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CSI > CHF > Flashcards

CHF Flashcards

1
Q

heart failure mostly caused by

A

fluid backing up into lungs–>pulmonary edema/congestion

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2
Q

LV failure: systolic or diastolic

symptoms due to ??

management ??

A

what is the EF? (not CO, can have EF of 10% or 70% in HF)

Symptoms due to low CO and congestion, including dyspnea

Optimal management includes: ACE-I/ARB, BB, aldosterone inhibitors

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3
Q

RV failure

A

most likely due to LV failure

primary RV failure: cor pulmonale

Peripheral congestion, acites, edema

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4
Q

Hi-output failure

A

beri beri: vit def (thiamine)

hyperthyroid

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5
Q

Causes of systolic CHF

A 
Ischemic cardiomyopathy (HA caused dead heart muscle)
HTN (stiffness inc. as afterload inc.)
hypo/hyperthyroid
HIV
ETOH
viral
dilated
cardiotoxins (herceptin, adriamycin?, doxirubicin)
infectious (Chagas)
hemochromatosis
sarcoid (both)
amyloid (both)
valvular
tachycardia-mediated
peri-partum

*important to know bc some causes are reversible

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6
Q

Systolic/Diastolic CHF

A

50/50

originally though HF was just systolic

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7
Q

Causes of diastolic CHF

A 
*HTN*-hypertrophic (dilated and burned out) 
restrictive (amyloidosis)
DM
pericardial disease
aging
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8
Q

Neurohormonal activation

A

Partially responsible for the mechanical changes in HF

Vasopressin (ADH) secretion – promotes water absorption by the kidney

(RAAA): Renin-angiotensin-aldosterone axis: maintains cardiac output (CO) and tissue perfusion

*now use B-blockers, used to be contraindicated

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9
Q

RAAA does what ??

A

stimulates arterial vasoconstriction with angII

expands intravascular volume with Na+ and water retention

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10
Q

important pressure to know

A

LVEDP: left ventr. end diastolic pressure
(preload)

dry or wet?

use surrogate endpoints

if too high will have backup into lungs

about equal to LA pressure (and wedge pressure, same as pulmonary artery diastolic pressure), and further back….jugular pulsations (JVP)

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11
Q

dec. CO

A

inc. SNS–>inc HR, contractility, vasoconstriction–>raise BP–>inc. CO
inc. RAAS–>vasoconstr, inc. circ volume–>inc. venous return (preload)–>inc. CO
inc. ADH–>inc. circ volume–>inc. venous return (preload)–>inc. CO

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12
Q

CHF classification

A

Stages A-D (Duke staging)
A: predisposed (poorly controlled HTN)
B: have LVEDP elev. (EF (more in recording)

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13
Q

Signs/Symptoms/Physical Exam/labs

A

Palpation: diffuse PMI may imply cardiomyopathy

S3/S4: (S3 systolic dysfunction, S4 diastolic dysfunction)

murmurs: mitral regurg-functional MR

HJR: press on liver area, see inc. in JP (hep jug reflex)

JVP
edema

BNP: heart damage from inc. LV wall stress, release naturitic peptide (NP) from atrium helps with diuresis

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14
Q

Assessment of LV function

A

Echo easiest, no radiation

MUGA (chemo pts) best way to grade EF, but don’t do much

angiogram

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15
Q

Pressure-Volume Loops

A

Frank-Starling curve
preload vs. CO

*lasix will reduce preload

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16
Q

Treatment options

A

Target any potentially reversible causes (CAD, tachycardia, ETOH, etc..)

17
Q

When to biopsy

A

acute fulminant myocarditis:

Acute presentation
hemodynamic compromise at initial presentation
new AVB, VT
don’t biopsy 95%, benign

18
Q

worst myocarditis

A

giant cell myocarditis

treatable with chemo
needs to be biopsied

19
Q

px CHF: 5-year mortality

A

50%

20
Q

s/s

A

tachycardia

venous congestion:
right-sided: hepatomeg, ascites, pleural effusion, edema, JVD
left-sided: tachypnea, nasal flaring/grunting, retractions, pulmonary edema

low CO: fatigue, pallor, sweating, cool extremities, poor growth, dizziness, alt. consciousness, syncope

21
Q

CHF etiologies

A

Infectious Myocarditis

Dilated cardiomyopathy

  • ARVD (arrhythmogenic RV dysplasia–>can lead to VT/sudden death)
  • non-compaction (massive trabeculation)- Uals (tx: defibrillator)

Tako-Tsubo (apical ballooning)

  • Stress cardiomyopathy
  • typ. older females, emotional stress–>symp. surge, hyper contrac. of LV base
  • most reversible

Hypertrophic

  • CHF and risk of sudden death (arrhyth, put in defib)
  • obstruc. of blood getting out of LV
  • myomectomy to relieve

Restrictive (amyloid, biopsy, MRI)

Drug-induced and toxic

22
Q

amyloid

A

apple green birefringence on electron microscopy

23
Q

slide 14-16

A

names and classes of meds

24
Q

CHF pt comes into HR: cool/clammy, respiratory distress, edema
what to do:

A

physical assessment most important
EKG: no STEMI
IV lasix
give O2

BP: 200/100
on no meds

get CXR
see cardiomeg, pulm vasc congestion
tachypnic, crackly

to lower BP: amlodipine (CCB), nitro, or metoprolol??
*will not use amlodipine, for long-term prevention
**cannot use B-blocker 1st time in acute compensated heart failure (unless they are on it), once stabilized can use
use nitro drip: venodilator, reduces pulmonary pressure, preload reduction, some drop in afterload

BIPAP
possible foley cath to measure output
troponin, Cr may be elevated

25
Q

stabilized pt goes up to heart unit, how tx??

A

need more info

26
Q

little old lady heart

A

low volume, high pressure
diastolic heart
EF>45%

27
Q

floppy-baggy heart (dilated)

A

high volume, low pressure
systolic heart
EF

28
Q

both hearts will have

A 
SOB (pulmonary congestion) 
elevated LVEDP
JVD
edema (elevated central vein pressures)
BNP elevated (stretch, volume tension, inc. work)
29
Q

how to tell difference btw hearts?

A

get an ECHO! determine EF

if hear S3: systolic

30
Q

FB heart, systolic

A 
ACE inhibs
ARBs
B-blockers: carbetolol, metoprolol XL/succinate
Aldosterone antagonists
*reduce mortality*

symptomatic relief:
*diuretic, large doses lasix
digoxin (reduces hospitalization, does not reduce mortality)
Afr. American: hydralizine combo (reduces mortality)

if EF 120ms: cardiac synchronization therapy

ionotropes: dobutamine (stim. EF), noronone (PDE inhibitors, relax pulm congestion, helps pump)
(do not improve mortality, to get out of acute trouble

31
Q

LOL heart, diastolic failure

A

nothing reduces mortality!

tx BP, DM
some lasix

(remember to determine etiology)

32
Q

ICD

A

under pec, dual-channel device screwed into RV apex, if detects VT will shock

33
Q

Bi-ventricular ICD (CRT)

A

LBBB
right atrial and ventricular lead, LV coronary sinus lead
pacing 100% of the time

34
Q

can’t get pt off balloon pump

A

LVAD implantation

takes place of LV, sucks blood out of LV and pumps to aorta-bridge to transplantation

35
Q

OMM in CHF

A

Lymphatic Pump: fluid mobilization
Diaphragmatic Techniques: abdominal and thoracic
Effluerage: mobilize peripheral fluid
Clavicular releases: promote thoracic duct drainage
CV4: fluid homeostasis and decrease stress
of course: OA, thoracics, lumbar, Chapman pts, fascia

36
Q

Dilated cardiomyopathies

A 
Systolic dysfunction
Eccentric hypertrophy (sarcomeres added in series)

ETOH, beri-beri, coxsackie, chronic cocaine, chagas, doxorubicin, hemachromotosis, sarcoid, peripartum

CHF, S3, systolic regurgitant murmur, cardiomegaly on CXR

Tx: Na+ restriction, ACE-I/ARB, BB, diuretics, digoxin, ICD, OHT
(more)

37
Q

Hypertrophic Cardiomyopathy

A

60-70% inherited as AD (Beta-myosin heavy-chain mutation)
Can be a/w friedrich ataxia
Syncope during exercise and sudden death in athletes due to VT

Tx: cessation of high-intensity athletics
BB, CCB, ICD if high risk
(more)

38
Q

Restrictive/infiltrative cardiomyopathy

A

Sarcoid, amyloid, postradiation fibrosis, Loffler (endocardial fibroelastosis a/w eosinophilic infiltrate), and hemochromotosis (dilated can also occur)

(more)

CSI (75 decks)

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