Cardio ppt 3 - Exam 6

Question 1

CHF patho?

Answer 1

Heart is unable to pump blood at a sufficient rate for demand of tissues

Final pathway of essentially every significant pathologic cardiac condition

Question 2

How does the heart compensate for demand?

Answer 2

Frank-Starling mechanism

Hypertrophy (remodeling) with or without dilation

Hormonal activation

Question 3

What hormones are activated when the heart is compensating for demand?

Answer 3

Norepinephrine

Renin-Angiotenison- aldosterone

Atrial natriuretic peptide

Question 4

Cardiac Pathologic causes

of CHF?

Answer 4

Hypertension

Myocardial infarction

Valve abnormalities

Ventricle preload or afterload disturbance

Heart rate

Question 5

Non-cardiac high output failure causes of CHF?

Answer 5

Thyrotoxicosis - can cause a catecholamine increase which increase HR and increase demands

Severe anemia

Question 6

CHF prevalence ?

Answer 6

2% of US population

10% of people over age 80

Question 7

Typical labs for dx CHF?

Answer 7

BNP - high indicates HF

CXR - fluid in heart? or crackles?

Echocardiography - how bad is
the HF?

EKG

Question 8

CHF BNP level?

Answer 8

N-terminal pro-BNP

Elevated

Question 9

CHF CBC finding?

Answer 9

anemia

Question 10

CHF BMP finding?

Answer 10

BUN elevated

Creatinine elevated

Potassium - elevated

Sodium - hypoatremia

kidneys gets creamed with CHF

Question 11

CHF LFT finding?

Answer 11

elevated

Hepatojugular reflux

Question 12

Cardiac enzymes CHF findings?

Answer 12

Troponin - elevated

CK-MB - elevated

Question 13

CHF CXR imaging ?

Answer 13

Cardiomegaly

Cephalization - lung marking in apex of lung

Interstitial edema - Kerley B lines - atelectasis

Alveolar Fluid

Bilateral pulmonary effusion

Venous dilation - batwing hilum

Question 14

CHF EKG findings?

Answer 14

LVH

low voltage

arrhythmia

conduction defects

new / old MI

Question 15

CHF Echo findings monitor?

Answer 15

most useful imaging study

monitor ejection fraction - a key diagnostic and prognostic indicator in CHF

Question 16

CHF Echo findings assess?

Answer 16

size and function of chambers

valve abnormalities

pericardial effusion

shunting - inappropriate movement of blood

segemental wall abnormality

Question 17

Other studies for CHF?

Answer 17

Cardiac catheterization - Evaluate atherosclerosis , CO

Stress imaging or radionucleotide angiography - assess cause or severity of disease

TSH

Iron studies - hemochromatosis

Question 18

Stage A Heart Failure ?

Answer 18

high risk of developing CHF

Question 19

Stage B Heart Failure ?

Answer 19

Structural heart disease - evidence ; no symptoms

Question 20

Stage C Heart Failure ?

Answer 20

Structural heart disease w/ symptoms - PND, Dysnpnea on extertion

Question 21

Stage D Heart failure ?

Answer 21

Advanced structural heart disease , symptoms at res

Dyspnea and everything at rest, and even worse with exertion t

Question 22

CHF prognosis

Answer 22

5 year mortality 50%

<5% yearly mortality rate for no symptoms (Stage B)

30% yearly mortality rate for severe symptoms (Stage D)

Question 23

NYHA classification I definition?

Answer 23

No limitation to physical activity

activity does not cause fatigue, dyspnea, anginal pain

Question 24

NYHA classification II definition?

Answer 24

Slight limitation to physical activity

Question 25

NYHA classification III definition?

Answer 25

marked limitation to physical activity

Question 26

NYHA classification IV definition?

Answer 26

symptoms even at rest - unable to engage in physical activity - STAGE D

Question 27

Typical CHF patient treatment?

Answer 27

LABAD lifestyle changes - lose weight Diuretic - Loop - furosemide - often first thing ordered cause the fluid and has most symptomatic relief ACEI - lisinopril BB - metoprolol Aldosterone antagonist - sprinolactione - increase mortality Digoxin - decrease symptoms - ATPase inhibitor , positive inotrope and negative chronotorpic effects

Question 28

Treatments to consider for CHF?

Answer 28

Digoxin Ivabradine Pacemaker - consider at mobitz II and 3rd degree Defibrillator - if EF is less than 30% LVAD - stethoscope will hear no heart beat Heart transplant - option Removing calcium channel blockers - good for HTN not so good for HF - cause some increase in mortality ( amilodipine and now they are developing HF you may want to consider taking them off it ) - long acting nitrates can be used but used for more acute HF presentation - helps with pain - but it mainly helps move fluid from lungs to other areas to help with diuresis - LOOK UP

Question 29

What is more important in patient education with CHF ?

Answer 29

evaluate for reversible causes

Question 30

Lifestyle modifications for CHF?

Answer 30

Progressive aerobic exercise sodium reduction smoking cessation alcohol cessation stress reduction

Question 31

What diuretics do you used for CHF?

Answer 31

Thiazide (better for HTN) or LOOP ( better for CHF) shorter acting they offer symptomatic relief especially for RSHF

Question 32

What is the only effective medication for Diastolic HF?

Answer 32

Diuretic

Question 33

What medications used for CHF decrease mortality?

Answer 33

ACEI or ARB BB

Question 34

What medications used for CHF decrease symptoms?

Answer 34

Digoxin - inotrope

Question 35

Surgery or procedures for CHF patients?

Answer 35

ICD Biventricular Pacemaker

Question 36

When do you consider ICD for CHF patients?

Answer 36

if EF below 35% - percentage when to start to consider it

Question 37

When do you consider a pacemaker for CHF patients?

Answer 37

if QRS is prolonged

Question 38

What is used in severe cases of CHF?

Answer 38

LVAD - left ventricular assist device Intra-aortic balloon pump - counter pulsation - allows more blood flow to the coronaries Heart transplant

Question 39

LCHF patho?

Answer 39

Inadequate pumping or filling of the left ventricle

Question 40

LCHF patho - systolic?

Answer 40

Inadequate pumping causes decreased forward flow and organ perfusion Reduced ejection fraction Ultimately to back up to pulmonary circulation

Question 41

LCHF patho - diastolic?

Answer 41

Inadequate filling Creates back flow to pulmonary circulation

Question 42

LCHF common causes?

Answer 42

Hypertension Ischemic heart disease Aortic or mitral valve disease Primary myocardial diseases

Question 43

LCHF history?

Answer 43

pulmonary issues ``` Dyspnea - exertional Orthopnea PND unproductive cough fatigue exercise intolerance ```

Question 44

LCHF physical exam?

Answer 44

S3 gallop - systolic - S4 gallop - diastolic bibasilar crackles occasional wheezing parasternal lift - heave Large apical impulse Pulse pressure narrow - systolic and diastolic are close together

Question 45

S3 is a ventricular gallop and it is a sign of ________ CHF and LV is __________.

Answer 45

systolic compliant - LV is like a bag

Question 46

S$ is a atrial gallop and it is a sign of __________ CHF and LV is ___-_________.

Answer 46

diastole non-compliant LV - cannot fill

Question 47

RCHF patho?

Answer 47

Abnormal filling or contractility of the right ventricle Leads to systemic back up of venous blood Especially to liver

Question 48

Common causes of RCHF?

Answer 48

LCHF COPD pulmonary HTN

Question 49

History of patient with RCHF?

Answer 49

Peripheral edema - biggest complaint Decreased appetite Nausea Nocturia -when patient lays down at night the fluid is returned to the vasculature system and goes to the kidneys which then try to get rid of it

Question 50

Physical exam on a patient with RCHF you will see what?

Answer 50

JVD - hepatojugular reflux pitting pedal edema variable BP hepatomegaly

Question 51

What medication offers the most symptomatic relief in RCHF patients?

Answer 51

Diuretics - Loop - furosemide