diabetes, Obesity, Smoking, CKD, Atrial fibrillation
What are the two main diagnostic tests to order if there are concerns for CHF?
NT-proBNP
TTE
What is the role of Macrolides in the treatment of COPD?
antibacterial effects, immuno-modulation and anti-inflammatory effects
What type of medications used to treat CHF may result in potassium retention?
ACE and ARB
What are the 3 drugs approved for smoking cessation?
Nicotine replacement, Bupropion (Wellbutrin) and Varenicline (Chantix)
What are the 3 main components of lung injury in COPD pathophysiology?
Oxidative stress
Chronic inflammation
Protease - antiprotease imbalance
What is Ejection Fraction and Cardiac output? ((100 bonus points if you provide the formulas for each!))
EF is the percentage of blood pumped out of the L ventricle per heart beat (Stroke volume / end diastolic volume).
CO is the total amount of blood pumped into the body in 1 minute (HR x Stroke volume)
Briefly describe all NYHA classes for heart failure
NYHA Class I: no limitation of physical activity;
Class II: slight limitation;
Class III: marked limitation;
Class IV: symptoms at rest and inability to perform physical activity without discomfort.
What are the 4 main groups of medications in GDMT for HF?
ARNI/ACE/ARB, BB, MRA, SGT2
What lab should be monitored daily in patients hospitalized for CHFe receiving IV diuresis?
The potassium!
What are the main components of the Neurohormonal response in CHF pathophysiology?
Neurohormonal response:
↑ Sympathetic tone → increase HR and contractility → further strain
Peripheral vasoconstriction → maintains multi-organ perfusion
↑ RAAS → vasoconstriction + fluid retention → Increase in preload
Ventricular remodeling → preserves wall stress with ventricular dilation
Define FEV, FEV1 and FEV₁/FVC
What are the GOLDS ABE stages? Do they rely on FEV1/FEV?
FEV: Forced Expiratory Volume is the amount of air forcefully exhaled from the lungs during a specified time.
FEV₁ is the amount exhaled in the first second, while written FEV₁/FVC is the ratio of air exhaled in the first second to the total forced vital capacity, used to assess airflow obstruction.
ABE based on mMRC and CAT.
What are the GOLD Stages and their FEV1% equivalents?
GOLD 1:Mild ≥80%
GOLD 2: Moderate 50–79%
GOLD 3: Severe 30–49%
GOLD 4: Very Severe <30%
Name one long-acting muscarinic antagonist (LAMA) and its function
Tiotropium/spiriva: it blocks muscarinic receptors, leading to bronchodilation and reduced mucus secretion.
How does CO₂ retention affect consciousness?
Causes cerebral vasodilation decrease brain perfusion leading to drowsiness, confusion, coma.
Aka CO₂ narcosis.