Flashcards in Heart Failure Deck (38):
1
left heart failure: signs and Sx
signs: bibasilar pulmonary crackles, tachycardia (due to SNS and Epi/NE from adrenal), S3, pedal, ankle or leg edema
Sx: dyspnea on exertion progressing to dyspnea at rest, orthopnea, PND (paroxysmal nocturnal dyspnea), fatigue
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right heart failure: signs and Sx
signs: pedal, ankle or leg edema (buildup of venous back pressure), jugular venous distension, hepatomegaly, ascites
Sx: edema of feet, then ankles, then legs, abdominal distention
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normal LVEDP/LVEDV/SV/EF/LVESV
10/150/100/67/50
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failing heart
LVEDP/LVEDV/SV/EF/LVESV
40/300/50/17/250
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At what % reduction of FSV do patients begin to have symptoms?
25%
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How do left HF patients develop edema?
ventricular dilation and myocardial hypertrophy -> decreased CO -> decreased renal perfusion -> increased Na retention -> increased osmotic pressure -> increased ADH -> increased water reabsorption -> edema
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Differentiate among pulmonary edema due to Left HF, septic shock, and hemorrhagic shock
pulmonary capillary pressure
left HF: high
septic shock: normal
hemorragic shock: low
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systolic HF
elderly
HF with dyspnea, orthopnea, PND, bibasilar pulmonary crackles
NORMAL EF
9
normal HF
long standing HTN, obese, concentric left ventricular hypertrophy
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diastolic HF
noncompliant left ventricle with impaired diastolic function and filling
preserved EF
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B-type natriuretic peptide
elevated in HF
function: counter-regulatory; vasodilation and increased sodium excretion
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causes of right heart failure
most common: left heart failure
cor pulmonale (most are compensated so don't have RHF)
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syndrome of inappropriate antidiuretic hormone (SIADH)
25% of acute heart failure
retain lots of water: systolic left HF
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peripartum cardiomyopathy (PPCM)
heart failure in previously healthy woman
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HF proinflammatory cytokines
TNF, IL-1, IL-6
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hemodynamic classifications of HF
1. warm and dry (goal)
2. cold and dry (inadequate perfusion; need vasodilator)
3. warm and wet (congestion; need diuretics)
4. cold and wet (congestion and inadequate perfusion; need vasodilators and diuretics)
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distributive shock
diffuse vasodilation
warm and dry
decrease: preload and after load (primary)
increase: CO
sepsis, anaphylaxis, TSS
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obstructive shock
obstruction
cold and clammy
increase: preload and after load
decrease: CO (primary)
cardiac tamponade and pulmonary embolism
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cardiogenic shock
ventricular failure
cold and clammy
increase: preload and after load
decrease: CO (primary)
acute MI, HF, valvular dysfunction, arrhythmia
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hypovolemic shock
loss of blood
cold and clammy
decrease: preload (primary) and CO
increase: after load
hemorrhage, dehydration, burns
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signs of shock
elevated serum lactate
hypotension (remember to adjust for people with HTN)
behavior: disorientation, confusion, obtundation
skin: mottled, cold, clammy, pale or cyanotic
urine: decreased output
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compensated aortic regurgitation LVEDP/LVEDV/SV/EF/LVESV
12/250/200/80/50
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decompensated aortic regurgitation (HF): LVEDP/LVEDV/SV/EF/LVESV
40/300/150/50/150
24
How should you treat a patient with severe acute uncompensated aortic regurgitation?
SURGICAL EMERGENCY
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normal LAP/LVEDV/RSV/FSV/EF/LVESV
10/150/0/100/67/50
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acute mitral regurgitation LAP/LVEDV/RSV/FSV/EF/LVESV
25/170/65/65/76/40
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compensated mitral regurgitation LAP/LVEDV/RSV/FSV/EF/LVESV
15/250/100/100/80/50
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chronic mitral regurgitation LAP/LVEDV/RSV/FSV/EF/LVESV
25/280/80/80/55/120
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severe blood loss
LVEDP/LVEDV/SV/EF/LVESV
2/100/75/75/25
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compensated HF LVEDP/LVEDV/SV/EF/LVESV
12/200/100/50/100
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dilated ventricle LVEDP/LVEDV/SV/EF/LVESV
40/250/65/26/185
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class I HF
asymptomatic
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class II HF
have to stop normal daily activities to rest
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class III HF
only make it a couple of steps before out of breath
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class IV HF
can't get out of bed
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What can EF not predict?
CO, renal blood flow, RAA activation, salt/H20 retention
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effect of bed rest on CHF with dilated myopathy
1st: signs and symptoms disappear
2nd: increased response to medical management
3rd: cardiomegaly recedes
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