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Pharm Final Exam > Heart Failure Patho > Flashcards

Heart Failure Patho Flashcards

more anatomy/physiology based

1
Q

The incidence of heart failure in the US is increasing. When are we starting to see diagnosis?

A

earlier in life (younger ages)

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2
Q

List the risk factors of heart failure

(hint: 11)

A

HTN

obesity

pre-diabetes

diabetes

cardiac disease (esp. MI)

familial or genetic cardiomyopathies

cardiotoxicity r/t cancer

substance abuse

autoimmune disease

iron overload

inflammatory disorders (covid), etc.
​

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3
Q

What race/ethnic disparities did we discuss relating to heart failure?

A

there is a greater incidence in African Americans and Hispanics​

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4
Q

is there a cure for heart disease?

A

no

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5
Q

Heart failure is a progressive disease. what occurs?

A

The heart cannot pump efficiently to meet the demands of the body

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6
Q

List the etiologies of heart failure

A

ischemic heart disease

chronic hypertension

COPD

Cardiomyopathies

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7
Q

what is the biggest etiology of heart failure?

A

chronic hypertension

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8
Q

COPD is the leading cause of what?

A

right ventricular (RV) failure

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9
Q

COPD can cause right ventricle changes and HF called what?

A

cor pulmonale

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10
Q

why can COPD lead to the development of pulmonary hypertension?

A

due to constriction of arterial vessels and increased workload and exhaustion of RV ​

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11
Q

Why ischemic heart disease an etiology of heart failure?

A

it is related to ischemic insults to myocardium, which weakens the strength of ventricular contraction​

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12
Q

how does heart failure impact cardiac output? why?

A

Leads to decrease in cardiac output because it decreases the ability of the heart to get oxygenated blood to where it needs to go

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13
Q

What are some underlying problems in heart failure?

(hint: 8)

A

Atherosclerosis (hypertrophy)

Cardiomyopathy

Hypertension

Alcoholism

Myocardial infarction

A-fib

valvular disease

Congenital cardiac defects

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14
Q

In heart failure pts, what is the reason for the following underlying problems: Hypertension, Alcoholism, MI, A-Fib, or valvular disease​?

A

the increase in workload to maintain an efficient output​

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15
Q

What happens in left-sided heart failure?

A

Left ventricle is to stiff and not contracting properly. it is unable to pump re-oxygenated blood from the lungs to the heart’s left atrium​

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16
Q

what does left-sided heart failure lead to?

(hint: 2)

A

Decreased cardiac output​

Pulmonary congestion

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17
Q

left sided heart failure is a common cause of what?

A

right sided heart failure

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18
Q

what are the two types of left sided heart failure?

A

systolic and diastolic

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19
Q

what occurs in systolic heart failure?

A

LV cannot contract forcefully enough to keep blood circulating normally throughout the body​

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20
Q

what occurs in diastolic heart failure?

A

LV has grown stiff or thick and is unable to fill the heart properly, which reduces the amount of blood pumped out to the body. ​

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21
Q

in systolic heart failure, you are not able to maintain adequate _____ ______

A

cardiac output

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22
Q

which type of heart failure consists of remodeling of the left ventricle?

A

diastolic heart failure

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23
Q

in diastolic heart failure, the heart is unable to ______ to allow the blood to get in

A

relax

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24
Q

in diastolic heart failure, there is a decrease in the amount of blood getting into the heart which leads to ?

A

a decrease in the amount getting out

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25
systolic heart failure deals with the _______ of the heart
contraction
26
in systolic heart failure there is a low ejection fraction. what number represents this?
<40%
27
list the symptoms of systolic heart failure (hint: 9)
Tiredness/fatigue Decreased urine production Increased heart rate; may be irregular Elevated blood pressure​ Enlarged heart​ Pulmonary “congestion” Coughing Weight gain​ Decreased blood flow to extremities​
28
what would cause someone with systolic heart failure to feel tiredness/fatigue?
lack of O2
29
what would cause someone with systolic heart failure to have decreased urine production?
fluid is backing up and not being filtered by the kidneys
30
what would cause someone with systolic heart failure to have an increased and possibly irregular HR?
the heart is trying harder to do its job
31
In someone with systolic heart failure, what might they experience if they have pulmonary congestion?
SOB
32
In someone with systolic heart failure, when might coughing be worse?
at night; when lying flat
33
In someone with systolic heart failure, what may lead to pulmonary congestion?
fluid or blood coming from the lungs cannot go anywhere
34
In someone with systolic heart failure who has pulmonary congestion, there is also decreased ___ _______
gas exchange
35
In diastolic heart failure, there is an issue with the left ventricle being too ____ to be able to properly fill and contract
stiff
36
what is the typical ejection fraction in diastolic heart failure?
typically normal >50%
37
more people have diastolic heart failure because of ________
hypertension
38
Are there medications available to fix diastolic dysfunction?
no
39
list the symptoms of pulmonary congestion in pts with left sided heart failure (hint: 5)
cough crackles wheezes blood-tinged frothy sputum tachypnea
40
list the overall symptoms of left sided heart failure (hint: 10 from image on slide)
restlessness confusion orthopnea tachycardia exertional dyspnea fatigue cyanosis paroxysmal noctural dyspnea elevated pulmonary capillary wedge pressure pulmonary congestion
41
why is there blood tinged sputum or secretions in pts with left sided heart failure?
the blood is trying to find any means to get to where it needs to be; this is it's way to clear the lungs and get rid of excess
42
pts with left-sided heart failure are essentially ________ in their own lungs bc there is too much fluid
drowning
43
What is the normal ejection fraction?
55-70%
44
When there is systolic dysfunction, the _______ ventricles fill with blood. the ventricles pump out less than ______ of the blood
enlarged; less than 40 to 50%
45
what does a low ejection fraction mean?
less blood is leaving the heart
46
when there is diastolic dysfunction, the ____ ventricles fill with ____ blood than normal The ventricles pump out about ____ of the blood, but the amount may be ______ than normal
stiff; less 60%; lower
47
why is the ejection fraction low when there is systolic dysfunction?
a lot more blood is coming into the heart but less is leaving the heart
48
when there is diastolic dysfunction, what does the stiffening of ventricles mean?
it causes less blood to come into the heart
49
why is the ejection fraction in diastolic dysfunction typically normal?
less blood is coming into the heart meaning less will exit (rather than more blood coming in and less exiting)
50
List the steps in the vicious cycle of left ventricular failure (hint: 4)
decreased renal perfusion renin production stimulated persistent cycling of RAAS further deterioration of heart function
51
what type of heart failure is not as common as left-sided HF?
right-sided
52
what occurs in right-sided heart failure?
Have deoxygenated blood coming from the body, but right side of heart not pumping as well as it should​
53
what does right-sided heart failure lead to?
a back up of blood in the body
54
list the symptoms of right-sided heart failure (hint: 12)
Peripheral swelling Weakness/fatigue​ Leg/feet edema​ Vein distension increased peripheral venous pressure Weight gain​ Increased urination​ Hepatomegaly Increased abdominal girth​ Ascites Splenomegaly Anorexia/GI distress
55
what vein is close to the liver where congestion might be seen in pts with hepatomegaly from right sided heart failure?
portal vein
56
who is right sided heart failure commonly seen in?
COPD pts smokers
57
right sided heart failure may be secondary to what?
chronic pulmonary problems
58
list the characteristics of ascites we discussed in class (hint: 4)
fluid distention in abdomen very hard (looks pregnant) bad stage can be seen in cancer pts
59
In right sided heart failure there is less O2 meaning there is what?
more CO2
60
in right sided heart failure, the kidneys are getting less ____
blood
61
In heart failure pts, what does the activation of the sympathetic nervous system cause? (hint: 9)
Increases Heart rate Increases contractility tachycardia​ ​ Vasoconstriction​ ​ Activates the Renin-Angiotensin System (RAS) ​ ​ Direct cardiotoxicity​ Increases myocardial O2 demand​ Increase wall stress​ ​ Decreased preload Increased afterload​
62
In pts with heart failure, about 50% have what?
three or more comorbidities
63
In pts with heart failure, how many medications do they average?
6
64
in pts with heart failure, 78% had what?
at least two admissions per year
65
in pts with heart failure, only 10% completed what?
their prescription regimen
66
in pts with heart failure, one-third did what?
never refilled any heart failure prescription
67
when you think about comorbidities for heart failure, think about the __________ syndromes
metabolic
68
list the goals of heart failure treatment
Address the effects of heart failure on airway, breathing, and circulation:​ 1. Treatment of the existing symptoms of the crisis situation​ 2. Prevention of further or expanding complications​ 3. Treatment of the underlying cause ​
69
List the stages of heart failure
Stage A: at risk for heart failure Stage B: pre-heart failure Stage C: symptomatic heart failure Stage D: advanced heart failure
70
what classifies someone as stage A of heart failure?
they are at risk for heart failure but WITHOUT current/previous symptoms and WITHOUT structural/functional HD or abnormal biomarkers
71
what disorders/things would classify the pt as heart failure stage A? (hint: 7)
hypertension CVD diabetes obesity exposure to cardiotoxic agents genetic variant for cardiomyopathy family hx of cardiomyopathy
72
Someone with Stage B heart failure is a pt without current/previous symptoms but evidence one out of 3 things. what are those things? (hint: 3)
structural heart disease evidence of increased filling pressures risk factors and increased natriuretic peptide levels or persistently elevated cardiac troponin in the absence of competing diagnoses
73
what would classify someone as Stage C heart failure?
pt with current or previous symptoms/signs of heart failure
74
what would classify someone has Stage D heart failure?
marked heart failure symptoms that interfere with daily life and with recurrent hospitalizations despite attempts to optimize medical therapy
75
When someone is classified Stage B of heart failure they already have a decrease in ______ _______, impaired ________ ________, and have some ventricular __________
ejection fraction; ventricular function; hypertrophy
76
how is new onset/de novo HF classified? (hint: 2)
newly diagnosed HF no previous hx of HF
77
A person is Stage C heart failure with previous sx of HF with persistent left ventricular dysfunction. When could we classify them as "resolution of symptoms" ?
HF in remission with resolution of previous structural and/or functional heart disease
78
how is persistent HF classified?
persistent HF with ongoing symptoms/signs and/or limited functional capacity
79
how is worsening HF classified?
worsening sx/signs/functional capacity
80
the worse a HF stage gets, the higher the chance of what?
morbidity or mortality bc the heart will stop working
81
What is included during the assessment portion when seeing a pt with suspected HF? (hint: 4)
clinical history physical examination ECG labs
82
what natriuretic peptide proBNP value would be indicative of HF?
>125 pg/mL
83
what natriuretic peptide BNP level would be indicative of HF?
>/ 35 pg/mL
84
After initial assessment and labs, what additional testing might be necessary in a pt with suspected HF?
transthoracic echocardiography
85
what should be done when a HF diagnosis is confirmed?
determine the cause and classify
86
what does HFrEF mean and what would be indicative of it?
meaning: heart failure with reduced ejection fraction indicative: left ventricle ejection fraction
87
what does HFmrEF mean and what would be indicative of it?
meaning: heart failure with mid-range ejection fraction indicative: left ventricle ejection fraction 41-49%
88
what does HFpEF mean and what would be indicative of it?
meaning: heart failure with preserved ejection fraction indicative: left ventricle ejection fraction >/ 50%

Pharm Final Exam (34 decks)

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