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DMST 283 ECHO 2 > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

What is cardiac arrest?

A

Heart stops beating properly due to electrical disturbances

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2
Q

What is a heart attack?

A

Blockage in or circulation cut off to the coronary arteries

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3
Q

What is heart failure?

A

Heart fails as a pump and cannot meet the O2 demands of the body

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4
Q

In terms of heart failure what is the difference between Systolic and diastolic in terms of EF?

A
  1. Systolic: Reduced EF
  2. Diastolic: Preserved EF
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5
Q

What is the difference between Systolic and diastolic in terms of EF numerically?

A
  1. Systolic: <40%
  2. Diastolic: >55%
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6
Q

What is the difference between systolic and diastolic in terms of contraction and relaxation during failure?

A
  1. Systolic: impaired contraction
  2. Diastolic: Impaired relaxation
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7
Q

How does heart failure happen commonly?

A

Most commonly due to IHD/CAD

(Ischemic heart disease)

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8
Q

How signs send patients into diastolic failure happen commonly?

A

Due to HTN and LVH

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9
Q

In all cases of CHF how many are systolic?

A

60%

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10
Q

How many diastolic failure consist of all CHF?

A

40% with increasing prevalence

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11
Q

What are some things we see during diastolic heart failure?

A
  1. Normal EF
  2. Reduced LV compliance elevated filling pressures
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12
Q

What are some less common things seen with diastolic heart failure?

A
  1. Infiltrative myocardial disease
  2. LVH caused by aortic stenosis
  3. HTN
  4. Advanced age

hila

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13
Q

What causes elevation of Diastolic failure?

A
  1. Elevation of LVEDP
  2. Elevation of LA pressure
  3. Elevation of pulmonary pressures
  4. Elevation of RT heart failure
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14
Q

What is LT CHF due to?

A
  1. Myocardial disease
  2. LT heart valves
  3. CAD
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15
Q

What are RT sided CHF due to?

A
  1. LT heart failure
  2. RT heart valves
  3. Lung Disease
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16
Q

What are two major left heart failure causes?

A
  1. Decreased myocardial function
  2. Increased myocardial workload
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17
Q

What conditions causes decreased myocardial function of the left heart?

A
  1. Coronary artery disease (CAD)
  2. Myocarditis
  3. Cardiomyopathy
  4. Infiltrative diseases
  5. Radiation therapy

rim cc

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18
Q

What causes increased myocardial workload category of left heart failure?

A
  1. Hypertension
  2. Valvular diseases
  3. Severe regurgitation/ stenosis
  4. Increased preload/ after load

his v

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19
Q

What are some symptoms of left sided CHF?

A
  1. The pneas (dyspnea)
  2. Fatigue
  3. Palpitations
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20
Q

What type of fatigue will we see in left sided CHF?

A

Not enough cardiac output +/- poor O2 exchange in lung due to increased pressure

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21
Q

What is the palpitations symptoms in left sided heart failure caused by?

A

Usually due to tachycardia, which is a frequent compensatory mechanism in systolic failure due to increased blood volume

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22
Q

What are some left sided CHF signs?

A
  1. Cardiomegaly
  2. Pulmonary edema
  3. Heart/ lung sounds
  4. Cheyene- stocked respiration
  5. Arrhythmia

cap ch

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23
Q

What is the most common cause of right sided CHF?

A

Left side heart failure

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24
Q

What are right sided CHF causes?

A
  1. Left sided heart failure
  2. Primary lung Disease
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25
Q

What are some types of primary lung disease that affect right sided CHF?

A
  1. Pulmonary hypertension
  2. Chronic obstructive pulmonary disease
  3. Emphysema

pec

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26
Q

What are some RV failure signs?

A
  1. Signs related to underlying disease
  2. Murmur
  3. Wheezing, SOB
  4. Systemic congestion signs
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27
Q

What are some systemic congestion signs in the right heart?

A
  1. Jugular venous pulse
  2. Pitting edema
  3. Ascites
  4. Cynaosis

j cap

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28
Q

What are some RV failure symptoms?

A
  1. Fatigue
  2. Dependent edema
  3. RUQ/LUQ pain
  4. Anorexia or bloating

draf

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29
Q

What is RV fatigue?

A

When CO is reduced, or poor O2 exchange in the lung

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30
Q

Why is there RUQ/LUQ pain in RV failure?

A

Liver/ spleen engorgement

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31
Q

Why can we get RV failure from anorexia or bloating?

A

From hepatic or visceral engorgement

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32
Q

Cor pulmonale = what?

A

Pulmonary heart disease

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33
Q

What is Cor pulmonale?

A

Right sided heart failure secondary to lung conditions such as COPD

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34
Q

What does Cor Pulmonale not include?

A
  1. RT heart failure secondary to LT sided dysfunction
  2. Congenital heart disease
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35
Q

When does the acute pathophysiology of Cor pulmonale occur?
What is an indicator?

A
  1. Occurs after sudden and severe stimulus with RV dilation and failure
  2. No RVH
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36
Q

What are pathophysiology of Cor pulmonale?

A

Chronic: prolonged pressure overload of the RV as it ejects into the high resistance vascular bed
1. RV hypertrophied
2. RV dilation
3. RA enlargement

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37
Q

What is the gold standard for measuring pulmonary pressure?

A

PCWP

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38
Q

What does PCWP stand for?

A

Pulmonary capillary wedge pressure

39
Q

Is PCWP invasive?

A

Yes

40
Q

Why is PCWP better then echo?

A

Echo is non- invasive, but only gives an estimate

41
Q

What are some PWCP ranges? What is PWCP roughly equal?

A

Left atrial pressure
1. 4-12 is normal
2. 12-15mmHg is boarderling
3. LAP >15mmHg PHTN

42
Q

How many classes of CHF?

A

4

43
Q

What is a class 1 CHF?

A

No limitation of physical activity, ordinary physical activity does not cause symptoms

44
Q

What is class 2 CHF?

A

Slight libation of physical activity, comfortable at rest. Ordinary physical activity causes symptoms.

45
Q

What is class 3 CHF?

A
  1. Marked limitation of physical activity.
  2. Comfortable at rest, but less than ordinary activity causes symptoms
46
Q

What is Class 4 CHF?

A
  1. Severe limitation
  2. Discomfort with any physical activity
  3. Symptoms present even at rest
47
Q

What is preload?

A

Volume dependent pressure exerted on the walls of the ventricles by the blood in the at end diastole

EDV or end diastolic volume

48
Q

Which law is related to preload?

A

Frank starling law

49
Q

What conditions cause increased preload states include?

A
  1. Pregnancy
  2. Obesity
  3. Valvular regurgitation
  4. Intracranial shunts
  5. Electrolyte imbalances

Vo pie

50
Q

What is venous return affected by?

A
  1. Blood volume
  2. Venous pressure
  3. Intrathoracic pressure
51
Q

What affects blood volume?

A
  1. Body volume
  2. Pregnancy
  3. Blood loss
52
Q

Intrathoracic pressure is ______________ in a normal adult?

A

Auto regulated

53
Q

What is afterload?

A

Amount of tension the ventricles must generate in order to eject blood

54
Q

Afterload is directly affected by what?

A

Arterial blood pressure

55
Q

High afterload reduces SV but increases what?

A

End systolic volume in the LV

56
Q

What is afterload increased by?

A
  1. High systemic BP = high afterload (LV)
  2. High PA pressure = High afterload (RV)
  3. Aortic stenosis (LV) / Pulmonary stenosis (RV)
  4. Coarctation of the aorta (LV)
57
Q

What is the Cardiac output formula?

A

CO = HR x SV

58
Q

What are some factors that affect Heart rate?

A
  1. Autonomic innvervation
  2. Hormones
  3. Fitness levels
  4. Age

Hafa

59
Q

What are factors affecting stroke volume?

A
  1. Heart size
  2. Fitness levels
  3. Gender
  4. Contractility
  5. Duration of contraction
  6. Preload
  7. Afterload (resistance)
60
Q

What are two CHF pathophysiology?

A
  1. Decreased SV/CO
  2. Compensation
61
Q

What does deceased SV/CO do in terms of CHF pathophysiology?

A
  1. BNP release
  2. BNP lab marker for CHF
62
Q

What is compensation in terms of CHF pathophysiology?

A
  1. Increase HR
  2. Structural changes to increase SV
  3. Renal changes
63
Q

How does compension increase HR?

A

Decreases the time to fill

64
Q

How does structural changes increases SV?

A
  1. DCM&raquo_space;» bigger, but weaker
  2. HCM&raquo_space;» thicker, but stiffer

Dilated cardio myopathy and hypertrophic cardio myopathy

65
Q

What is renal changes in terms of compensation?

A

Kidneys want more blood, so they release hormones which inadvertently lead to salt and water retention

66
Q

What are some treatment options for CHF?

A

Depends upon underlying cause and symptoms but generally
1. Lifestyle
2. Medication
3. Pacemakers, defibrillator, LV assist devices

67
Q

What are some medications for CHF?

A
  1. Diuretics
  2. Inotropic agents
  3. Beta blockers
  4. Anti- arrhythmic
68
Q

What does diuretics do in terms of CHF?

A

Decreases preload and afterload by promoting urination to decrease intravascular volume

69
Q

What does inotropic agents due in terms of CHF?

A
  1. increases contractility, SV
  2. HFrEF pts
70
Q

How does ACE inhibitors affects CHF?

A

Decreases afterload by dilated blood vessels

71
Q

How does beta blockers affect CHF?

A

Decreases HR and contractility by blocking the sympathetic response

72
Q

How does anti-arrhythmic affects CHF? How does each type work?

A
  1. Corrects arrhythmias
  2. Each type works differently
73
Q

PTs with arrhytmias are are also frequently on what in conjunction with anti-arrhytmics?

A

Blood thinners due to high risk of thrombus

74
Q

Most pacemakers have how many wires?

A

two wires

75
Q

______ pacemakers are new technology

A

Leadless

76
Q

Where does the two wires of the pacemaker go?

A

1 lead wire in the RV and one in the RA coronary sinus

77
Q

What is an LV assist device?

A

External control device with internal pump

78
Q

LV assist devices are very helpful for patients with what?

A

Severe LV systolic dysfunction <30% EF

79
Q

What does LV assist devices lower?

A

Lowers LV afterload by pumping some of the forward volume

80
Q

What is the role of echo in CHF?

A

Determination underlying etiology

81
Q

What does echo assess in terms of CHF?

A
  1. Chamber sizes
  2. LV/RV systolic function
  3. Diastolic function and filling pressures
  4. RT sided pressures
  5. Valvular function
  6. Progression of known diseases
82
Q

What happens to the LV Mass during CHF in terms of geometry?

A

Increase in LV mass via hypertrophy

83
Q

What are two results of LV increasing of mass during CHF?

A
  1. Concentric LVH: Result of increased pressure (ex/ HTN)
  2. Eccentric LVH: Result of increased volume (ex/ severe AI)
84
Q

What happens to the size of the heart during CHF?

A
  1. It increases due to dilation of the LA and the LV
  2. The RV and RA may also dilate
85
Q

What is the most common method to assess LA size?

A

LA Volume trace

86
Q

What is the ASE recommended method for assessing LA size?

A

LA volume trace

87
Q

LA length should differ by how much between the views?

A

<5mm

88
Q

What do we use to assess systolic performance?

A

Simpsons biplane EF

89
Q

What can increase preload or afterload significantly

A

Moderate- severe valvular regurgitation or stenosis

90
Q

What can push an unfit or mildly diseased heart into failure?

A

Increased preload or afterload due to moderate- severe valvular regurgitation or stenosis

91
Q

What does HFrEF stand for?

A

Systolic failure

92
Q

What does HFpEF stand for?

A

Diastolic failure

93
Q

What is this an example of?

A

Concentric LVH

94
Q

What is this an example of?

A

Eccentric LVH

DMST 283 ECHO 2 (14 decks)

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