Exam 3, HF, myocarditis, Pales Flashcards Preview

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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

2

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

5

What causes systolic HF

inadequate CO/EF

6

how do you calculate EF

SV/EDV

7

What causes Diastolic HF

inability of ventricles to relax and fill normally with blood during diastole

8

What is forward HF

decrease in perfusion of the organs/tissues down-stream from the heart

9

What is backward failure

backing up blood into organs upstream, increasing hydrostatic P, leading to congestion/edema

10

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

11

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

12

what is biventricular failure

end result of L and R failure

13

What causes acute HF

massive MI, chorda tendinae rupture
Large PE
predominately forward failure

14

what causes chronic HF

progresses slowly
exacerbation
predominately backward failure

15

What are 3 main causes of HF

L heart
R Heart
High output

16

What can cause high output HF

metabolic disorders: thyrotoxicosis
Excessive blood flow: anemia, AV fistula, beriberi

17

What are causes of diastolic HF

chronic HTN, Hypertrophic CMP, restrictive CMP, ischemic fibrosis, pericardial diseases

18

what are causes of R HF

Cor pulmonale, pulm art HTN

19

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

21

how can HTN lead to dilated cardiomyopathy

HTN causes left ventricular Hypertrophy causing diastolic dysfunction and then ventricular dilation so systolic dysfunction

22

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

26

when can peripartum cardiomyopathy occur

between last mo of pregnancy and first 5 mo after delivery

27

What is takosubo cardiomyopathy

stress, apical ballooning or broken heart

28

what ar Sx of takotsubo cardiomyopathy

CP, SOB, syncope

29

what gene mutations can cause genetic HCM

myosin heavy chains
proteins regulating Ca handling
autosomal dominant

30

What type of dysfunction (systolic or diastolic) does HCM cause

diastolic

31

what are symptoms and signs of HCM

SOB, chest pain, syncope, arrhythmias
systolic murmur along left sternal border

32

What maneuvers increase/decrease systolic murmur along left sternal border

increase with valsalva menuever/upright
decrease with squatting

33

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

34

What are Sx of non-genetic hypertrophic CM

diastolic dysfunction: SOB, edema
obstruction: syncrope, chest pain

35

what is restrictive cardiomyopathy chracterized by:

impaired filling causing predominately diastolic dysfunction

36

what are the infiltrative diseases that cause restrictive cardiomyopathy

amyloidosis
sarcoidosis

37

what systemic storage diseases cause restrictive cardiomyopathy

hemochromatosis, glycogen storage diseases

38

what fibrotic and endomyocardic conditions can cause restrictive cardiomyopathy

fibrotic: radiation, scleroderma
endomyocardiac: lofflers endocarditis, endomyocardial fibrosis

39

What is pulmonary BP usually measured at

20/10

40

What are the 4 general categories that can cause pulm HTN

pulm arterial HTN
L heart disease
Cor Pulmonale
Chronic thrombotic/embolic disease

41

What drugs are assoc with Pulm HTN

fenfluramine (weight loss)
amphetamines
cocaine

42

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

43

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

44

What can cause an increase in metabolic demand that does not match with CO

thyrotoxicosis

45

What can cause excessive blood flow that overwhelms normal abilities of the pump

anemia, AV fistula
conditions that dec TPR (beri beri, sepsis)

46

Clinical manifestations of L sided HF

paroxysmal nocturnal dyspnea
elevated pulm capillary wedge P
pulmonary congestion
restlessness
confusion, orthopnea, tachy, exertional dyspnea, fatigue, cyanosis

47

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

49

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

57

What are Kerley B lines on CXR

the whispy looking infiltrate from CHF in lungs

58

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

60

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

62

what do the drugs that decrease mortality in CHF have in common

decrease systolic function/ejection fraction