Flashcards in Exam 3, HF, myocarditis, Pales Deck (62):
1
Definition of CHD
syndrome with abnormality of cardiac structure or function is responsible for inability of heart to eject or fill with blood at a rate sufficient to meet demands
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What are the systolic components of HF
myocardial function
preload (EDV)
afterload
HR
3
What are the diastolic components of HF
impaired relaxation
impaired compliance- stiff
4
What is high output failure HF
normal heart function
increased metabolic demand, increased peripheral blood flow from decreased PVR
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What causes systolic HF
inadequate CO/EF
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how do you calculate EF
SV/EDV
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What causes Diastolic HF
inability of ventricles to relax and fill normally with blood during diastole
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What is forward HF
decrease in perfusion of the organs/tissues down-stream from the heart
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What is backward failure
backing up blood into organs upstream, increasing hydrostatic P, leading to congestion/edema
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What is L HF
caused by conditions affecting L ventricle
CAD/ MI
aortic/mitral valve problems
HTN
cardiomyopathies
forward failure Sx in systemic circulation (downstream)
backward Sx in lungs
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What is R HF
caused by conditions primarily affecting R ventricle
pulmonary diseases/ cor pulmonale
tricuspid/ pulmonary valves
pulmonary HTN
pulmonary emboli
backward failure symptoms in systemic circulation
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what is biventricular failure
end result of L and R failure
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What causes acute HF
massive MI, chorda tendinae rupture
Large PE
predominately forward failure
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what causes chronic HF
progresses slowly
exacerbation
predominately backward failure
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What are 3 main causes of HF
L heart
R Heart
High output
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What can cause high output HF
metabolic disorders: thyrotoxicosis
Excessive blood flow: anemia, AV fistula, beriberi
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What are causes of diastolic HF
chronic HTN, Hypertrophic CMP, restrictive CMP, ischemic fibrosis, pericardial diseases
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what are causes of R HF
Cor pulmonale, pulm art HTN
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What are causes of systolic HF
decreased contractility, icn preload, inc afterload, change in HR
20
CAD or MI will lead to what changes in the heart
dilated CM
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how can HTN lead to dilated cardiomyopathy
HTN causes left ventricular Hypertrophy causing diastolic dysfunction and then ventricular dilation so systolic dysfunction
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how does valvular Heart disease lead to dilated CM
regurg, increase EDV, preload, increase worklooad, hypertrophy, dilation, systolic dysfunction
23
What changes occur in heart from infective myocarditis
dilated cardiomyopathy
can be viral, bacerial fungal or helminthic
24
What are types of non-infective myocarditis
toxic: chemo, metals, lithium, malaria, radiation causing inflammation and fibrosis
autoimmune/CTD assoc myocarditis: giant cell myocarditis PM/DM, SLE/RA
25
What are the affects of cocaine on myocardium
may cause vasospasm leading to MI
arrhythmia
myocarditis/cardiomyopathy from released catecholamines
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when can peripartum cardiomyopathy occur
between last mo of pregnancy and first 5 mo after delivery
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What is takosubo cardiomyopathy
stress, apical ballooning or broken heart
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what ar Sx of takotsubo cardiomyopathy
CP, SOB, syncope
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what gene mutations can cause genetic HCM
myosin heavy chains
proteins regulating Ca handling
autosomal dominant
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What type of dysfunction (systolic or diastolic) does HCM cause
diastolic
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what are symptoms and signs of HCM
SOB, chest pain, syncope, arrhythmias
systolic murmur along left sternal border
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What maneuvers increase/decrease systolic murmur along left sternal border
increase with valsalva menuever/upright
decrease with squatting
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What are causes of non-genetic hypertrophic cardiomyopathy
similar to HCM but more generalized thickening with no disproportional involvement of the septum
aortic stenosis-related hypertrophy
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What are Sx of non-genetic hypertrophic CM
diastolic dysfunction: SOB, edema
obstruction: syncrope, chest pain
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what is restrictive cardiomyopathy chracterized by:
impaired filling causing predominately diastolic dysfunction
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what are the infiltrative diseases that cause restrictive cardiomyopathy
amyloidosis
sarcoidosis
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what systemic storage diseases cause restrictive cardiomyopathy
hemochromatosis, glycogen storage diseases
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what fibrotic and endomyocardic conditions can cause restrictive cardiomyopathy
fibrotic: radiation, scleroderma
endomyocardiac: lofflers endocarditis, endomyocardial fibrosis
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What is pulmonary BP usually measured at
20/10
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What are the 4 general categories that can cause pulm HTN
pulm arterial HTN
L heart disease
Cor Pulmonale
Chronic thrombotic/embolic disease
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What drugs are assoc with Pulm HTN
fenfluramine (weight loss)
amphetamines
cocaine
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how can L heart disease lead to pulm HTN
L ventricular failure, increase volumes, increase pressures which increase pulm a P and so hypertrophy and ventricular failure on R side
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What is most common cause of pulm HTN and pathogenesis
cor pulmonale
pulmonary disease leading to HTN and increase RV afterload, RV hypertrophy, RV failure
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What can cause an increase in metabolic demand that does not match with CO
thyrotoxicosis
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What can cause excessive blood flow that overwhelms normal abilities of the pump
anemia, AV fistula
conditions that dec TPR (beri beri, sepsis)
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Clinical manifestations of L sided HF
paroxysmal nocturnal dyspnea
elevated pulm capillary wedge P
pulmonary congestion
restlessness
confusion, orthopnea, tachy, exertional dyspnea, fatigue, cyanosis
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Clinical manifestations of R sided HF
fatigue, increase TPR
ascites
enlarged liver and spleen
may be secondary to chronic pulm problems
distended jugular vv
anorexia and complains of GI distress
weight gain
dependent edema
48
What are Sx of L HF, backward failure
pulmonary edema
SOB, cough, PND, orthopnea, pleural effusion
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what are symptoms of R HF
lower extremity swelling/edema
anasarca/ascitis/pleural and pericardial effusion
could affect lungs too
end organ damage
50
what are Sx of forward failure
L HF usually
hypotenstion
weakness
exercise intolerance
end organ damage
51
What are The New York classes for Heart Failure
I- Sx with more than ordinary actvity
II- Sx with ordinary activity
III- Sx with minimal activity
IIIa- No dyspnea at rest
IIIb- recent dyspnea at rest
IV- Sx at rest
52
What are the Stages of HF according to ACC/AHA
A- high risk HF with no structural heart disease
B- structural Heart disease without Sx or signs of HF
C- structure hear disesase with prior or current Sx of HF
D- Refractory HF requiring specialized intervention
53
What CHF physical findings can be seen in neck region
JVD
hepato-jugular reflux
thyroid enlargement in toxic goiter may be present
54
What PE of CHF patient in lungs
crackles and rales
decrease breath sounds at base
dullness to percussion
tactile fremitus
55
what are heart PE findings in CHF
PMI displaced if LV enlarged
parasternal lift/heave if RV enlarged
arrhythmia common
S1 diminished, P2 accentuated with pulm HTN
S3 with low EF
S4 with diastolic dysfunction
56
What other conditions can lead to increased BNP levels
old age
renal failure
cor pulmonale
pulm HTN
pulm embolism
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What are Kerley B lines on CXR
the whispy looking infiltrate from CHF in lungs
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What infor can an echo give you
size of heart chambers
thickness of walls
contractility
septal defects
valvular structures and their integrity
intracardiac structures
diastolic dysfunction
pulm pressures
59
What drugs improve mortality in CHF
ACEI, ARB, aldosterone antagonists
Beta blockers: metoprolol succinate, carvedilol, bisoprolol
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how do beta blockers work in HF
up regulate beta R improving inotropic and chronotropic responsiveness of myocardium imrpoving contractile function
reduce level of vasoconstrictors
increase contractility
reduce myocardial consumption O2
decrease frequency of PVC and sudden cardaic death
61
what medication combination specifically reduces mortality in african americans
hydralasine and nitrate
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