heart failure Flashcards
1
Q
inability of the heart to meet the body’s metabolic needs. at rest or during stress, without exceeding physiologic left and right filling pressures s
A
heart failure
2
Q
most common primary diagnosis on admissions within the medicare population
A
heart failure
3
Q
total cost of heart failure in US
A
28.8 billion
4
Q
cost of HF sustainable?
A
nope
5
Q
independent risk factors of HF
A
- HTN
- obesity
- diabetes
6
Q
treatments for HF
A
- digoxin
- diuretics
- bed rest
7
Q
HF prognosis
A
- progressive disability
2. uniform mortality
8
Q
determinants of systolic performance
A
ejection fraction:
- myocardial mass and architecture
- contractility
- preload
- afterload
9
Q
how to measure cardiac output
A
thermodilution
10
Q
goal of managing HF
A
achieve adequate cardiac output while minimizing wedge P
11
Q
Diastolic relaxation components (3)
A
- Myofibrillar dissociation
- Calcium removal from the cytoplasm against the concentration gradient
- Requires enzymatic action and energy
12
Q
Diastolic passive compliance components (2)
A
- A tissue property (stress-strain relationship) during passive myocardial stretch
- A ventricular property related to both myocardial stretch response and to constraining effect of contiguous structures
13
Q
Systolic dysfunction:
- Etiology
- Pathology components
- Pathophysiology
A
- Chronic volumes overload, ischemia, infectious, substance abuse or genetic
- Dilated LV and hypertrophied LV and/or RV
- Decrease in contractility and decrease resting EF (LV remodeled with dilation)
14
Q
Diastolic dysfunction; HHpEF; Metabolic CV dx.:
- Etiology
- Pathology
- Pathophysiology
A
- HTN, Diabetes, Obesity and advanced age
- Hypertrophy, fibrosis w/out dilatation
- NI resting EF (non-dilated LV) with decrease relaxation and decrease in compliance
15
Q
Increased load structure HF:
- Etiology
- Pathology
- Pathophysiology
A
- Valvular, congenital, obstructive, systemic shunt
- Hypertrophy and/or dilatation
- Pressure and/or volume overload
16
Q
Increased load and demand HF:
- Etiology
- Pathology
- Pathophysiology
A
- Anemia and thyrotoxicosis
- Dilated and hypertrophied LV and RV
- Increased C.O. And increased O2 consumption or decreased O2 extraction
17
Q
Restrictive/ constrictive HF:
- Etiology
- Pathology
- Pathophysiology
A
- Infiltration, inflammatory and neoplasticism
- Infiltrated / thickened mayo/ pericardium
- Restricted LV and RV filling
18
Q
Left Heart failure HF:
- Etiology
- Manifestations
A
- MI, cardiomyopathy, valvular congenital, HTN
2. Pulmonary congestion and low cardiac output
19
Q
Right Heart failure:
- Etiology
- Manifestations
A
- Left heart failure, MI, cardiomyopathy, valvular, congenital, cardiomyopathy, lung disease and pulmonary emboli
- Peripheral edema, ascites, low cardiac output
20
Q
Heart failure has a maladaptive adaptation
A
the heart will undergo hypertrophy to normalize wall stress and systolic function but it will lead to altered contractile proteins and calcium handling, apoptosis, fibrosis and failure
21
Q
function of natriuretic peptides
A
vasodilate and promote sodium excretion
22
Q
high pulmonary venous pressure
A
left heart failure
23
Q
high systemic venous pressure
A
right heart failure
24
Q
NY heart association class (4)
A
- no symptoms
- symptoms on mod-severe exertion
- symptoms on mild exertion
- symptoms at rest
25
ivabradine
heart rate lowering agent acting by inhibiting the If current in the sino-atrial node
26
Shift trial hypothesis
addition of ivabradine to recommended therapy would be beneficial in heart failure patients with elevated heart rate
27
neprilysin
inhibition leads to a potentiation of vasoactive peptides that counter maladaptive mechanisms in HF
28
produces a positive inotropic effect through inhibition of the Na-K exchanger that results in higher intracellular sodium levels causing increased calcium transport via sodium-calcium exchange channel
digoxin
29
the loss of what can worsen HF?
synchronous LV contraction
30
most commonly used drug for suppression of ventricular arrhythmias in HF is
amiodarone
31
indications for implantable cardioverter defibrillators
syncope or resuscitated cardiac arrest thought ti be due to a ventricular arrhythmia
32
clinical assessment of hemodynamic status (2)
1. thermodilution
| 2. swanz catheter
33
thermodiultion can measure _____ but there are some pitfalls in inaccuracy such as with (2)
CO
1. tricuspid regurg
2. fluctuation in body temp
34
Total uptake and release of a substance by an organ equals the blood flow to the organ and the arterio-venous concentration difference for that substance
Fick's method
35
Non-invasive general assessment of atrial, ventricular and valve structure and function
TTE
36
Invasive and requires conscious sedation
Higher resolution imaging gives better assessment of valvular structure (e.g. infectious vegitations on valve from endocarditis)
TEE
37
Color-flow doppler measures blood velocity (direction and speed) by either TTE or TEE
Does not measure pressure directly, but can make inferences about pressure by converting velocity to pressure:
echo
38
Reflection of intravascular volume status
Estimated by pressure in the right atrium (“central venous pressure or CVP”) and/or left atrium (“pulmonary capillary wedge pressure”)
Preload: volume of blood in LV at end-diastole
39
Reflection of the heart’s intrinsic ability to contract and generate force during systolic
Estimated generally by the Left Ventricular Ejection Fraction
Contractility: ability of myocardium to contract
40
Left ventricular wall stress
| Estimated by systemic vascular resistance (SVR) or mean arterial pressure
Afterload: resistance to ventricular contraction
41
disease modifying therapies for HF
1. catecholamine pathway
2. RAAS pathway
3. revascularization
42
palliative therapies for HF
1. diuretics
| 2. implantable defibrillator
43
is a life-threatening medical condition of low tissue perfusion resulting in oxygen and nutrient deficit (ischemia/infarction) the impairs tissue function
Circulatory shock
44
types of shock (4)
1. hypovolemic
2. cardiogenic
3. septic
4. obstructive
45
causes:
1. Hypovolemic
2. Cardiogenic
3. Septic
4. Obstructive
1. Hypovolemic
GI bleeding, excessive diarrhea and dehydration
Cardiogenic
s/p large myocardial infarction, acute valvular disorder
Septic
Significant systemic infection
Obstructive
Pulmonary embolus
46
primary problem:
hypovolemic
low preload
47
primary problem:
cardiogenic
loss of contractility
48
primary problem:
septic
non-specific vasodilation and dehydration
49
primary problem:
obstructive
physical blockage preventing blood flow
50
inotropic drugs used (3)
1. Beta-adrenergic agonists
2. phosphodiesterase inhibitors
3. digitalis glycosides
51
2 key components of diastolic function:
1. relaxation
| 2. compliance
52
is the process of myofibrillar dissociation, an active process requiring enzymatic action and energy to remove calcium from the cytoplasm against the concentration gradient.
relaxation
53
is the passive property of the myocardium or of a cardiac chamber, describing (for an intact cardiac chamber) the change in volume for a given change in filling pressure, after relaxation is complete.
compliance
54
. A low ejection fraction is generally accompanied by
ventricular dilatation.
55
Systolic dysfunction is most often a consequence of
myocardial infarction (“ischemic cardiomyopathy”) or primary myocardial disease (“dilated cardiomyopathy”)
56
Isolated, or primary, diastolic dysfunction occurs most commonly in the _____, as a consequence of long-standing hypertension and resulting left ventricular hypertrophy.
elderly
57
Diastolic dysfunction may also occur as a consequence of___________, a family of genetic disorders linked to mutations of a variety of contractile proteins.
familial hypertrophic cardiomyopathy
58
cor pulmonale a sign of
right heart failure
59
long standing pressure-overload, as exemplified by hypertensive cardiomyopathy
diastolyc dysfunction
60
ventricular dilatation, reduced ejection fraction, commonly referred to as
“systolic dysfunction”.
61
hypertrophied myocyte manifests altered expression of
contractile proteins and of enzymes that regulate calcium movement,
62
what does the adrenergic nervous system, RAAS pathway, vasopressin and endothelin do in HF?
these systems and substances tend to vasoconstrict; augment contractility; promote hypertrophy and interstitial fibrosis; and induce sodium and water retention.
63
levels are elevated in heart failure.
B-type natriuretic peptide (BNP)
64
effective means of preventing or reversing progressive left ventricular dilatation (ventricular remodeling) in heart failure.
carvedilol
65
A typical regimen for such HF patients includes an
ACE inhibitor, beta blocker, digoxin, and diuretic.
66
These agents are useful in the management of acute exacerbations of heart failure
vasodilators
67
reduce pulmonary capillary (artery) wedge (PCW) pressure in patients with severe heart failure
dobutamine and milrinone
