02.12 Heart Failure and Cor Pulmonale Flashcards Preview

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Flashcards in 02.12 Heart Failure and Cor Pulmonale Deck (32):
1

Most common lung disease that causes cor pulmonale

COPD

2

Dilation and hypertrophy of the right ventricle in response to disease of the pulmonary vasculature and or lung parenchyma

Cor pulmonale

3

Clinical manifestations of cor pulmonale

dyspnea, orthopnea, PND, abdominal pain , ascites
Tachypnea, elevated JVP, hepatomegaly, bipedal edema, cyanaosis

4

Most common cause of RV failure

LV failure

5

Right ventricular hypertrophy, right axis deviation
Enlargement of central main pulmonary artery and hilar vessels

Cor pulmonale

6

Impaired ability of the ventricle to fill with blood

Heart failure with preserved ejection fraction

7

Impaired ability to eject blood

Heart failure with reduced ejection fraction

8

Cardinal clinical symptoms of heart failure

Dyspnea and fatigue

9

Cardinal clinical signs of heart failure

Edema and rales

10

Main causes of death in heart failure

Sudden cardiac death (arrythmic death)
Progressive HF

11

According to Framingham Criteria: ____ die within 1 year (28% M, 24% F), while ____ die within 5 years (59% M, 45% F)

30-40%
60-70%

12

Compensatory mechanism for heart failure

Activation of RAAS and adrenergic nervous system
Increased myocardial contractility and vasoconstriction
Release of vasodilating molecules

13

Changes include myocyte hypertrophy, alterations in contractile properties, progressive loss of myocytes, beta-adrenergic desensitization, abnormal myocardial energetics and metabolism, reorganization of the cellular matrix

LV remodeling

14

Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, dyspnea or anginal pain

Class I (NYHA)

15

Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitations, dyspnea or anginal pain

Class II

16

Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain

Class III

17

Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased

Class IV

18

Framingham criteria: ___ major and ___ minor

2, 1

19

Major criteria based according to Framingham

PND
Neck vein distention
Rales
Cardiomegaly
Acute pulmonary edema
S3 gallop
Increased JVP (>16 cm)
Hepato-jugular reflux
Weight loss > 4.5 kg in 5 days

20

Minor Framingham criteria

Bilateral ankle edema
Nocturnal cough
Dyspnea on exertion
Hepatomegaly
Pleural effusion
Decrease in vital capacity
Tachycardia

21

In determining the cause of HF, assess:

Severity, hemodynamic profile, response to therapy

22

Late abdominal signs of HF

Ascites
Jaundice

23

Cardiac manifestations of HF

Cardiomegaly (PMI displaced)
Apex beat > 2.5 cm (LVH)
S3 (ventricular contration)
S4 (atrial contraction)

24

High negative predictive value for detection of HF

ECG

25

Most useful for detection of LV function

2D echo/doppler

26

Provides comprehensive analysis of cardiac anatomy and function
Gold standard for assessment of LV mass and volume
Useful in determining other cardiac causes like amyloidosis and hemosiderosis

MRI

27

Sensitive markers for HF
Useful for prognosis, disease severity, optimal therapy guide

BNP/NT

28

Useful prognostic marker

ST2

29

In exercise testing, peak oxygen uptake of ____ is associated with poor prognosis (indication for transplant)

< 14 ml/kg

30

Preload unloader

Diuretics (furosemide, spironolactone, indapamide)

31

Afterload unloader

Vasodilator (ACE-I, ARBs)

32

Criteria for discharge

24h of stable fluid status, blood pressure, renal function on the oral regimen planned for home
Free of dyspnea or asymptomatic hypotension while at rest and walking on the ward