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Clin med cardiology > CHF & Shock > Flashcards

CHF & Shock Flashcards

(55 cards)

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1
Q

What is normal ejection fraction

A

50-70%

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2
Q

What are the main causes of CHF

A

Uncontrolled HTN
CAD / cardiac ischemia
valvular heart disease
arrhythmias
decreased O2
increased demand
cardiomyopathy
pericardial disease
congenital disease

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3
Q

What are the most common causes of CHF in the US

A

uncontrolled HTN (#1)
CAD / Ischemia

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4
Q

What are the models of heart failure

A

hemodynamic
neurohormonal
ventricular

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5
Q

What is the hemodynamic model of CHF

A

Emphasizes the effect of altered load of failing ventricles

*tx focuses on vasodilators and inotropic agents

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6
Q

What is the neurohumoral model of HF

A

activation of RAAS axis
activates sympathetic system
releases cardiac hormones (BNP)

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7
Q

What is ventricular remodeling

A

Mechanical, neurohormonal or genetic alteration in ventricular size, shape, and function

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8
Q

What are examples of ventricular remodeling

A

hypertrophy
loss of myocytes
increase in interstitial fibrosis

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9
Q

What is systolic dysfunction

A

Can’t squeeze -> stretched thin and weakened heart muscle, enlarged chambers

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10
Q

What is diastolic dysfunction

A

cant relax and fill -> stiff and thickened heart wall, smaller ventricle chamber

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11
Q

What are cardiomyopathy pathologies

A

amyloid
sarcoid

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12
Q

What does an increase in aldosterone aid with

A

increasing stroke volume during CO

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13
Q

What does the pituitary glad release when RAAS is activated

A

ADH

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14
Q

What is left sided backward failure

A

When blood backs up into the lungs causing pulmonary congestion

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15
Q

What symptoms may a patient have with left sided backward failure

A

Orthopnea
Dyspnea
coughing up frothy pink sputum
PND
mild-mod JVD
pulm edema

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16
Q

What type of failure is HFrEF

A

Systolic

*Cannot squeeze as much blood out

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17
Q

What type of failure is HFpEF

A

Diastolic

*Cannot relax and accommodate enough blood

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18
Q

What symptoms will a patient have with right sided heart failure

A

pitting edema
severe JVD
Nocturia
hepatomegally
splenogmegally

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19
Q

What criteria is used to diagnose CHF

A

Framingham criteria

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20
Q

What are CHF differential diagnosis

A

Acute renal failure
ARDS
Cirrhosis
Pulmonary fibrosis
nephrotic syndrome
pulmonary embolism

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21
Q

What is seen on a chest xray in someone with CHF

A

Cardiomegaly
pulmonary congestion
pleural effusion

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22
Q

What is cephalization on xray

A

increased prominence of upper lobe vasculature

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23
Q

What are Kerley b lines on xray

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A

edema of interlobar septa

24
Q

What is included on a CHF workup

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A

ECG abnormalities
Echo
Angio
BNP
CXR

25
What type of test is a BNP
Sensitive
26
What are the treatment options for acute and chronic CHF
Diet / lifestyle changes Daily weight monitoring Intensive management regular activity Surgery
27
What are the surgical options for CHF
CABG Valve repair / replacement Heart transplant Device therapy
28
What is the benefit of a CABG in CHF
reduces ischemia
29
What is the treatment of choice if a patient has severe CHF, is <60, has no other life-threatening conditions, and adheres to management recommendations
Heart transplant
30
What are the different device therapy options
ICD CRT Intra-aortic balloon pump LVAD
31
When is an LVAD used
generally awaiting a transplant
32
When is an ICD used in HF
Sustained VT or vfib persistent symptoms and LVEF<30%
33
When are CRT devices used in HF
HFrEF (<35%) wide QRS LBBB
34
What are the goals of treatment in chronic CHF
improve symptom management decrease hospitalizations decrease mortality associate w/ disease
35
What is the first step in chronic CHF treatment
correct reversible causes
36
What can you give a patient queen an RAAS is contraindicated
hydralazine + a nitrate
37
What medication combo will be prescribed to patients in HF
Diuretic RAAS Beta blocker
38
What kind of drug is ivabradine
inhibits SA node so the heart can pump more effectively
39
Which medications help reduce mortality in patients with HFrEF
Beta blockers ACEi Spironolactone Hydralazine (w/ nitrate)
40
Where is fluid located in cariogenic pulmonary edema
Interstitial space of the lungs
41
What are causes of non-cariogenic pulmonary edema
Damage to aveoli increased capillary permeability sepsis low oncotic pressure
42
How does low oncotic pressure cause pulmonary edema
there is not enough protein due to not making enough (Liver failure) or losing it too quickly (nephrotic syndrome)
43
How does sepsis cause pulmonary edema
there is systemic inflammation everywhere in the body, leading to extra fluid in all interstitial spaces
44
Why will a patient have dyspnea/orthopnea with pulmonary edema
O2/CO2 gas exchange is difficult because of the interstitial fluid
45
How can pulmonary edema be treated
supplemental O2 treat underlying cause If cardiogenic-> increase contractility and lower systemic BP If inflammatory or oncotic-> treat related illness
46
What is occurring in the body during cariogenic shock
heart cannot pump enough blood/O2 to brain and other vital organs
47
What are the main causes of cariogenic shock
MI HF trauma PE
48
What are signs of cariogenic shock
Low BP weak/irregular pulse
49
Which patients are at increased risk of cariogenic shock
Age Women CAD HF HTN DM obesity sepsis hx of CABG
50
How can you test for cariogenic shock
CXR EKG Cardiac Cath echo
51
What labs can be drawn for cardiogenic shock
ABG lactate renal function
52
What are symptoms of cariogenic shock
Dyspnea cold extremities clammy dizziness confusion LOC decreased urination LE edema
53
What meds can be used in cariogenic shock
antiarrhythmics anticoags inotropes/vasopressors
54
What interventions can be done for cariogenic shock
CABG PCI IABP ECMO PCADS
55
What is supportive treatment for cariogenic shock
dialysis IV fluids ventilator supplemental O2

Clin med cardiology (10 decks)

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