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Cardiology-Exam 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

________ ________ is the FINAL common pathway of many cardiac diseases

A

Heart Failure

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2
Q

Early compensatory mechanisms to myocardial insults include……….. and are initially protective but become maladaptive with time

A

Inc. preload and wall thickness (SNS and RAAS)

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3
Q

clinical syndrome characterized largely by fluid retention leading to pathologically elevated filling pressure; worsened by physiologic compensation with SNS and RAAS; decreased contractility, stroke volume, and increased preload

A

Heart Failure

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4
Q

Heart failure can be caused by… (4 total)

A

Impaired contractility (ischemia, dilation)
Inc. afterload (HTN, AS)
Inc. volume (valve insufficiency)
Impaired ventricular filling (hypertrophy)

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5
Q

Most common cause of heart failure

A

Myocardial infarction

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6
Q

Two main physiologic adaptations to decreased stroke volume are…….

A

Inc. preload (Frank-Starling)

Inc. wall thickness

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7
Q

When contractility is impaired, a higher _________ is required to increase stroke volume

A

preload

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8
Q

Increased preload leads to increased stroke volume up to a point (True or False)

A

True. (plateaus to where no increase in pressure affects stroke volume)

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9
Q

Increased left atrial pressure can result in…

A

pulmonary edema

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10
Q

How is preload regulated (3 total)

A 
Venous tone (sympathetic activity via baroreceptors)
Blood volume (Sympathetic, RAAS, ADH)
Body position
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11
Q

Norepinephrine application to the kidney causes…

A 
Renin release
Fluid retention (inc. preload)
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12
Q

Cardiovascular response to chronic beta-adrenergic receptor stimulation

A 
Downregulation of receptors
Energy starvation
Cardiomyocyte death
Ventricular arrhythmias
Fibrosis
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13
Q

Dec. perfusion stimulates sympathetic outflow, causing……. which worsens disease progression

A

Cardiac activity–> myocardial toxicity and arrhythmias

Renal activity–> vasoconstriction and fluid retention

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14
Q

Renal response to reduced stroke volume

A

Reduced stroke volume—> reduced effective arterial blood volume—> increased renin and aldosterone—> increased blood volume and vasoconstriction

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15
Q

How does heart failure disrupt the negative feedback loop of the renin-angiotensin system?

A

Gradual decrease in cardiac output, and thus renal perfusion, perpetually stimulates renin release (as futile as a dog chasing it’s own tail)

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16
Q

How does the SNS and RAAS increase preload?

A

Inc. circulating volume

Inc. venous return

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17
Q

Natriuretic peptides that counteract maladaptive neurohormones (help reduce blood volume and promotes vasodilation)

A

ANP (atrial natriuretic peptide)

BNP (brain natriuretic peptide)

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18
Q

Determinants of afterload (3 total)

A

Systemic vascular resistance
Aortic compliance
Aortic valve resistance

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19
Q

Concentric hypertrophy (pathologic) will progress to what over years of chronic stressors

A

Eccentric hypertrophy (dilation)

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20
Q

Most common phenotype for heart failure

A

Cardiac dilation (eccentric hypertrophy)

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21
Q

Two main modes of heart failure

A

Ischemia

Hypertrophic (concentric to eccentric)

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22
Q

Fibrosis impairs the heart’s ability to (contract/relax/both)

A

Both

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23
Q

Morphologic features of ventricular remodeling

A

Hypertrophic myocytes
Dead myocytes
Fibrosis

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24
Q

When stroke volume decreases, ______ will increase in an attempt to preserve MAP

A

Systemic vascular resistance

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25
Q

The increase in __________ due to SNS and RAAs can further impair cardiac performance by decreasing stroke volume, beginning the maladaptive cycle

A

afterload (due to increased SVR)

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26
Q

Medications to _______ ________ are central to treating heart failure (opposed SNS and RAAS effects)

A

reduce afterload

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27
Q

You can have good systolic activity with diastolic dysfunction (True or False)

A

True

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28
Q

Dec. Contractility
Dec. Stroke Volume
Inc. stiffness

A

Systolic Dysfunction

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29
Q

Normal contractility
Dec. stroke volume
Inc. stiffness
Diastolic Dysfunction

A

Diastolic Dysfunction

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30
Q

Why does the RAAS contribute to the worsening of heart failure?

A

The kidneys cannot tell the difference between poor perfusion due to dehydration vs. low cardiac output

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31
Q

Mean survival after a diagnosis of heart failure is…

A

5 years

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32
Q

Classification system for Heart Failure

A

NYHA Functional Class (I-IV)

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33
Q

Dyspnea that occurs while lying flat and is relieved by sitting upright

A

Orthopnea

34
Q

What is nearly diagnostic of right-sided heart failure (besides dyspnea)

A

Jugular vein distention/pressure

35
Q

The most common cause of right heart failure is ______ ______ ______

A

left heart failure

36
Q

What can cause primary right-sided heart failure

A 
Right ventricle infarction
Pulmonic stenosis
Tricuspid regurgitation
CHF
Arrhythmogenic RV Dysplasia
37
Q

Most common presenting symptom of heart failure

A

Dyspnea on exertion

38
Q

HFpEF

A

Heart Failure with Preserved Ejection Fraction

39
Q

Heart failure always results in reduced ejection fraction (True or False)

A

False (40% have preserved Ejection Fraction)

40
Q

Heart failure with preserved ejection fraction (HFpEF) is most commonly due to (diastolic/systolic) dysfunction

A

Diastolic dysfunction (doesn’t fill adequately)

41
Q

HFpEF can present with both left and right sided heart failure (True or False)

A

True; indistinguishable from HFrEF (unless you know the EF)

42
Q

Blood tests to run to diagnose heart failure

A

Chemistry panel (renal, sodium, glucose)
Liver function tests
Troponin
BNP

43
Q

Heart sound/gallop from early diastolic filling into an overloaded ventricle; normal in children

A

S3

44
Q

Heart sound/gallop that is normal to hear in children

A

S3

45
Q

Heart sound/gallop from late diastolic filling; atrial “kick” into a stiff ventricle

A

S4

46
Q

Chest X-ray findings indicative of pulmonary edema

A 
Whitewashed lung (alveoli filled with fluid)
Prominent upper-lung vessels (redistribute blood to viable alveoli in upper lung)
47
Q

One of the best chemicals in the blood to diagnose heart failure; released almost exclusively from stretched cardiomyocytes

A

BNP (B-type Natriuretic Peptide)

48
Q

How do ACE inhibitors and ARBs help heart failure?

A

Reverse remodeling to lower wall stress and oxygen demand (Dec. fluid)
Dec. afterload, thus dec. oxygen demand and inc. stroke volume (Dec. SVR)

49
Q

Contraindications for ACE inhibitors and ARBs

A

Angioedema
Renal artery stenosis
Advanced renal dysfunction

50
Q

Excess ________ can cause cough and angioedema

A

Bradykinin (ACE breaks it down, so ACEi cause elevated levels)

51
Q

aldosterone antagonists; block mineralocorticoid receptors systemically; indicated with Class II-IV heart failure, HTN or hyperaldosteronism; contraindicated for hyperkalemia

A

Spironolactone

Eplerenone

52
Q

Aldosterone antagonists are indicated for what NYHA classes of heart failure?

A

Class II-IV

53
Q

Aldosterone antagonists help prevent………… in the setting of heart failure

A

Cardiac/vascular fibrosis

LVH

54
Q

Contraindications of beta-blockers

A

Bronchospasm
Severe decompensated CHF
Severe bradycardia
AV block

55
Q

Why might some men not like being on a beta-blocker?

A

an adverse effect is sexual dysfunction

56
Q

old school cardiac medicine; inhibits Na export via Na/K ATPase, increasing internal Na conc. and Ca retention; made from foxglove extract; very narrow therapeutic window, so not used that often

A

Digitalis (Digoxin)

57
Q

Why might Digitalis (Digoxin) not be the best choice for heart failure?

A

Narrow therapeutic window with toxicities like arrhythmias and seizures

58
Q

Diuretics: __________ are typically used for HTN, but ___________ are used for heart failure

A

Thiazides; Loop diuretics (Furosemide)

59
Q

Loop diuretics help heart failure by excreting fluid, improving symptoms and prolonging life (True or False)

A

False; help symptoms but don’t prolong life

60
Q

How do diuretics alleviate symptoms of heart failure?

A

Decrease fluid volume, thus decreasing preload

61
Q

trial that sought to study the hypothesis that ISDN/hydralazine (BiDil) would provide a survival benefit for African American patients with HFrEF

A

A-HeFT

62
Q

What complications kill heart failure patients?

A

SCD

Arrhythmias

63
Q

ICDs are put in the left-upper chest and the lead is inserted into the ______________ vein and into the right atrium

A

Axillary/Subclavian

64
Q

When do you want to put in an ICD?

A

EF <30%

NYHA Class I-III

65
Q

difference in the timing of ventricular contractions in the heart; large differences in timing of contractions can reduce cardiac efficiency and is correlated with heart failure; can be seen on echo

A

Ventricular dyssynchrony

66
Q

Treatment for ventricular dyssynchrony

A

Cardiac Resynchronization Therapy (biventricular pacemaker)

67
Q

Placement of leads in biventricular pacemaker

A

On IVS and LV free wall

68
Q

Only cure for heart failure

A

Heart transplant (but there is an organ donor shortage)

69
Q

Device used to help heart failure patients; flow is directed from the apex of the LV to the ascending aorta

A

Left Ventricular Assist Devices

70
Q

Drugs for HFpEF

A

No evidence-based drug to reduce mortality (treat predisposing conditions)

71
Q

Heart failure is progressive, with periods of ___________

A

decompensation (ADHF)

72
Q

ADHF

A

Acute Decompensated Heart Failure

73
Q

Acute decompensated heart failure signs/symptoms can be divided into what categories

A

Cold (Shock): nausea, AMS, reduced capillary refill, hypotension, cold skin, narrow pulse pressure
Wet: dyspnea/orthopnea, cough, peripheral edema, rales, JVD, hepatic congestion

74
Q

Most patients with ADHF require…..

A

diuretics to relieve excess fluid retention

75
Q

Patients with decompensated heart failure (hypoperfusion) need…

A

Diuretics
Inotropes (dobutamine, milrinone)
Vasodilators

76
Q

Inotropes used in cardiogenic shock

A

Dobutamine

Milrinone

77
Q

Why might routine use of IV inotropes (dobutamine) actually shorten life in regards to HF

A

Possibly increased intracellular calcium and arrhythmias

78
Q

Cornerstone management of chronic heart failure

A

Neurohormonal antagonists (beta-blockers, ACEi and ARBs)

79
Q

Two central goals for management of ADHF

A 
Relieve congestion (diuretics; optimize preload)
Adequate tissue perfusion (vasodilators, inotropes)
80
Q

Dilated Cardiomyopathy causes

A

ABCCCD: Alcohol abuse, Beriberi, Coxsackie B myocarditis, chronic Cocaine use, Chagas disease, and Doxorubicin toxicity

Cardiology-Exam 2 (23 decks)

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