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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

2

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

3

normal LVEDP/LVEDV/SV/EF/LVESV

10/150/100/67/50

4

failing heart
LVEDP/LVEDV/SV/EF/LVESV

40/300/50/17/250

5

At what % reduction of FSV do patients begin to have symptoms?

25%

6

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

7

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

8

systolic HF

elderly
HF with dyspnea, orthopnea, PND, bibasilar pulmonary crackles
NORMAL EF

9

normal HF

long standing HTN, obese, concentric left ventricular hypertrophy

10

diastolic HF

noncompliant left ventricle with impaired diastolic function and filling
preserved EF

11

B-type natriuretic peptide

elevated in HF
function: counter-regulatory; vasodilation and increased sodium excretion

12

causes of right heart failure

most common: left heart failure
cor pulmonale (most are compensated so don't have RHF)

13

syndrome of inappropriate antidiuretic hormone (SIADH)

25% of acute heart failure
retain lots of water: systolic left HF

14

peripartum cardiomyopathy (PPCM)

heart failure in previously healthy woman

15

HF proinflammatory cytokines

TNF, IL-1, IL-6

16

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)

17

distributive shock

diffuse vasodilation
warm and dry
decrease: preload and after load (primary)
increase: CO
sepsis, anaphylaxis, TSS

18

obstructive shock

obstruction
cold and clammy
increase: preload and after load
decrease: CO (primary)
cardiac tamponade and pulmonary embolism

19

cardiogenic shock

ventricular failure
cold and clammy
increase: preload and after load
decrease: CO (primary)
acute MI, HF, valvular dysfunction, arrhythmia

20

hypovolemic shock

loss of blood
cold and clammy
decrease: preload (primary) and CO
increase: after load
hemorrhage, dehydration, burns

21

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

22

compensated aortic regurgitation LVEDP/LVEDV/SV/EF/LVESV

12/250/200/80/50

23

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

25

normal LAP/LVEDV/RSV/FSV/EF/LVESV

10/150/0/100/67/50

26

acute mitral regurgitation LAP/LVEDV/RSV/FSV/EF/LVESV

25/170/65/65/76/40

27

compensated mitral regurgitation LAP/LVEDV/RSV/FSV/EF/LVESV

15/250/100/100/80/50

28

chronic mitral regurgitation LAP/LVEDV/RSV/FSV/EF/LVESV

25/280/80/80/55/120

29

severe blood loss
LVEDP/LVEDV/SV/EF/LVESV

2/100/75/75/25

30

compensated HF LVEDP/LVEDV/SV/EF/LVESV

12/200/100/50/100

31

dilated ventricle LVEDP/LVEDV/SV/EF/LVESV

40/250/65/26/185

32

class I HF

asymptomatic

33

class II HF

have to stop normal daily activities to rest

34

class III HF

only make it a couple of steps before out of breath

35

class IV HF

can't get out of bed

36

What can EF not predict?

CO, renal blood flow, RAA activation, salt/H20 retention

37

effect of bed rest on CHF with dilated myopathy

1st: signs and symptoms disappear
2nd: increased response to medical management
3rd: cardiomegaly recedes

38

stiff non-compliant ventricle
LVEDP/LVEDV/SV/EF/LVESV

40/100/65/65/35