CV Diseases Flashcards
(265 cards)
s/s of LHF
orthopnea
paroxysmal nocturnal dyspnea
pulmonary edema
s/s of RHF
hepatomegaly
JV distension
peripheral edema
MCC of CHF?
ischemia and MI
Pump dysfunction primary etiology of what?
CHF
name 4 elements of CHF etiology:
- pump dysfunction
- decreased contractility
- increased afterload
- increased preload
pump dysfunction leads to
congestion and low perfusion
causes of decreased contractility:
- ischemia/MI
- cardomyopathy
- valvular heart disease
Valvular stenosis causes
pressure overload
valvular regurgitation causes
volume overload
systemic hyptertension causes
increased afterload
increased preload leads to symptoms of
pulmonary vascular congestion
s/s of increased preload include:
dyspnea
orthopnea
paroxysmal nocturnal dyspnea
pulmonary edema
MCC of Right sided HF
left sided HF
the RV may fail secondary to pulmonary disease (COPD) which causes increase in pulmonary vascular resistance, resulting in right sided pressure overload
• Backward congestion symptoms
o Dyspnea , orthopnea, PND
o JV distension ( venous pressure)
o Peripheral pitting edema
signs and symptoms of CHF
• Signs o Tachycardia o S3 (ventricular gallop), S4 (atrial gallop) o Rales o Cardiomegaly o Ascites o Hepatic congestion ( increased CVP) o Systolic dysfunction o Diastolic dysfunction
o Diastolic dysfunction (to ef, edv, etc)
heart unable to dilate/relax; becomes stiff
Preserved EF, normal EDV, ↓ compliance (↑EDP) often secondary to myocardial hypertrophy
o Systolic dysfunction (to EF, EDV, etc.)
Reduced EF, ↑ EDV, ↓ contractility often secondary to ischemia/MI or dilated cardiomyopathy
heart sounds associated with HF
o S3 (ventricular gallop), S4 (atrial gallop)
Diagnostics for HF
- BNP 100-300 (normal ~ 100)
- EKG - evidence of ischemia, chamber enlargement
- CXR - cardiomegaly, pleural effusion/edema
- Echo - systolic and diastolic dysfunction
Treatment for HF (broad goals):
- treat diminished contractility
- treat high preload
- treat high afterload
specific treatment for HF contractility
Amrinone (PDE inhibitor)
Beta agonist - Dopamine
Digoxin
Specific treatment of HF for high afterload
ACE inhibitors or ATR blockers
-reduce afterload and improve survival
Role of digoxin in HF treatment
o Inhibit Na/K ATPase
o BEWARE digoxin toxicity with hypokalemia (with diuretics) , elderly and renal insufficiency
o EKG finding in toxicity
—- PVC’s
—–ST depression ‘ dig effect’
—–Paroxysmal atrial tachycardia with varying block
ABCDE tx of HF
ABCDE
-ACE Inhibitors- reduce afterload -Beta-blockers -Calcium Channel Blockers -Diuretics - Endothelin Receptor Blockers --> decrease pulmonary vascular resistance