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Test 4 Health Assessment (Mordecai) > Exam 4 Heart Failure Part 2 Ashley > Flashcards

Exam 4 Heart Failure Part 2 Ashley Flashcards

1
Q

What is the mainstay Tx for patients who have acute reduced contractility or cardiogenic shock?

A

Positive Inotropes

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2
Q

Several inotropes increase ____, which increases intracellular ____ and ____

A

cAMP
Ca
excitation-contraction coupling

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3
Q

Catecholamines stimulate ____ receptors on the ____ to activate ____ to increase ____

A

beta
myocardium
adenylyl cyclase
cAMP

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4
Q

PDE inhibitors ____ increase cAMP by inhibiting its degredation

A

indirectly

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5
Q

What is another name for exogenous BNP?
How does it work?

A

Nesiritide

binds to A- and B-type natriuretic receptors –> inhibiting the RAAS –> promotingvasodilation = decreasing LVEDP and improving dyspnea

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6
Q

Nesiritide has not shown advantage over traditional vasodilators such as ____ & ____

A

NTG and SNP

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7
Q

What is indicate for acute HF when medical management fails and organ dysfunction occurs?

A

Urgent mechanical circulatory support

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8
Q

How does intra-aortic balloon pump function?

A

cyclic helium balloon inflation after aortic valve closure, followed by deflation during systole

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9
Q

IABP improves what 2 things?

A

LV coronary perfusion and reduces LVEDP

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10
Q

What is used as the primary mode for placement evaluation of an IABP?

A

TEE and XRAY

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11
Q

IABP degree of support varies based on the ____, ____ and ____

A

set volume, size of the balloon, and ratio of supported beats

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12
Q

IABP only provides ____ improvememnts in CO (____)

A

modest
0.5-1

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13
Q

____ is a VAD that can be placed percutaneously to reduce LV strain and myocardial work in the setting of acute heart failure

A

Impella

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14
Q

How long can impella be used for?
What does it serve as?

A

14 days
transition to recovery or a bridge to a cardiac procedure (CABG, PCI, VAD, transplant)

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15
Q

Impella is also known as what?

A

The world’s smallest heart pump

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16
Q

A peripheral VAD consists of a small pump and controller which is helpful for ____, but it generates ____ causing more ____ and ____

A

transport
heat
hemolysis
lower flows

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17
Q

A central VAD/ECMO has cannulas placed in the ____ and ____
it is invasive and requires ____ or ____ for placement
What are the benefits?

A

RA, aorta
sternotomy, thoracotomy
benefits: complete ventricular decompression, avoidance of limb impairment, and avoidance of SVC syndrome

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18
Q

T/F
Pts on ECMO do not have reduced lung perfusion

A

False
Pts on ECMO likely have reduced lung perfusion as blood bypasses the lungs before returning to the aorta

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19
Q

inahled anesthetics may be signficantly limited by ____ around the lungs

A

functional shunting

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20
Q

What type of anesthetic should be considered for patients on ECMO?

A

TIVA

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21
Q

Since the ECMO membrane is ____, many of our drugs including ____ will become ____ in the circuit

A

lipophilic
fentanyl
sequestered

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22
Q

Once a patient on ECMO is stabilized, what can we do to start weaning?

A

decouple support of the ventricles with two independent circuits to allow for weaning of either the left- or right-sided support

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23
Q

How do separate circuits be achieved with ECMO?

A

percutaneous placement to support the right and left sides separately

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24
Q

What is another alternative method for separating the assistance of the L and R sides of the heart?

A

The right and left sides can be centrally cannulated individually

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25
Q

HF patients are at increased risk for developing what 4 things?

A

Renal failure
sepsis
pneumonia
cardiac arrest

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26
Q

Pre-op, we need to examine whether HF patients are ____ or require ____

A

compensated
treatment

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27
Q

Surgery for HF should be postponed in what 3 scenarios?

A

decompensation
a recent change in clinical status
in de novo acute heart failure

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28
Q

Which medications reduce peri-operative morbidity and mortality?

A

Beta blockers

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29
Q

generally, which type of medications used for HF should be held on the day of the surgery?

A

Diuretics

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30
Q

Because ACE inhibitors increase the risk of HoTN, the AHA guidelines reccommend discontinuing ACE inhibitors before surgery. T/F?

A

False- maintain therapy peri-operatively

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31
Q

TTE is indicated in patients with ____ during their pre-op eval

A

worsening dyspnea

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32
Q

What labs are recommended in HF patients?
Which labs are not routinely recommended?

A

CBC, electrolytes, liver function, and coag studies
BNP is not routinely recommended

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33
Q

Cardiomyopathies have ____ or ____ dysfunction and usually exhibit ventricular ____ or ____

A

mechanical or electrical
hypertrophy or dilation

Slide 43

34
Q

2 groups that cardiomyopathies can be divided into. Define them

A

Primary: confined to the heart muscle
secondary: pathophysiologic cardiac involvement in the context of multiorgan disorder

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35
Q

hypertrophic Cardiomyopathy affects ____ ages and has a prevalence of about ____ per 1,000 people

A

all
2-5

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36
Q

What is the most common genetic cardiovascular disease?

A

Hypertrophic cardiomyopathy

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37
Q

Hypertrophic cardiomyopathy is characterized by ____ in the absence of other diseases capable of inducing ____

A

LVH
ventricular hypertrophy

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38
Q

Hypertrophic cardiomyopathy usually presents with hypertrophy of which portions of the heart?

A

interventricular septum
anterolateral free wall

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39
Q

What are histological features of hypertrophic cardiomyopathy?

A

hypertrophied myocardial cells and patchy myocardial scarring

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40
Q

What are 6 phathophysiological features related to hypertrophic cardiomopathies?

A

myocardial hypertrophy
dynamic LVOT obstruction
mitral regurgitation
diastolic dysfunction
myocardial ischemia
dysrhythmias

Slide 45

41
Q

hypertrophied myocardium has a ____ relaxation time and ____ compliance

A

prolonged
decreased

Slide 45

42
Q

T/F
Myocardial ischemia is present in patients with hypertrophic cardiomyopathy regardless of whether or not they have CAD

A

True

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43
Q

What is the cause of sudden death in HCM?

A

Dysrythmias

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44
Q

What causes dysrhythmias in HCM?

A

disorganized cellular architecture, myocardial scarring, and an expanded interstitial matrix

Slide 45

45
Q

If patients with HCM are asymptomatic, what may be the only sign?

A

LVH

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46
Q

HCM patients have ____ seen in 75-90% of them.

A

EKG abnormalities

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47
Q

HCM
wall thickness in Echo is ____
EF is ____ reflecting ____, except in patients in ____ states where EF is ____

A

>15mm
>80%
hypercontractility
Terminal, severely depressed

Slide 46

48
Q

How can we directly measure LVEDP??

A

Cardiac Catheterization

Slide 46

49
Q

The initial medical therapy for HCM is ____ and ____. If patients develop HF despite management with these meds, they may show improvement with ____

A

BB and CCB
diuretics

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50
Q

after giving BB, CCB, and diuretics, patients who have HCM may consider ____ as an add-on therapy.
it has ____ intotropic effects which improves ____ obstruction and heart failure symptoms

A

Disopyramide
negative
LVOT

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51
Q

what common dysrhthmia develops with HCM?

A

A-fib

Slide 47

52
Q

This subgroup of patients in HCM can be treated with surgery

A

HCM with Large outflow tract gradients and severe symptoms despite treatment

Slide 48

53
Q

What are the 3 surgical strategies for HCM?

A

septal myomectomy
cardiac cath w/injection to induce ischemia of the septal perforator arteries
echocardiogram-guided percutaneous septal ablation

Slide 48

54
Q

Dilated Cardiomyopthy is a PRIMARY myocardial disease characterized by what 5 abnormalities?

A

LV or biventricular dilatation
biatrial dilation
decreased ventricular wall thickness
systolic dysfunction w/o abnormal loading conditions
CAD

Slide 49

55
Q

What is the initial symptom of dilated cardiomyopathy (DCM)?

A

HF, chest pain may also occur

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56
Q

DCM

What leads to mitral or tricuspid regurg?

A

ventricular dilation

Slide 49

57
Q

What is common with DCM?

A

dysrhythmias, conduction abnormalities, emboli, and sudden death

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58
Q

Echo in pts with DCM reveals dilation of ____ chambers, predominantly the ____ as well as ____ ____

A

all
LV
global hypokinesis

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59
Q

What is the treatment of DCM similar to?
What is an addition that is commonly initatied?

A

HF
anti-coagulation

Slide 50

60
Q

EKG of DCM shows ____, ____, and ____

A

ST segment abnormalities
T wave abnormalities
LBBB

Slide 50

61
Q

What are common dysrhythmias seen in DCM?

A

PVC and A fib

62
Q

Prophylactic ____ placement decreases risk of sudden death by ____% in DCM

A

ICD
50%

Slide 50

63
Q

What is the principle indication for cardiac transplant?

A

DCM

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64
Q

Stress cardiomyopthy is also known as ____ and is a ____ primary cardiomyopathy characterized by LV apical hypokinesis w/ischemic EKG changes, however the coronary arteries remain patent

A

Apical ballooning syndrome
temporary

Slide 51

65
Q

Stress cardiomyopthy has a temporary dysruption in the contractility in the ____ while the rest of the heart has normal contractility

A

LV apex

Slide 51

66
Q

what are common symptoms of stress cardiomyopathy?
What is the main causative factor?
Which population has higher amounts?

A

chest pain and dyspnea
stress (physical or emotional)
Women more than men

67
Q

What is a rare type of primary cardiomyopathy?
What kind of cardiomyopathy is it?
When does it arise?

A

peripartum cardiomyopathy
dilated
3rd trimeester to 5months post-partum

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68
Q

Secondary cardiomyopathies are d/t ____ that produce myocardial infiltration and severe diastolic dysfunction.

A

systemic diseases

69
Q

What is the most common cause of secondary cardiomyopathy?
Other causes?

A

amyloidosis
Other causes: hemochromatosis, sarcoidosis, and carcinoid tumors

Slide 53

70
Q

Secondary cardiomyopathy should be considered in patients who have HF, but no evidence of what?

A

cardiomegaly or systolic dysfunction

Slide 53

71
Q

How are primary cardiomyopathies classified?

A

Genetic
Mixed
Acquired
Other

Slide 54

72
Q

____ is RV enlargement (hypertrophy and/or dilatation) that may progress to right-sided heart failure

A

Cor Pulmonale

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73
Q

What are common causes of Cor Pulmonale?

A

Causes:pulmonary hypertension,myocardial disease, congenital heart disease, or any significant respiratory, connective tissue, or chronic thromboembolic disease

Slide 56

74
Q

What is the most common cuase of Cor Pulmonale?

A

COPD

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75
Q

EKG changes with Cor Pulmonale

A

RA and RV enlargement
RA is suggested by peaked P waves in leads II, III, and aVF
Right axis deviation and RBBB are also often seen

Slide 56

76
Q

What diagonistics outside of EKG can be done for Cor Pulmonale?

A

TEE, Right heart cath, and CXR

Slide 56

77
Q

HFrEF is commonly d/t what problem?

A

Ischemic Heart Disease

Slide 58

78
Q

Factors that induce LVOT obstruction in HCM include what?

A

hypovolemia, tachycardia, increased myocardial contractility, and decreased afterload

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79
Q

DCM is the most common form of ____ and is the ____ most common cause of HF

A

cardiomyopathy
2nd

Slide 59

80
Q

Cor Pulmonale is ____ enlargement that may progress to ____ HF. it is caused by dieseases that promote ____.

A

RV
Right HF
pulmonary HTN

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81
Q

What is the most important determinant of pulmonary HTN and cor pulmonale in patients with chronic lung disease?
How do we treat it?

A

alveolar hypoxia
long-term oxygen therapy

Slide 59

Test 4 Health Assessment (Mordecai) (13 decks)

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