7. Heart Failure/Cardiomyopathy

Question 1

contributing factors of SV

Answer 1

1. preload
2. afterload
3. contractility

Question 2

contractility is independent of

Answer 2

preload and afterload

Question 3

estimate afterload

Answer 3

MAP
SBP

Question 4

afterload impact on CO

Answer 4

inversely related

Question 5

preload estimateion

Answer 5

LVEDP estimated by PAWP

Question 6

all forms of heart disease have

Answer 6

high ventricular end diastolic pressure

Question 7

does LVEDV increase with LVEDP

Answer 7

not necessarily

Question 8

estimate for LVEDP

Answer 8

PAWP

Question 9

estimate LVEDV

Answer 9

LVEDV ~ CO = HR*SV

Question 10

Cardiac index

Answer 10

CI= CO/BSA

Question 11

normal CI

Answer 11

2.5-4.2L/min/m2

Question 12

Systolic heart failure

Answer 12

decr EF
chronic LV systolic dysfunction

Question 13

systolic HF compensatory mechanism

Answer 13

tachycardia to incr CO

Question 14

diastolic HF

Answer 14

inadequate relaxation of heart
improper filling

Question 15

diastolic HF compensatory mechanism

Answer 15

tachycardia will decr CO

• better to be bradycardic to allow for adequate filling

Question 16

general HF compensatory mechs

Answer 16

decr Vmax
incr afterload
incr sympathetics
incr vascular tone

Question 17

frank starling HF compensation

Answer 17

fluid retention/resuscitation

higher filling pressures needed to achieve similar SV/CO

Question 18

incr afterload causes

Answer 18

heart needs to work harder

Question 19

myocardial remodeling processing

Answer 19

hypertrophy
dilation
wall thining
incr collagen
myocardial fibrosis
scar formation
myocyte death

Question 20

compensatory mechanism for pressure overlad

Answer 20

myocardial hypertrophy

Question 21

myocardial hypertrophy is a _____ state

Answer 21

lower inotropic state

Question 22

compensatory mechanism for fluid overload

Answer 22

dilation

Question 23

most common cause of myocardial remodeling

Answer 23

ischemic injury

Question 24

treatment for myocardial remodeling

Answer 24

ACE inhibitors
aldosterone inhibitors

Question 25

Answer 25

cardiomegaly

Question 26

Answer 26

alveolar edema (pulm venous congestion severity level 3)

Question 27

Answer 27

pulmonary edema

Question 28

Answer 28

pleural effusion

Question 29

Answer 29

pericardial effusion

Question 30

acute HF management

Answer 30

loop diuretics vasodilators - NTG - nipride inotropes - epi/Ne - dobutamine - milrinone BNP balloon pump PVAD

Question 31

balloon pump: systole

Answer 31

deflates suction incr EF

Question 32

balloon pump: diastole

Answer 32

inflates incr CPP

Question 33

causes of RHF

Answer 33

Left ventricular failure pulmonary HTN right heart MI

Question 34

most common cause of RHF

Answer 34

left ventricular failure

Question 35

causes of LHF

Answer 35

left heart MI (LAD) chronic HTN acute HTN crisis aortic/mitral valve disease

Question 36

high output HF

Answer 36

normal cardiac function unable to provide adequate perfusion

Question 37

high output HF diagnostic values

Answer 37

CO > 8L/min CI > 4L/min2

Question 38

causes of high output HF

Answer 38

hyperthyroid sepsis beriberi lung disease arteriole/capillary bypass severe anemia pregnancy

Question 39

HR: 65 BP: 80/45 SVR: 1400 CI: 1.5 PA: 40/20 Treatment?

Answer 39

milrinone - incr inotropy - decr PAP

Question 40

HR: 65 BP: 80/45 SVR: 650 CI: 3.0 PA: 20/10 Treatment?

Answer 40

NE - incr SVR

Question 41

HRL 50 BP: 80/45 SVR: 650 CI: 1.0 PA: 20/10 Treatment?

Answer 41

Epi - incr HR - incr inotropy - incr SVR

Question 42

post heart transplant

Answer 42

immunocompromised need direct acting beta agonists (Phenylephrine) pre-load dependent avoid fluid overload

Question 43

HR: 60 BP: 80/45 SVR: 1200 CR: 1.0 PA: 20/10 Treatment?

Answer 43

dobutamine - incr inotropy

Question 44

hypertrophic cardiomyopathy anatomic changes

Answer 44

septum hypertrophy absence of cardiac disease LVOT

Question 45

factors that worsen LVOT

Answer 45

incr contractility - beta stimulation decr preload - hypovolemia - vasodilators - tachycardia - PPV decr afterload - hypotension - vasodilators PPV

Question 46

factors that improve LVOT

Answer 46

decr contractility - beta blockers - VA - CCB incr preload - hypervolemia - bradycardia incr afterload - HTN - alpha adrenergics

Question 47

goals for HCM

Answer 47

decr LVOT minimize ischemia avoid arrythmias

Question 48

anesthetic managment for HCM

Answer 48

beta blockers CCB euvolemia mx SVR mx sinus avoid contractilioty changes

Question 49

what drugs worsen LVOT

Answer 49

ephedrine dobutamine epi

Question 50

HCM pregnancy management

Answer 50

epidurals hypotension: fluid+phenylephrine labor worsens LVOT

Question 51

dilated cardiomyopathy anatomic changes

Answer 51

LV dilation regional wall abnormalities valvular abnormalities

Question 52

DCM anesthetic management

Answer 52

treat like HF give anticoag regional if not on anticoag

Question 53

peripartum cardiomyopathy treatment

Answer 53

diuretics vasodilators

Question 54

peripartum cardiomyopathy is ______

Answer 54

dilated cardiomyopathy

Question 55

restrictive cardiomyopathy characteristic

Answer 55

severe diastolic dysfunction incr stiffness of myocardium

Question 56

restrictic cardiomyopathy management

Answer 56

sinus avoid bradycardia mx venous return euvolemia ketamine induction avoid PPV

Question 57

cor pulmonale

Answer 57

right ventricular enlargement (hypertrophy and/or dilation) may progress to RHF

Question 58

causes of Cor pulomonale

Answer 58

COPD restrictive lung disease pulm artery HTN

Question 59

cor pulmonale management

Answer 59

euvolemia ABG avoid hypoxia avoid hypercarbia avoid overnarcs