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Cardiovascular II Exam 3 > CHF lecture > Flashcards

CHF lecture Flashcards

1
Q

Explain the CHF - RAAS loop.

A
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2
Q

Congestive Heart Failure (CHF) is a _____.

A

Syndrome, not a disease

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3
Q

Syndrome is a______.

A

constellation of signs and symptoms occurring together and characterizing a particular abnormality or condition

The same syndrome may occur with different diseases, which may have distinctly different etiologies and pathogenesis

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4
Q

CHF Clinical Syndrome in which

A

an abnormality of cardiac structure or function is responsible for the inability of the heart to eject or fill with blood at a rate sufficient to meet the demands of the metabolizing tissues.

Pump failure

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5
Q

CHF Epidemiology.

A

Prevalence is 5,000,000 patients

Incidence is 500,000 patients per year

1 million of hospital admissions a year

50,000 death a year

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6
Q

Systolic Heart failure results from

A

inadequate cardiac output (C.O.)/Ejection Fraction (E.F.)

C.O. = S.V. x H.R.

S.V. = E.D.V. – E.S.V.

E.F. = S.V./E.D.V.

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7
Q

Diastolic Heart Failure results from

A

inability of the ventricles to relax and fill normally with blood during diastole.

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8
Q

Forward vs. Backward Heart Failure. Explain?

A

Forward failure is decrease in perfusion of the organs/tissues down-stream from the heart

Backward failure is “backing up” of the blood into the organs upstream, increasing hydrostatic pressure, which leads to congestion/edema

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9
Q

Left ventricle CHF caused by?

A

Caused by conditions primarily affecting left ventricle

CAD/MI

Aortic/Mitral valves problems

HTN

Cardiomyopathies

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10
Q

Forward failure symptoms in left ventriclular CHF

A

Forward failure symptoms are primarily in systemic circulation (downstream)

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11
Q

Backward failure symptoms in left ventricular CHF?

A

symptoms/congestion in the lungs (upstream)

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12
Q

Right ventricle CHF caused by?

A

Caused by conditions primarily affecting right ventricle

Pulmonary diseases/cor pulmonale

Tricuspid/pulmonary valves

Pulmonary Hypertension

Pulmonary emboli

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13
Q

Right ventricle CHF primary effects

A

Backward failure symptoms/congestion in the systemic venous circulation (upstream)

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14
Q

Biventricular Failure is?

A

End result of left and right failure

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15
Q

Acute HF is caused by

A

due to a sudden and severe event

Massive MI

Chorda tendinae rupture

Large PE

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16
Q

Acute HF symptoms?

A

Predominantly forward failure

Flash Pulmonary Edema

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17
Q

Compared to Acute HF, Chronic HF does what?

A

Progresses slowly

Has exacerbation

Predominantly backward failure

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18
Q

Dilated Cardiomyopathy is due to?

A

Due to death or functional ischemic dysfunction of myocardial tissue due to complete or partial blockage of coronary arteries

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19
Q

In Dilated Cardiomyopathy the Degree of dysfunction depends on

A

the percent of myocardium affected

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20
Q

Describe the path of effects in Dilated Cardiomyopathy due to HTN.

A
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21
Q

Describe the path of effects in Dilated Cardiomyopathy due to valvular heart disease.

A
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22
Q

One of the main causes of dilated cardiomyopathy?

A

Infective Myocarditis

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23
Q

etiological agents of Infective Myocarditis

A

Viral

Bacterial

Fungal

Helminthic

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24
Q

In Infective Myocarditis ______ or _______ frequently precedes cardiac symptoms by few weeks.

A

Febrile illness or URI

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25
Non-infective toxic Myocarditis can be caused by?
Chemotherapy Doxorubicin (Adriamycin) Heavy metals (copper, iron, lead) Lithium Malaria drugs Radiation causing inflammation and fibrosis
26
Autoimmune/ CTD associated Myocarditis can be caused by?
Giant Cell Myocarditis PM/DM SLE/RA
27
Cocaine can cause CHF through which mechanisms?
May cause vasospasm leading to MI May cause arrhythmia May cause drug-induced myocarditis/cardiomyopathy due to released catecholamines
28
How can ETOH cause CHF?
Alcoholic Cardiomyopathy From prolonged chronic alcohol use (at least 10 years of chronic exposure) Due to direct toxic effect of alcohol on myocardium
29
When is Peripartum Cardiomyopathy most common?
Between last month of pregnancy and first 5 months after delivery
30
Do patient recover from Peripartum Cardiomyopathy?
More than ½ of patients improve within 6 months
31
Peripartum Cardiomyopathy is due to?
Likely due to immune-mediated process
32
Takotsubo Cardiomyopathy's other names?
A.K.A. Stress cardiomyopathy A.K.A. Apical Ballooning Syndrome A.K.A. Broken Heart Syndrome
33
Takotsubo Cardiomyopathy is caused by?
Triggered by an acute medical illness or by intense emotional or physical stress
34
Takotsubo Cardiomyopathy symptoms?
Symptoms are similar to an acute MI CP, SOB, Syncope,
35
What is Hypertrophic Cardiomyopathy
Myocardial hypertrophy unrelated to any pressure or volume overload
36
Hypertrophic Cardiomyopathy is due to?
Due to different genes mutations Myosin heavy chains Proteins regulating Calcium handling Most are autosomal dominant
37
Which portion of the heart is unproportionally effected in Hypertrophic Cardiomyopathy?
Inter-ventricular septum often disproportionally involved causing sub-aortic stenosis
38
Hypertrophic Cardiomyopathy mostly causes what type of dysfunction?
Mostly causes diastolic, not a systolic dysfunction
39
Symptoms/signs of HOCM
SOB Chest Pain Syncope (often after exercise) Arrhythmias Atrial Fibrillation Ventricular arrhythmias Sudden death Systolic murmur along the left sternal border increases with Valsalva maneuver/upright position decreases with squatting
40
What differences are present in non-genetic, or HTN HOCM?
Similar to HOCM except for more generalized thickening with no disproportional involvement of the septum Aortic stenosis-related hypertrophy
41
Symptoms of HTN HOCM d/t diastolic dysfunction? Obstructive dysfunction? (2 each)
**_Related to diastolic dysfunction_** SOB Edema **_Related to Obstruction_** Syncope Chest Pain
42
Restrictive Cardiomyopathy Characterized by?
impaired filling causing predominantly diastolic dysfunction
43
Restrictive Cardiomyopathy is due to?
* Infiltrative disease * Amyloidosis * Sarcoidosis * Systemic storage diseases * Hemochromatosis * Glycogen Storage Diseases * Metabolic disorders * Fibrotic * Radiation * Scleroderma * Endomyocardiac * Loffler’s endocarditis * Endomyocardial Fibrosis
44
Typical pulmonary pressures?
20/10mmHg
45
Idiopathic Pulmonary Hypertension characteristics
Uncommon (2 cases per million) Females\>males 30-50 is predominant age of onset 12-20% is autosomal dominant genetic disorders with incomplete penentrance Mean survival is 2-3 years from diagnosis
46
Left to right shunting results in PHTN due to which defects?
Ventricular septal defect Patent ductus arteriosus Atrial septal defect Atrioventricular septal defect
47
Drugs-associated Pulmonary HTN
Fenfluramine (weight loss pill) Direct effect on pulmonary vasculature Secondary effect via right sided valvular heart disease Amphetamines Cocaine
48
What is Cor Pulmonale
Heart disease due to lung disease
49
Most common cause of PHTN?
50
Typical origin of pulmonary embolism?
Usually originates from lower extremities
51
Pulmonary Embolism results in?
Results in increase in pulmonary artery pressure therefore increasing after-load for right ventricle May lead to right ventricular failure
52
High Output Failure is?
Increase metabolic demand doesn’t match with cardiac output
53
High Output Failure caused by?
Thyrotoxicosis Anemia AV fistula Conditions decreasing peripheral vascular resistance (Beriberi, sepsis etc)
54
Symptoms of CHF from Backward Left heart failure?
Pulmonary edema SOB, cough (frosty) PND Orthopnea Pleural effusions
55
Symptoms of CHF from Backward right heart failure?
Lower extremity swelling/edema Anasarca/ascitis/pleural and pericardial effusion Could affect lungs as well End organ damage Congestive hepatopathy/nutmeg liver Splenomegaly with hypersplenism Intestinal congestion leading to GI symptoms
56
Symptoms of Forward failure CHF
Mostly in left heart failure Hypotension Weakness Exercise intolerance End organ damage Cardiac ischemia Watershed infarcts Renal failure Bowel ischemia Shock liver
57
New York Heart Association (NYHA) Functional Classification?
Class I: Symptoms with more than ordinary activity Class II: Symptoms with ordinary activity Class III: Symptoms with minimal activity Class IIIa: No dyspnea at rest Class IIIb: Recent dyspnea at rest Class IV: Symptoms at rest
58
Stages of Heart Failure ACC/AHA 2005 Guidelines
59
CHF typical VS
BP may be low in advanced CHF Tachycardia is often present Tachypnea and hypoxia in severe cases
60
CHF. Physical findings. Neck?
Jugular Vein Distention Hepato-jugular (Abdominal-jugular) reflux Thyroid enlargement in toxic goiter may be present
61
CHF. Physical findings. Lungs
Crackles/rales. * Usually bilateral * Bi-basilar The higher you can hear them, the worse CHF is Sometimes decrease breath sounds on bases Dullness on percussion Tactile Fremitus * Decreased in case of bilateral pleural effusion * Increased in case of alveolar/interstitial edema
62
CHF. Physical findings. Heart Palpation
PMI is displaced if LV is enlarged ## Footnote Parasternal lift (heave) if RV is enlarged Arrhythmia is common
63
CHF. Physical findings. Heart Auscultation
S1 may be diminished if LV function is very poor P2 (Pulmonic component of S2 ) may be accentuated when pulmonary hypertension is present. An apical third heart sound (S3) with low EF S4 is usually present with diastolic dysfunction Murmurs may indicate the presence of significant valvular disease as the cause of heart failure or the result of it.
64
Signs of Left Ventricular Hypertrophy
65
Signs of Right Ventricular Hypertrophy
66
Signs of Biventricular Hypertrophy
67
Cor Pulmonale (R.A. hypertrophy + R.V. Hypertrophy)
68
Atrial Fibrillation
69
Ventricular ectopy
70
Brain Natriuretic peptide BNP produced by?
heart cells (ventricles)
71
BNP with ANP (atrial natriuretic peptide, which is produced by atrial cells) released in response to?
increased ventricular/atrial filling pressures
72
Both BNP and ANP have \_\_\_\_, \_\_\_\_\_\_and \_\_\_\_\_\_effect (compensatory effect in response to increase in ventricular filling pressures)
diuretic natriuretic hypotensive
73
Problems with using BNP?
High false positive rates Increased in other conditions Old age Renal failure Cor pulmonale Pulmonary hypertension Pulmonary embolism Doesn’t rule out other causes of dyspnea Chronic elevation in cardiomyopathy doesn’t help with diagnosing exacerbations
74
Heart Failure. CXR findings.
75
Kerley B lines
76
Echocardiogram looks at?
Size of the heart chambers Thickness of the walls Contractility Ejection fraction Wall motion abnormality Septal defects Valvular structures and their integrity Intracardiac structures (clots, tumors) Diastolic dysfunction Pulmonary pressures
77
CHF treatment, meds.
Diuretics ACE inhibitors ARBs Digoxin β − Blockers Aldosterone antagonists Nitrates Hydralazine
78
Which diuretics are used in CHF?
Loop diuretics
79
How do diuretics help in CHF?
Help with “congestion” part of CHF Improvement of symptoms, but not mortality
80
What to watch for when using diuretics in CHF?
May worsen renal function and cause electrolytes abnormalities
81
Why are ACE inhibitors used in CHF?
Decrease after-load ► increase ventricular function Improves symptoms and mortality.
82
Why are ARBs used in CHF?
Decrease after-load Improve symptoms and mortality
83
Why is digoxin used in CHF?
Increases contractility Improves symptoms, decrease hospitalizations
84
What to watch out for with digoxin use?
No effect on mortality May cause arrhythmia Narrow therapeutic index
85
Why are ß blocker used in CHF? Which three are shown to reduce mortality?
Used only with low EF Improves symptoms Prolongs life Started only in stable patients Counter-intuitive treatment Usually decrease contractility and C.O. Only 3 beta-blockers have a proven effect on mortality Metoprolol Succinate Carvedilol Bisoprolol
86
ß blockers in CHF. That doesn't make since. How does it work?
Upregulate beta receptors improving inotropic and chronotropic responsiveness of the myocardium ► improvement in contractile function. Reduce the level of vasoconstrictors ► decreased after-load. Have a beneficial effect on LV remodeling ► improvement in LV geometry ► ^ contractility. Reduce myocardial consumption of oxygen. Decrease the frequency of ventricular premature beats and the incidence of sudden cardiac death (SCD), especially after a myocardial infarction
87
Why are Aldosterone antagonists used in CHF?
Diuretic and a final piece of the renin-angiotensin-aldosterone axis Decreases mortality in severe heart failure
88
Why are nitrates used in CHF?
Decrease preload and somewhat after-load Improve symptoms of acute CHF In combination with hydralasine improve mortality in African-Americans
89
Why is hydralizine used in CHF?
Decrease after-load, because dilates arterioles only.

Cardiovascular II Exam 3 (15 decks)

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