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Cardiovascular > 04.17 - Heart Failure (Nichols) > Flashcards

04.17 - Heart Failure (Nichols) Flashcards

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1
Q

___ stroke volume is often a threshold of heart failure, when pts begin to have symptoms

A

25% reduction in forward stroke volume

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2
Q

2 causes of Systolic Dysfunction

A

Ischemic heart disease, HTN

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3
Q

2 Symptoms of Right Heart Failure

A

(1) Edema of feet, then ankles, then legs; (2) Abdominal Distention

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4
Q

4 causes of Diastolic Dysfunction

A

Massive LV Hypertrophy, Myocardial Fibrosis, Amyloidosis, Constrictive Pericarditis

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5
Q

4 Left Heart Failure Signs

A

(1) Bibasilar Pulmonary Crackles; (2) Tachycardia; (3) S3; (4) Pedal, ankle, or leg edema

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6
Q

4 Right Heart Failure Signs

A

(1) Pedal, ankle, or leg edema; (2) Jugular Venous Distension; (3) Hepatomegaly; (4) Ascites

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7
Q

4 symptoms of Left Heart Failure

A

(1) Dyspnea on exertion progressing to at rest; (2) Orthopnea; (3) PND; (4) Fatigue

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8
Q

Action of BNP

A

Vasodilation, Increased Urinary Sodium Excretion (Counterregulatory)

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9
Q

Acute Heart Failure patients have what 2 major spectrums

A

Congestion and Perfusion

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10
Q

Ankle and Pretibial edema is a hallmark of

A

Right Heart Failure

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11
Q

Aortic regurgitation causes a heart murmur during

A

Diastole

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12
Q

Aortic Stenosis causes a heart murmur during

A

Systole

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13
Q

Best measure of hypertrophy in volume-overloaded hearts

A

Heart weight, rather than wall thickness

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14
Q

Biochemical sign of shock

A

Elevated Serume Lactate from anaerobic metabolism

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15
Q

Complications of A Fib in left sidede heart failure

A

Reduced stroke volume, thrombosis

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16
Q

Diastolic Dysfunction is inability to

A

Relax and Fill

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17
Q

Diastolic Dysfunction/ HF with Preserved Ejection Fraction + Decompensation =

A

Systolic Dysfunction; HF w Decreased Ejection

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18
Q

Diastolic Heart Failure is aka

A

Heart Failure with Preserved Ejection Fraction

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19
Q

Earliest and most significant symptom of left sided heart failure

A

Dyspnea

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20
Q

Gross morphologic changes in left ventricle due to left sided heart failure dilation (besides hypertrophy)

A

Papillary muscles displace outward –> Mitral regurg (systolic murmur)

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21
Q

HF in which populations may be more commonly attributable to Diastolic Dysfunction

A

Elderly, Women, Diabetics

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22
Q

In left sided heart failure, where does fluid accumulate in lungs

A

Alveoli, Interstitium, Pleura (Effusion)

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23
Q

In most cases of chronic cardiac decompensation, pts present with

A

Biventricular CHF, encompassing the clinical syndromes of both right and left HF

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24
Q

Initial symptom of heart failure is usually only with __ and is ___

A

Exertion, Dyspnea

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25
Is mitral valve regurgitation a cause or effect of heart failure?
Can be either
26
Key morphologic finding in lungs of left sided heart failure
Heart Failure Cells: Hemosiderin-laden Alveolar Macrophages
27
Management of Acute HF should be directed toward a __ profile
Warm and Dry
28
Mitral regurgitation causes a heart murmur during
Systole
29
Mitral stenosis causes a heart murmur during
Diastole
30
Most cases of heart failure are due to ___ dysfunction
Systolic
31
Most common cause of isolated right sided HF
Severe Pulmonary HTN --> Cor Pulmonale
32
Most common causes of left sided cardiac failure
IHD, systemic HTN, Mitral or Aortic Valve disease, primary diseases of myocardium
33
Most common clinical scenario for Heart Failure with Preserved Ejection Fraction
Elderly, Long-standing HTN, Obesity, Concentric LV Hypertrophy
34
Most common type of shock?
Distributive (Septic), then Cardiogenic and Hypovolemic
35
Most heart failure patients have both ___
left and right heart failure
36
Normal central venous pressure range (and average)
2-8 mmHg (6 average)
37
Normal Ejection Fraction Range
50-75% (average 60)
38
Normal LVEDP Range
4-12 (10 average)
39
Normal LVEDV Range
65-240 (120-150 average)
40
Normal LVESV Range
15-145 (average 50)
41
Normal Pulmonary Capillary Pressure
10 mm Hg
42
Normal Stroke Volume
55-100 (70 average)
43
Patients with large MI's do NOT go thru
a phase of diastolic dysfunction, heart failure with preserved ejection fraction
44
Patients with large MI's go straight to
HF w Systolic Dysfunction and Decreased Ejection Fraction
45
Pattern of Hepatic Passive Congestion is referred to as
Nutmeg Liver
46
Peptide elevated in heart failure patients
B-type Natriuretic Peptide
47
Primary microscopic changes in Left Sided Heart Failure
Myocyte hypertrophy with interstitial fibrosis
48
Respiratory symptoms in Right HF?
Very few, unlike left
49
Result of Atrial Natriuretic Peptide release?
Diuresis and Vascular SM relaxation
50
Right sided heart failure is usually the consequence of
Left Sided HF
51
Severe acute uncompensated aortic regurgitation is a
surgical emergency
52
Skin signs of shock
Mottled, Cold, Clammy, Pale, or Cyanotic
53
Structural changes that occur in Pressure Overload State
Concentric Hypertrophy -- Vent thicker w/out increase in size of chamber
54
Structural changes that occur in Volume Overload State
Dilated ventricle; Wall thickness can decrease, stay same, or increase
55
T/F: Morbid obesity can cause heart failure by itself
TRUE
56
Take Home Point: BNP is
Counterregulatory
57
The dx of shock is based on __ signs
Clinical, Hemodynamic, and Biochemial
58
The Pulmonary Capillary Wedge pressure is approx the same as
Left Atrial Pressure and Left Vent End-Diastolic Pressure (LVEDP)
59
Three major things that lead to Diastolic Dysfunction/ HF w Preserved Ejection Fraciton
(1) Compensated HTN Heart Disease; (2) Compensated Hypertrophic Cardiomyopathy; (3) Compensated Restrictive Cardiomyopathy
60
Three windows of clinical shock
Behavior, Skin, Urine
61
Tx for Wet Acute HF
Diuresis
62
Tx for Wet and Cold Acute HF
Vasoactive therapy (vasodilators, inotropes) with Diuresis
63
Type of edema seen in bedridden right HF patients?
Presacral
64
Urine signs of shock
Decreased Output
65
Ventricular dilation comes at expense of
Increased wall tension and amplifies oxygen requirements of myocardium
66
What can cause Pulmonary Edema with normal Pulmonary Capillary Pressure?
Septic Shock
67
What can cause Pulmonary Edeme with low pulmonary capillary pressure?
Hemorrhagic Shock
68
What causes fine rales at lung base in left sided heart failure?
Opening of edematous alveoli
69
What causes Systolic Murmur in left sided HF
Vent Dilation --> Papillary muscles displace outward --> Mitral regurg
70
What increases risk of A Fib in left sided heart failure
Atrial Dilation
71
What is anasarca?
Generalized massive edema
72
What is backward failure?
Increased congestion of the venous circulation
73
What is compensated heart failure?
Increased EDV dilate heart --> Increased stretching --> Increased contraction force --> Increased CO
74
What is decompensated heart failure?
Ventricular dilation comes at expense of increased wall tension --> Amplifies O2 requirements fo mycocardium --> failure muscle eventually can't meet needs of body
75
What is Distributive Shock?
Vasodilation --> Capicitance of vascular system too big for amount of blood availabe
76
What is Obstructive Shock?
PE, Hyperpericardium (Cardiac Tamponade)
77
What type of edema is a hallmark of righ heart failure
Ankle and Pretibial
78
Which comes first: Dyspnea or Transudation of Fluid into lungs?
Dyspnea in case of increaed venous pulmonary pressure
79
Which comes first: Interstitial or Alveolar Pulmonary Edema?
Interstitial (20mmHg), then Alveolar (25mmHg)
80
Why do Left Heart Failure pts have edema?
Decreased renal perfusion, increased sodium retention, increased osmotic pressure then ADH
81
Why do left sided HF patients experience Orthopnea
Supine increases venous return from lower extremities and also elevates diaphragm
82
Worst prognosis type of Acute HF
Cold and Wet (40% mortality)

Cardiovascular (18 decks)

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