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Physiology 1 > CHF > Flashcards

CHF Flashcards

1
Q

number of americans with CHF

A
  • 5 million

- most frequent medicare primary discharge diagnosis

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2
Q

prevalence of CHF in AA population

A

25% higher than whites

-greater portion of risk attributable to modifiable factors

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3
Q

CHF stats

A
  • HTN doubles risk
  • pts with NYHA class 4 HF have 50% 1 yr mortality
  • 5 yr survival is 25% in men and 38% in women
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4
Q

pathogenesis of CHF

A
  • MISMATCH BETWEEN OUTPUT AND NEED
  • mismatch could happen because there isnt enough volume in the ventricle (diastolic HF) or the ventricle is unable to overcome the pressure in the system (systolic HF)
    1. myocardial hypertrophy
    2. increased sympathetic activity
    3. fluid retention
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5
Q

pressure overload

A

elevated systolic BP

-forces heart to overcome excess pressure

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6
Q

volume overload

A

increased diastolic volume

-causing dilation of the ventricle

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7
Q

MCC CHF

A
  • diabetes and coronary disease

- HTN and valve disease

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8
Q

myocardial hypertrophy

A
  • heart size increases and the chambers dilate
  • heart muscle stretches: stronger contraction initially
  • excessive elongation of the fibers results in weaker contractions - eventually you pull too far and you can’t generate any tension at all
  • NORMAL MYOCARDIAL CELLS HYPERTROPHY TO MAINTAIN CONTRACTILE FORCE
  • increases myocardial oxygen consumption because muscle is bigger and needs more food
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9
Q

characteristics of hypertrophic myocardium

A
  • slowed contraction time
  • increased time to develop maximum tension
  • delayed relaxation
  • ultimately constricts chamber cells
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10
Q

increased sympathetic activity in CHF

A
  • activation of beta-adrenergic receptors in the heart: increased HR (tachy), greater force of contraction of heart muscle
  • vasoconstriction enhances venous return and increases cardiac output
  • decreased diastolic filling time
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11
Q

RAAS activation in CHF

A
  • decreased CO means the kidneys think blood volume is decreased
  • release renin etc. to retain sodium and water
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12
Q

effect of angio II on the heart

A
  • CARDIOTOXIC!!

- causes cardiac hypertrophy and ventricular remodeling

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13
Q

Vasodilator peptides

A
  • Atrial natriuretic peptide (ANP)
  • Brain natriuretic peptide (BNP): released by dilated heart by stimulation of stretch receptors
  • elevated BNP correlates with more severe HF and poorer prognosis
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14
Q

Effect of ANP and BNP

A
  • diuresis of fluid and sodium
  • decreased vascular resistance
  • decreased renin/angio/aldo
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15
Q

underlying causes of CHF

A
  • myocardial injury: MI, ischemia, cardiomyopathy, myocarditis
  • ischemic heart dz/CAD (DM) causes 75% of all CHF
  • HTN
  • Valvular heart dz
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16
Q

precipitating factors for CHF

A
  • acute infections
  • arrhythmias (tachy, afib, brady, AV block)
  • excess exertion
  • excess Na intake
  • PE
  • anemia (causes tachy)
  • thyrotoxicosis
  • pregnancy
  • cardiac toxins (i.e. alcohol or chemo agents)
  • fluid overload (i.e. IV or transfusion)
17
Q

Systolic failure

A

-failure is at systole where we are supposed to have ejection

Caused by:

  • decreased contractility (i.e. MI, ischemia, infection, myocarditis, other injury); volume overload due to MR, AR
  • pressure overload (i.e. aortic stenosis, uncontrolled HTN)

-decreased ejection fraction measured via ECHO (<0.4)

18
Q

diastolic failure

A
  • ventricle doesnt fill well and this often has to do with compliance of ventricular wall - its stiff and doesnt expand to accept volume (i.e. from scar tissue, obstruction, or concentric hypertrophy)
  • contractility is normal, ejection fraction 55-78%

Caused by:
-ventricular hypertrophy, hypertrophic cardiomyopathy, restrictive cardiomyopathy (fibrosis, scarring), transient ischemia, obstruction of ventricular filling (MS, pericardial constriction [effusion, tamponade])

19
Q

Left heart failure causes and sxs

A
  • onset of injury is abrupt (e.g. acute MI) heart failure may be limited to one side - wont see systemic edema but will have pulmonary edema
  • sxs: pulmonary congestion, orthopnea, exercise intolerance, PND, DOE
20
Q

Right sided heart failure causes and sxs

A
  • causes: cor pulmonale, pulmonary embolus with shunt, COPD (fibrosis and scarring), valvular disease)
  • sxs: peripheral edema, ascites, congestion in liver
21
Q

low output failure

A
  • MOST CASES OF CHF ARE LOW OUTPUT FAILURE associated with VASOCONSTRICTION
  • ex) ischemic heart dz, HTN, dilated cardiomyopathy, valvular dz, pericardial dz
  • sxs: cold, clammy, pale extremities, oliguria, low pulse pressure, wide arterial-venous oxygen difference
22
Q

pulse pressure

A

systolic - diastolic

23
Q

high output failure

A
  • less common, caused by hyperactive circulatory condition
  • ex) anemia (tachy), thyrotoxicosis, pregnancy, paget’s dz of bone, AV fistula
  • VASODILATION (unlike low output failure)
  • sxs: warm, flushed skin, bounding pulse, arterial-venous oxygen difference is normal
  • increased CO
24
Q

Backward failure

A
  • transmission of increased pressure backward

- ex) pulmonary HTN d/t problems with left side of heart

25
Q

forward failure

A
  • inadequate CO
  • ex) altered mental status (decreased cerebral perfusion), fatigue (decreased skeletal muscle perfusion), edema (decreased renal perfusion)
26
Q

CHF diagnostic sxs

A
  • DOE, dyspnea at rest, orthopnea, PND, dry cough

- fatigue/weakness, confusion, nocturia, oliguria, abdominal pain, edema

27
Q

CHF NYHA classification

A
  • 1: heart dz present but no limitation of physical activity
  • 2: slight limitation of physical activity, sxs on significant exertion
  • 3: marked limitation of physical activity; less than ordinary activity leads to sxs
  • 4: sxs at rest
28
Q

CHF findings on PE

A

-dyspnea, hypoxia, JVD (over 4cm above sternal angle w/ pt @ 45 degrees), tachy, S3 gallop, crackles at bases of lungs, hepatomegaly, ascites, edema of feet and ankles, anasarca if severe CHF

29
Q

CHF ECG findings

A
  • sinus tachy
  • atrial enlargement (wide P wave)
  • LVH or RVH may be present
  • LBBB may be present
30
Q

CHF CXR findings

A

-cardiomegaly, upper lung redistribution of flow (cephalization), interstitial fluid, kerley B lines, pleural effusion

31
Q

CHF ECHO findings

A
  • GOLD STANDARD
  • establish type of cardiomyopathy (dilated, restrictive, hypertrophic)
  • identify causes (valvular dz, intracardiac shunts)
  • gives measure of LV EF
32
Q

CHF Laboratory tests

A
  • theres no blood test for HF
  • elevated BNP = good monitoring tool
  • hypoxemia
  • respiratory acidosis
  • hyponatremia
  • elevated liver enzymes
33
Q

BNP

A

B-type natriuretic peptide

  • secreted in response to volume expansion and ventricular pressure overload
  • BNP > 80 SUGGESTS ACUTE HF
  • causes for BNP elevation: PE, lung CA, pulmonary TB
34
Q

Shock

A
  • acute drop in CO
  • imminently life threatening
  • cardiogenic: low output (SBP <90 for 30 mins, adequate volume)
  • Hypovolemic: bleeding
  • Anaphylactic: allergic rxn
  • Septic: infxn
35
Q

causes of cardiogenic shock

A
  • AMI: pump failure

- mechanical defect (VSD, tamponade)

Physiology 1 (6 decks)

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