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PNS/Cardiology > Congestive Heart Failure > Flashcards

Congestive Heart Failure Flashcards

(48 cards)

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1
Q

What is the definition of heart failure?

A

Inability of heart to pump blood sufficiently to meet metabolic needs of body
OR
ability to do so, but with an abnormally high filling pressure (ventricular pressure)

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2
Q

What happens to stroke volume when you increase preload?

A

Increases

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3
Q

What happens to stroke volume when you increase contractility?

A

Increases

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4
Q

What happens to stroke volume when you increase afterload?

A

Decreases

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5
Q

What are the two causes of an increase in ventricular end-diastolic pressure?

A

Increase in diastolic volume

Increase in diastolic stiffness

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6
Q

What causes an increase in end-systolic volume?

A

Increase in afterload

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7
Q

What is the formula for ejection fraction?

A

(EDV-ESV) / EDV = stoke volume / EDV

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8
Q

What are symptoms of left-sided heart failure?

A 
Dyspnea on exertion (DOE)
Shortness of breath (SOB)
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
Fatigue
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9
Q

What are symptoms of right-sided heart failure?

A

Jugular venous distension
Peripheral edema
Hepatomegaly

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10
Q

What are the major etiologies of heart failure?

A 
Coronary heart disease
Hypertension
Cardiomyopathy (dilated, hypertrophic, or infiltrative)
Valvular heart disease
Pericardial disease
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11
Q

What is the common denominator of right sided heart failure?

A

Increase in right ventricular diastolic pressure –> increase in venous pressure –> peripheral edema and passive liver congestion

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12
Q

What is the common denominator of left sided heart failure?

A

Increase in left ventricular diastolic pressure –> increase in pulmonary capillary pressure –> transudation of fluid into lungs

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13
Q

What are causes of stiffening of a ventricle (which then causes increase in ventricular end-diastolic pressure)?

A

Myocyte abnormality (ischemia or hypertrophy)
Fibrosis
Loss of elasticity
Age

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14
Q

What is a normal ejection fraction?

A

> 0.50

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15
Q

What is a poor ejection fraction?

A

<0.30

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16
Q

What are the two categories of heart failure based on systolic function?

A

HFREF (heart failure with reduced ejection fraction)

HRPEF (heart failure with preserved ejection fraction)

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17
Q

Why does abnormal systolic function in HREF lead to increased LV diastolic pressure?

A

Poor contraction –> heart dilates to maintain SV –> increases end diastolic pressure

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18
Q

Why would patients with preserved systolic function in HRPEF have increased LV diastolic pressure?

A

Impaired relaxation or decreased compliance (stiff LV) –> increases end diastolic pressure but no effect on systolic function

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19
Q

What are causes of HFREF?

A

Dilated cardiomyopathy
Myocardial infarction (not enough muscle)
“End stage” hypertension

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20
Q

What are causes of HFPEF?

Study These Flashcards
A

Left ventricular hypertrophy (hypertension, aortic valve stenosis)
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Constrictive pericarditis

21
Q

What lab tests can be used to determine if heart failure and the etiology?

Study These Flashcards
A

Chest x-ray
Echocardiogram
Gated blood pool scan or MUGA (multiple gated acquisition scan)

22
Q

What are 3 different types of cardiomyopathy?

Study These Flashcards
A

Dilated
Hypertrophic
Infiltrative

23
Q

What will you see on an echo for dilated cardiomyopahy?

Study These Flashcards
A

Dilated ventricle, poorly contracting

24
Q

What will you see on an echo for hypertrophic cardiomyopathy?

Study These Flashcards
A

Left ventricular hypertrophy, often asymmetric and vigorously contracting

25
What will you see on an echo for infiltrative cardiopyopathy?
Looks like left ventricular hypertrophy, but is actually just infiltrated by amyloid
26
What are secondary causes of dilated cardiomyopathies?
Alcohol Beriberi Coxsackie, Cocaine Doxorubicin
27
Do the following characteristics increase, decrease, or stay normal in dilated cardiomyopathy? - LV cavity size - Wall thickness - LV contractility
LV cavity size - increased Wall thickness - normal LV contractility - decreased
28
Do the following characteristics increase, decrease, or stay normal in hypertrophic cardiomyopathy? - LV cavity size - Wall thickness - LV contractility
LV cavity size - decreased or normal Wall thickness - increased LV contractility - increased
29
Do the following characteristics increase, decrease, or stay normal in infiltrative cardiomyopathy? - LV cavity size - Wall thickness - LV contractility
LV cavity size - normal Wall thickness - increased LV contractility - decreased or normal
30
What is a gated blood pool scan or MUGA (multiple gated acquisition scan)?
Nuclear labling of read blood cells | Examine radioactivity of amount of blood in cavity at any one time
31
What are the goals of therapy for heart failure?
Treat hemodynamic abnormalities (treat symptoms) | Treat neurohumoral abnormalities (improve long term survival and preventing remodeling)
32
What are the categories of drugs used to treat heart failure?
Diuretics Inotropes Vasodilators (venous and arterial) Neurohumoral antagonists
33
What categories of drugs are used to treat hemodynamic abnormalities (symptoms) of heart failure?
Diuretics Inotropes Vasodilators
34
What categories of drugs are used to treat neurohumoral abnormalities (improve long term survival) of heart failure?
ACE-I ARB Spironolactone Beta-blockers
35
What is the mechanism of action of diuretics?
Decrease sodium and water via kidney --> decreases intravascular volume --> decreases preload --> decreases pulmonary and peripheral congestion (edema) --> decreases symptoms of heart failure
36
What are side effects of diuretics?
``` Overdiuresis Electrolyte disturbances (hypokalemia, hypomagnesemia) ```
37
What is the mechanism of action of inotropic drugs?
Increase availability of intracellular calcium, increasing the force of ventricular contraction
38
What are side effects of inotropic drugs?
Cardiac: arrhythmias, AV block GI: nausea, vomiting Other: yellow vision, gynecomastia
39
What is the mechanism of action of venous vasodilators?
Increase venous capacitance --> blood pools in legs --> decreased venous return to heart --> decreased LV preload --> decreases pulmonary and peripheral congestion (edema) --> decreases symptoms of heart failure
40
What is the mechanism of action of arteriolar vasodilators?
Reduces TPR --> reduces LV afterload
41
What are side effects of venous vasodilators?
Headache Hypotension Tolerance
42
What are side effects of arteriolar vasodilators?
Hypotension | Lupus-like syndrome
43
Describe how neurohormonal response can worsen LV function?
Impaired LV function --> neurohumoral imbalance --> increased systemic vascular resistance --> increased afterload --> further impaired LV function
44
Describe the cycle of ventricular remodeling and heart failure
Reduced cardiac function --> ventricular dilation --> elevated wall stress --> relative myocardial ischemia --> energy depletion --> progressive interstitial fibrosis --> further activation of adrenergic and RAAS --> reduced cardiac function
45
If patient has low EF and signs and symptomas of fluid retention, what drugs should they be given?
Diuretic ACE-I Beta-blocker
46
If patient has low EF and NO signs and symptoms of fluid retention, what drugs should they be given?
ACE-I | Beta blocker
47
If patient has normal EF, what drugs should they be given?
Diuretics, but need to treat the underlying causes like hypertension and coronary disease
48
What lab measurement can indicate heart failure?
BNP | Gets released from ventricle due to stretch of myocytes, so it increases with heart failure

PNS/Cardiology (33 decks)

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