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Clin med cardiology > CHF & Shock > Flashcards

CHF & Shock Flashcards

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

A

edema of interlobar septa

24
Q

What is included on a CHF workup

A

ECG abnormalities
Echo
Angio
BNP
CXR

25
Q

What type of test is a BNP

A

Sensitive

26
Q

What are the treatment options for acute and chronic CHF

A

Diet / lifestyle changes
Daily weight monitoring
Intensive management
regular activity
Surgery

27
Q

What are the surgical options for CHF

A

CABG
Valve repair / replacement
Heart transplant
Device therapy

28
Q

What is the benefit of a CABG in CHF

A

reduces ischemia

29
Q

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

A

Heart transplant

30
Q

What are the different device therapy options

A

ICD
CRT
Intra-aortic balloon pump
LVAD

31
Q

When is an LVAD used

A

generally awaiting a transplant

32
Q

When is an ICD used in HF

A

Sustained VT or vfib
persistent symptoms and LVEF<30%

33
Q

When are CRT devices used in HF

A

HFrEF (<35%)
wide QRS
LBBB

34
Q

What are the goals of treatment in chronic CHF

A

improve symptom management
decrease hospitalizations

decrease mortality associate w/ disease

35
Q

What is the first step in chronic CHF treatment

A

correct reversible causes

36
Q

What can you give a patient queen an RAAS is contraindicated

A

hydralazine + a nitrate

37
Q

What medication combo will be prescribed to patients in HF

A

Diuretic
RAAS
Beta blocker

38
Q

What kind of drug is ivabradine

A

inhibits SA node so the heart can pump more effectively

39
Q

Which medications help reduce mortality in patients with HFrEF

A

Beta blockers
ACEi
Spironolactone
Hydralazine (w/ nitrate)

40
Q

Where is fluid located in cariogenic pulmonary edema

A

Interstitial space of the lungs

41
Q

What are causes of non-cariogenic pulmonary edema

A

Damage to aveoli
increased capillary permeability
sepsis
low oncotic pressure

42
Q

How does low oncotic pressure cause pulmonary edema

A

there is not enough protein due to not making enough (Liver failure) or losing it too quickly (nephrotic syndrome)

43
Q

How does sepsis cause pulmonary edema

A

there is systemic inflammation everywhere in the body, leading to extra fluid in all interstitial spaces

44
Q

Why will a patient have dyspnea/orthopnea with pulmonary edema

A

O2/CO2 gas exchange is difficult because of the interstitial fluid

45
Q

How can pulmonary edema be treated

A

supplemental O2
treat underlying cause

If cardiogenic-> increase contractility and lower systemic BP

If inflammatory or oncotic-> treat related illness

46
Q

What is occurring in the body during cariogenic shock

A

heart cannot pump enough blood/O2 to brain and other vital organs

47
Q

What are the main causes of cariogenic shock

A

MI
HF
trauma
PE

48
Q

What are signs of cariogenic shock

A

Low BP
weak/irregular pulse

49
Q

Which patients are at increased risk of cariogenic shock

A

Age
Women
CAD
HF
HTN
DM
obesity
sepsis
hx of CABG

50
Q

How can you test for cariogenic shock

A

CXR
EKG
Cardiac Cath
echo

51
Q

What labs can be drawn for cardiogenic shock

A

ABG
lactate
renal function

52
Q

What are symptoms of cariogenic shock

A

Dyspnea
cold extremities
clammy
dizziness
confusion
LOC
decreased urination
LE edema

53
Q

What meds can be used in cariogenic shock

A

antiarrhythmics
anticoags
inotropes/vasopressors

54
Q

What interventions can be done for cariogenic shock

A

CABG
PCI
IABP
ECMO
PCADS

55
Q

What is supportive treatment for cariogenic shock

A

dialysis
IV fluids
ventilator
supplemental O2

Clin med cardiology (10 decks)

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