heart fialure Flashcards
(99 cards)
1
Q
the level of stretch in the relaxed muscle immediately before it contracts
A
preload
2
Q
: volume of blood pumped out by the heart per minute
A
Cardiac Output
3
Q
volume of blood returning to the heart via the veins per minute
A
Venous Return
4
Q
volume of blood pumped out with each contraction of the heart
A
Stroke Volume:
5
Q
volume of blood returning to the heart via the veins per minute
80% blood volume in veins when ambulatory.
A
Venous Return
6
Q
volume of blood pumped out by the heart per minute
A
Cardiac Output
7
Q
Three components of SV
A
= Contractillity, preload, and afterload.
8
Q
franks sterling’s law
A
stroke volume is dependent on your venous return
rubberband analogy
9
Q
% of blood that is pumped out of the hear to the body
A
ejection fraction
10
Q
what is normal ejection fraction
A
50-75%
11
Q
mild ejection fraction
A
wheN the LVEF falls before 50% and is above 40%
12
Q
moderate ejection fracrion
A
LVEF 30-39%
13
Q
progressive condition in which the heart has los the ability to pump to the tissues because of what two general physiological causes
A
poor contraction or poor relaxation
14
Q
Inability of heart to contract enough to provide blood flow forward to the body.
Problem of Contraction and Ejection of Blood
A
systolic heart failure
15
Q
Inability of left ventricle (LV) to Relax normally resulting in fluid backing up to the lungs.
Involves a thickened and stiff LV muscle
Problem with heart relaxation and filling with blood.
A
Diastolic Heart Failure (Filling Problem)
16
Q
reasons for left sided systolic heart failure
A
ischemic heart disease
long standing hTN
dilated cardiomyopathy
17
Q
when right ventricle looks bigger than the left
A
that is pulmonary HTN and right sided heart failure (usualy have 18months to live)
18
Q
most common reasons for right sided heart failure
A
cor pulmonale or left sided heart failure
shunt
19
Q
why would you see diastolic heart failure on the left side
A
hypertrophy causeing less room
can be cause by aortic stenosis and start as systolic
20
Q
HErEF
A
heart failure reduced EF
<40% = systolic hF
21
Q
HFpEF
A
> 50% will let you know it is diastolic HF
22
Q
causes of ACUTE decompensation of HF
A
Noncompliance with diet or therapy
Sepsis, Acute Illness (coxsackie, HIV, Influenza).
New onset arrhythmias (A. Fib)
Pulmonary Embolus: everything this getting backed up
Anemia Pregnancy Hyper/hypothyroidism Acute Coronary Syndrome Uncontrolled hypertension Toxins: Alcohol, cocaine NSAIDS Holliday Heart Valvular dysfunction Idiopathic
23
Q
most common shunt
A
atrial septal defect
foramen ovale
24
Q
JVD would be a symptom of what type of HF
A
right sided heart failure
25
asceitis would be a symptom of
right sided heart failure
26
risk factors for HF
```
CAD
Cigarette smoking/ Nicotine Use
Hypertension
Obesity
Diabetes
CKD
Cardiotoxins
Alcohol, Cocaine, Cancer chemotherapeutics.
Valvular heart disease
Rheumatic Fever
Structural heart disease
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
```
May develop over time i.e. HTN, Alcohol, cocaine, CKD.
27
what two structural changes do we see with heart failure
muscle wall stretches and thins
or muscle wall thickens and becomes ischemic
both lead to heart cells becoming irritated and arrhythmia
28
how many people will develop heart failure
1/5
29
how many people will die of heart failure
1/9
30
myocardial injury can be due to was dx
```
CAD
HTN
DM
Cardiomyopathy
valvular dz
```
31
symptoms of low ejection fraction
dyspnea, fatigue, and edema
32
angiotensinogen is found in the
liver and is the precursor to angiotensin I
33
angiotensin II is responsible for
ADH release at the cite of the pituitary
arteriole vasoconstriction
aldosterone secretion in the adrenals
tubular NA+ cl- reabsorption and K+ excretion, H20 retention
and increases SNS activity
34
ADH is responsible for
H20 absorption
35
how do you manage activation of SNS from RAAS
Beta blocker
36
how do you manage aldosterone release in RAAS
spironolactone
37
inotropy is synonymous w/
Contractility
38
Norepinephrine via ______recptors cause vasoconstriction
Norepinephrine via α1-adrenorecptors cause vasoconstriction
39
Arterial vasoconstriction maintains BP but, increases ______
Arterial vasoconstriction maintains BP but, increases Afterload.
40
Venous vasoconstriction increases______in an attempt to maintain SV.
Venous vasoconstriction increases venous return (Preload) in an attempt to maintain SV.
41
Increase venous pressure leads to _________
Increase venous pressure leads to pulmonary edema.
42
______ receptors increase HR
Nor Epi β1receptors increase HR
43
________receptors cause vasoconstriction
Nor Epi α1receptors cause vasoconstriction
44
clinical presentation
```
Orthopnea : Sleeping in a chair/ or on multiple pillows
PND (paroxysmal nocturnal dyspnea)
SOB / DOE
Fatigue
CP
Palpitations
Edema
Insomnia
Change in Exercise capacity
Poor appetite or recent weight gain ?
Abdominal distention/bloating? RUQ tenderness?
```
Sudden Cardiac Death
45
pulmonary HTN is seen as what pressure in the lungs
>25 mmHg
46
pulses alterans
variable pulse
| usually really strong and then not so strong
47
acute lung disorder that can lead to HF
cor pulmonale
resulting from pulmonary ebolism
48
what might you see in a pt with HF
Displaced PMI? Diffuse or focal? Lift? Heave? Double tap?
49
“Ken-tuc-ky” is used to distinguish what sound associated with HF
S3 gallop (“Ken-tuc-ky”),
50
anascara
full body edema
will present in flanks while lying down
51
pulmonary HTN can be caused by
damage to the lung tissue (COPD)
damage to vessels
something that affects spine or rib cage
52
what are some examples of damage to the pulmonary vessls that can result on pulmonary HTN and cor pulmonale
chronic thromboembolisms
recurrent blood clots
53
labs for suspected
cbc: rule out anemia (can't add anything into the system)
chem panel : looking at renal function, electrolytes including Ca++, K, Mg. Hyponatremia common
Liver function tests: Liver damage from hepatic congestion
BMP
TSH
54
Biomarkers you would want to check in a pt suspected of HF
BNP, NT-proBNP, Can be useful in diagnosing, and tracking medical therapies, establishing prognosis or disease severity in chronic HF
however it may not be as specific in patients who are old or have COPD
Cardiac enzymes: Troponin, CK-MB – often elevated by HF itself.
55
What would you be looking for on an EKG
arrhythmias, LVH, LAE, widened QRS complex (if wide difficulty with electricity getting through the heart muscle).
56
besides EKG and lab work, what other diagnostic test would you want to order and what would you be looking for
Chest X-ray:
cardiomegaly, pulmonary edema
Kerley B Lines- short parallel lines at the lung periphery near the bases that indicate pulmonary congestion
Batwing or Butterfly shadow – enlarged hila and alveolar edema
Water bottle or boot shaped heart
57
echo image of a heart is seen as normal
with atrium on the bottom
58
how to diagnose HF
two major or two minor and one major
59
major criteria for modified framingham (7)
```
PND: relieved with walking for a minute with rule of OSA
Orthopnea
elevated JVP
Rales
S3
cardiomegaly on CXR
PE on CXR
```
60
minor Framingham Criteria (6)
```
bilateral edema
nocturnal cough
dyspnea on ordinary exertion
hepatomegaly
pleural effusion
tachycardia (HR>120)
```
61
management of diastolic HF
No consensus yet, ongoing studies
Systolic and diastolic BP should be controlled according to guidelines
Control their HR (Lower the better)
Diuretics should be used for relief of symptoms due to volume overload
Coronary revascularization is reasonable in patients with CAD that is symptomatic or demonstrable myocardial ischemia
Manage AF preferably rhythm control > rate control
Use of BB, ACE-I, ARB’s in those with hypertension is reasonable.
ARBs might be considered to reduce hospitalizations
62
HF and HTN waht tx
ACE or ARB (not both)
63
why, physiologically do ACE's cause cough
above the lung
| ARB below
64
biggest sx of HF
shortness of breath
65
Expands blood vessels which lowers blood pressure, neurohormonal blockade
ACE inhibitor (angiotensin-converting enzyme)
66
ACE inhibitor (angiotensin-converting enzyme)
ARB (angiotensin receptor blockers)
67
Reduces the action of stress hormones and slows the heart rate
Beta-blocker
68
Slows the heart rate and improves the heart’s pumping function (EF)
Digoxin
69
why would you use digoxin
on a little bit of a BB but still need more HR control
70
Filters sodium and excess fluid from the blood to reduce the heart’s workload
Diuretic
71
Blocks neurohormal activation and controls volume
Aldosterone blockade
spironolactone but this a potassium sparing blocade
72
when would you increase Lasixs (furosemide) in a pt who is gaining fluid
5lbs in a week or 3lbs in a day
73
what dies changes do you want to see in a pt with HF
```
low sodium
low fat
no alcohol or caffeine
quit smoking
lose weight
```
74
best tool for measuring HF
scale
75
Abbott device
pulmonary artery pressure reader
| measuring pressure that is going into the lung
76
what is the time window you want to be mindful of following a MI
90 days
| cna vest cardio defibrillator
77
Apical ballooning with NORMAL coronaries and wall motion abnormalities
Takotsubo / Broken Heart Syndrome:
78
most common ischemic cardiomyopathy
heart attack
79
most common non ischemic cardiomyopathy
alcohol
80
```
Hypertension
Arrhythmias
Myocarditis (viral)
Alcohol – most common Non-Ischemic
Chemotherapy
Pregnancy
Connective tissue disease
Sepsis
```
all reasons for what type of cardiomyopathy
dialated
81
Infiltrative disease : Amyloidosis, Sarcoidosis
Non-dilated, non-hypertrophic, impaired filling
Familial
Hemochromatosis, Scleroderma
Cancer
are all associated with what type of cardiomyopathy
restrictive
82
Dilated CMP Sxs
```
Dyspnea : DOE / SOB
Edema
Orthopnea
PND
Fatigue
S3
MV Murmur
```
83
Hypertrophic CMP (HOCM) sxs
```
Syncope
Sudden Cardiac Death in Young Person
light headed after typical workout routine
Dyspnea
Fatigue
Angina
Orthopnea
Palpitations – Atrial Fib
S4 on Physical Exam
```
84
Restrictive sxs
```
Dyspnea on Exertion
Symptoms of Right Heart Failure
Fatigue
S3 or S4
Mitral Valve Regurg Murmur
```
85
dilated CMP diagnostics
EKG
NSSTC, AV Blocks, Ventricular Ectopy
```
Echo
Dilated LV, Low CO
Reduced or Preserved EF
Enlarged Atria
MV Regurg or Insufficiency?
CXR
Cardiomegaly
Pulmonary Edema
```
Stress Echo/ Thallium
Angiogram
Labs – find the cause!
BNP?
86
HCOM diagnostics
```
EKG
LVH, NSSTC, Septal Q waves
Echo
LVH!
Asymmetric Septal Hypertrophy
Small LV Volume
Diastolic Dysfunction
CXR
Not remarkable
Cardiac MRI
```
87
RESTRICTIVE diagnostic tests
```
EKG
Low Voltage non specific changes
Echo
Large RV, Stage 4 Diastolic Dysfunction
Endomysial Biopsy
```
88
TX of DILATED CMP
Tx Heart Failure
Tx Underlying Heart Disease/ Cause
Abstain from ETOH and Sodium
Severity of HF? -- ?ICD/ LVAD/ Heart Transplant
89
RESTRICTIVE CMP tx
Diuretics – symptom control
PAH Drugs
( Sildenafil, Letairis, Tracleer, Flolan…etc)
Heart Transplant
90
HCOM tx
Beta Blockers or CCBs
Surgical Myomectomy or Ablation (cutting of the muscle)
ICD for prevention of SCD
Valve Replacement (MVR) if indicated
91
reversible cardiomyopathy with a clinical presentation that mimics an acute coronary syndrome (ACS).
Takotsubo / Broken Heart CMP
92
normal arteries in a pt with acs seen with transient ST elevation looks like an MI
Takotsubo / Broken Heart CMP
93
TX of Takotsubo / Broken Heart CMP
sx control and supportive care
94
HCOM is a 100% genetic disorder of what ventricle
left
95
AHA focuses on what for a sports physical
on medical history (family and personal) and physical examination
96
The European Society of Cardiology for sports physicals
recommends a pre participation screening strategy that comprises family and personal history, physical examination, and 12-lead ECG
97
Cardiovascular Screening History for Preparticipation Examinations: Critical Questions
Exertional chest pain or discomfort, or shortness of breath?
Exertional syncope or near-syncope, or unexpected fatigue?
Past detection of cardiac murmur or systemic hypertension?
Known family history of hypertrophic cardiomyopathy, other cardiomyopathies, long QT syndrome, Marfan syndrome, significant dysrhythmias?
Family history of premature death or known disabling cardiovascular disease in a first- or second-order relative younger than 50 years? (More concern if younger than 40 years.)
98
valsalva maneuver will do what to a murmur in Hypertrophic cardiomyopathy
intensity of the ejection systolic murmur promptly declines because of an increased left ventricular volume and arterial pressure, which increase the effective orifice size of the outflow tract; the carotid pulse upstroke remains sharp, and the volume may increase.
99
For the above patient, which test would be most helpful in assessing this patient’s murmur and risk for sudden cardiac death?
: Stress Echo
