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Echo 2 > C5: CHF > Flashcards

C5: CHF Flashcards

1
Q

define heart failure

A

a state in which the heart is unable to meet the oxygen and metabolic demands of the body

symptoms may be present in a rest state or w/ exertion

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2
Q

define heart function

A

producing a cardiac output sufficient enough to meet all physiological needs and to generate arterial press sufficient to profuse all organs (under low pressure)

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3
Q

do compensatory mechanisms for heart failure help or hurt?

A

hurt

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4
Q

can we diagnose CHF on echo?

A

no, its diagnosed clinically based on signs and symptoms, we look for cause and grading

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5
Q

1 year mortality rate for severe, moderate and mild CHF

A

S: 50-60%
Mod: 15-30%
Mild: 10%

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6
Q

3 general causes left heart failure

A

diseases of:
the myocardium
valves
coronary arteries

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7
Q

what causes right heart failure

A

Lft heart faliure

diseases of:
the lung parenchyma (COPD, emphysema)
lung vascularity (emboli, HTN)
cor pulmonale

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8
Q

most common cause of right heart failure

A

left heart failure, due to rising pressures, R heart fails b/c it cant handle the high afterload

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9
Q

describe some causes of decreased myocardial function that cause LHF

A

decreased myocardial function - CAD, CMO, myocarditis, infitrative diseases (hemochromatosis, amyloidosis, sarcoidosis), vascular diseases, medicatins, radiation therapy

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10
Q

describe some causes of increased myocardial workload that cause LHF

A

HTN
valvular diseases (severe regurg/stenosis)
increase preload/afterload

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11
Q

does LHF eventually cause RHF

A

yes

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12
Q

2 types of heart faliure

A

systolic/forward HF

diastolic/backwards HF

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13
Q

another term for systolic/forward HF and diastolic/backwards HF

A

S/F: Heart Failure reduced EF (HFrEF)

D/B: Heart Failure normal EF (HFnEF)

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14
Q

which type of HF is reversible to some extent?

A

diastolic…. systolic is not reversible

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15
Q

can LHF be both systolic or diastolic

A

yes, often there is an element of both in one patient

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16
Q

can diastolic HF be isolated? (w/o systolic HF)

A

yes, diastolic HF can be isolated

w/ systolic HF there will ALWAYS be a component of diastolic HF

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17
Q

what is the EF w/ SHF

how will CO be effected

A

<40%

CO will also be decreases

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18
Q

what is the EF w/ DHF

how will CO be effected

A

> 55%

CO will be normal

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19
Q

what causes SHF

what is the most common cause

A

impaired ventricular contraction - most CHF are this type (50-60%)

ischemic heart disease

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20
Q

what causes DHF

what is the most common cause

A

impaired ventricular relaxation
40-50% of CHF cases

HTN and LVH

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21
Q

causes of impaired ventricular relaxation of the LV

A

reduced compliance and possibly LVH….

…infiltrative myocardial disease, LVH by AS, high BP, advanced age

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22
Q

describe the physiology of DHF of the LV

A

reduced compliance of the LV leads to increased LVEDP and LA filling pressures (Gr 2/3 DD), which translates into higher pressure backing up in the PVs , lungs and eventually to the R heart

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23
Q

symptoms of both types of LV CHF

A

dyspnea due to pulm. congestion

orthopnea - diff breathing laying down

parxysmal nocturnal dyspnea - diff breathing at night
acute pulnomary edema
chronic fatigue
palpitations

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24
Q

what is the most common palpitation/arrhythmia to experience w/ CHF

A

afib

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25
signs of both types of LV CHF
cardiomegaly ventricular heave - LV pushes against chest wall 3rd and 4th heart sound rales or crackles when breathing cheyne-stokes respiration - w/ end stage CHF - starting and stopping breathing tachycardia to compensate for low volume output
26
what causes the 3rd and 4th heart sound
3rd - early filling 4th - decreases compliance
27
signs of RHF
``` signs related to underlying disease RV hypertrophy murmur due to pulm. or TV regurg wheezing and SOB elevated jugular venous pulse (JVP) pitting edema, ascites, cyanosis ```
28
symptoms of RHF
``` main symp. related to systemic venous congestion (JVP or leg edema) fatigue when CO is reduced dependent edema liver enlargement/RUQ pain anorexia or bloating ```
29
whats the gold standard for measuring pulmonary pressure what is its downside
pulmonary capillary wedge pressure its invasive, where as echo is not, but we canonly estimate LAP
30
how is pulmonary capillary wedge pressure measures
catheter is inserted into the R heart through the femoral vein or wrist and advanced into the RA, RV, RVOT, PA and then into a smaller pulmonary vessel
31
another term for LAP
PWCP - pulmonary wedge capillary pressure
32
norm LAP an LAP over what value is considered hypertension
3-12 mmHg >18 mmHg
33
NYHA functional CHF categories
Grade I - no symp and no limitations w/ norm activity Grade II - mild symp or some limitations, can engage in low levels of excercise and comfortable at rest Grade III - marked limitations w/ activity but comfortable at rest Grade IV - severe limitations w/ symptoms are rest
34
review pressure/volume loops for SHF and DHF
pg 18 and 19 of PP
35
how does SHF and DHF effect frank starling law
FSL is lost in both SHF and DHF b/c of the lack of compliance
36
what does the term left heart venous return refer to
pulmonary venous return
37
3 things that effect venous return
``` blood volume (obesity, preg, blood loss) venous press (related to volume, venous constriction and temp) intrathoracic press ```
38
does expiration increase or decrease venous return fro the lower extremities
increases
39
how does high after load reduce stroke volume
by increasing the end systolic volume in the LV
40
the parasympathetic nervous sys stimulates which areas of the heart what pathway does it use
SA node and AV node (decreased HR) vagus nerve
41
the sympathetic nervous sys stimulates which areas of the heart what pathway does it use
SA node, AV node and purkinje fibers (increases HR) cardiac fibers/nerves
42
how does the parasympathetic nervous sys slow HR
by moving the resting membrane potential to a more negative state... sympathetic does the opposite
43
what determines HR
steepness of phase 4 slope
44
as BP drops, what happens to HR, contractility and blood vessles
increased HR increased contractility systemic vasoconstriction
45
relationship b/w vasoconstriction and BP
inversely related
46
why do compensatory mechanisms kick in w/ CHF are they helpful
to counter act a drop in EF and BP, they are helpful in the short term but eventually make CHF worse
47
how does sodum and h20 retension effect contractility of the heart
makes it harder for the heart to contract
48
which hormones are released in order to counter act the compensatory mechanisms what are the effects of these hormones
atrial natriuretic peptide B-type natriuretic peptide (tested to see if someone is in CHF) water excresion and vasodilation
49
which specific parameters are we assessing when scanning a patient in CHF
``` underlying etiology chamber sizes and LV/RV mass systolic function diastolic filling press R side heart pressure valve function ```
50
concentric LVH is seen more often with which type of CHF
backward concentric is thick walls, norm chamber size
51
eccentric LVH is seen more often with which type of CHF
fowards eccentric is normal wall thickness, dilated chamber
52
what do we need to determine RAP
IVC sniff test | TR jet
53
how do we find RVSP
4(v)^2 + RAP
54
how can moderate or severe regurg OR stenosis cause heart failure
it alters preload and afterload significant;y which puts stress on the heart
55
treatment for CHF
depends on causes and symptoms lifestyle medication pacemakers
56
goal of medical treatments for CHF
mitigate symptoms to improve quality of life and improve the patients NYHA classification if possible... ... also to balance the effects of the compensatory mechanisms
57
how do diuretics work how do they help w/ CHF
-promote urination to decrease blood volume - decrease preload and afterload - relieves pulmonary congestion/pedal edema - also to treat high BP by decreasing blood volume
58
what are inotropic agents when are they used
improve contractility of the heart used for those w/ reduced EF to increase SV and stimulated viable wall segments to contract
59
will necrotic heart tissue respond to inotropic agents
no
60
examples of inotropic agents
digitalis, digoxin
61
describe ACE inhibitors what is there effect
angiotension converting enzyme blocker -used for arterial and venous vasodilation effects... this drug would increase BP .... look for drugs ending in "pril" (enalopril, captopril)
62
describe beta blockers when would they be used
slow the force of contractions and HR used in patients w/ diastolic HF.... controversial in patients w/ low EF since they can decrease SV futher
63
do beta blockers increase the hearts filling time
yes
64
examples of beta blockers
propranolol, atenolol, metoprolol.... names ending in olol
65
drugs used for arrhythmias
anti-arrhythmias like calcium channel blockers, lidocaine, beta blockers prophylactic anticoagulation for a fib - to reduce risk of clots
66
which arrhythmia is common in CHF describe its effects
a fib, it decreases SV and leads to a risk of clot formation and ventricular arrhythmias.
67
non medical anti-arrhythmic treatments
- pacemakers -biventricular pacing - implantable cardioverter/defibrillators (ICD) - stops v fib and v tachycardia - LV assist device (LVAD) - can be temporary of permanent w/ internal or external pumps
68
LVADs are good for which type of HF
forward/SHF

Echo 2 (15 decks)

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