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Q2 Clin Med Final (Cardiology, Hyperlip) > HF > Flashcards

HF Flashcards

(68 cards)

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1
Q

Hear Failure definition?

A

any structural or fxnl disorder that impairs heart’s ability to pump needed blood

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2
Q

HF underlying causes?

A

ºCAD
Ischemic cardiomyopathy
HTN

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3
Q

HF precipitating causes?

A 
Infection
Anemia
Arrhyth
Fluid overload
HTN
MI
PE
endo/myocarditis
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4
Q

HF: Left-Sided

Systolic Dysfxn definition?

A

inability to contract and expel blood

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5
Q

HF: Left-Sided

Systolic Dysfxn etiology?

A 
CAD
impaired contractility (cardiomyopathy)
high afterload (high pressure)
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6
Q

HF: Left-Sided

Diastolic Dysfxn definition?

A

inability to relax/fill

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7
Q

HF: Left-Sided

Diastolic Dysfxn etiology?

A

Ischemia
Fibrosis
Sarcoids

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8
Q

Left HF Hemodynamic changes due to?

A

Pulmonary Edema caused by ↑ pressure in:
LA
pulmonary veins
pulmonary capillaries

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9
Q

↑ in Pulmonary arterial P causes what?

A

↑ after load on RV

(P) Right HF

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10
Q

Right side of heart is what type of system?

A

low P

high compliance

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11
Q

Increase in what leads to Right-Sided issues?

A

afterload

e.g. (P) caused by pulmonary embolism, chronic pulmonary disease

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12
Q

Right HF Hemodynamic changes due to?

A 
↑  RA pressure
↑  venous P
↑  capillary P
↑  tissue fluid
↑  PERIPHERAL EDEMA
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13
Q

HF effect on:

EF?
Vent dilation?
Resting SV?
Cardiac Index?
Rest HR?
Exercise Intolerance?
A

EF 5.6cm @ ED
Rest SV <2.5L/min/m2
Rest HR 75-105/min
EI: CO ↓ 40%, SV ↓ 50%

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14
Q

NYHA HF classification system:

Class 1

A

No limit on physical activity

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15
Q

NYHA HF classification system:

Class 2

A

Sxs cause slightly ↓ physical activity

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16
Q

NYHA HF classification system:

Class 3

A

DOE (sxs w/ ADL)
Marked ↓ physical activity
Asympt at rest

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17
Q

NYHA HF classification system:

Class 4

A

Severe ↓ phy activity

Sxs at rest

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18
Q

ACC/AHA HF classification system:

Stage A

A

No structural abnorm but high risk for developing HF

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19
Q

ACC/AHA HF classification system:

Stage B

A

Structural disorder but no HF sxs

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20
Q

ACC/AHA HF classification system:

Stage C

A

Past or current sxs and structural dx

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21
Q

ACC/AHA HF classification system:

Stage D

A

end-stage HF

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22
Q

HF signs? (4)

A

Edema (2º to vol overload)
Rales @ bases
JVD
S3/4 (early)

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23
Q

HF sxs? (5)

A 
Dyspnea
Fatigue (2º to low perfusion)
Cough (nocturnal, non-productive)
Early satiety (2º to hepatic congestion)
Nocturia (2º to ↑ renal perfusion when supine)
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24
Q

Left HF presentation?

A 
Dyspnea (fluid in lungs)
Diaphoresis (sweat)
Tachypnea (fluid in lungs)
Tachycardia
Rales
S3/4
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25
Right HF presentation?
Peripheral edema RUQ pain JVD Ascites (serous fluid in peritoneum)
26
Systolic dysfxn presentation?
``` Hx valve dx, DM, CAD S3/4 Mitral regurge Rales Cardiomegaly JVD ```
27
Diastolic dysfxn presentation?
Hx HTN, DM S4 Rales LVH
28
HF ddx
``` PUD Asthma COPD PNA PE ARDS ```
29
HF tests: ECG?
= Ischemia, arrhythmia
30
HF tests: Echo?
Syst dysfxn = EF < 40%, dilated LV Diast dysfxn = EF >45% (normal), LVH
31
HF tests: CXR?
= cardiomegaly, r/o pulmonary etiology
32
Transudative vs exudative?
``` Trans = fluid move in to tissue/capillary (HF) Exud = fluid moved out of tissue/capillary ```
33
HF tests: CBC?
look for anemia (can exacerbate HF)
34
HF tests: CMP?
(Ca2+, Mg, PO4) liver fxn r/o DM
35
HF tests: Thyroid panel?
hypothyroidism can exacerbate HF or present as HF
36
HF tests: BNP
(brain-type natriuretic peptide) = ↑ levels use to differentiate pulmonary dz from HF
37
Brain-type Natriuretic Peptide released in response to?
vent wall stretching
38
HF management?
cause risk factors sxs review meds for for adverse rxn
39
HF goals of tx?
↓ preload -> ↓ congestive sxs ↓ afterload -> ↑ cardiac fxn
40
HF tx: | Stage A/Class 1-3
ACE inhibitor
41
HF tx: | Stage B-C/Class 1-3
ACE inhib β block diuretics
42
HF tx: | Initial therapy for ALL pts
ACE inhibitor Digoxin diuretics
43
Systolic/Diastolic dysfxn tx?
Treat systolic
44
Diastolic dysfxn U found in who?
old F w/ HTN, DM
45
ACE inhibitor benefits?
↓ morbidity and mortality | in sympt and asympt pts
46
Angiotensin-receptor blockers (ARBs) benefits? Use when? Monitor what?
↓ morbidity and mortality ↓ sxs use if can't use ACE inhib BP, renal fxn, electrolytes
47
β blockers benefits?
↓ mortality not for unstable pts
48
Diuretics benefits?
Loop-type prefered manage fluid overload unproven
49
Spironolactone is?
``` Aldosterone antagonist (K+ sparing diuretic) ```
50
Spironolactone indicated for?
dyspnea at rest | post-MI w/ syst dys
51
Spironolactone benefits?
↓ mortality
52
Spironolactone side-effect?
(P) hyperkalemia
53
Digoxin is?
Inotropic (contractility) agent
54
Digitoxin benefits?
↓ sxs | ↑ exercise tolerance
55
Drugs that worsen HF? (6)
``` NSAIDS Glucophage (DM) boner meds TCAs (tricyclic) Sporanox (antifung) Tegretol (seizures, nerve pain) ```
56
Pulmonary edema results from?
↑ venous P | a/w HF, MI, ischemia, mitral stenosis
57
Pulmonary edema (from HF) presentation?
dyspnea PRODUCTIVE cough diaphoresis (sweat)
58
Pulmonary edema exam findings?
rales wheeze rhonchi
59
Pulmonary edema CXR findings?
Kerley B lines edema cardiomegaly
60
Pulmonary edema Pulmonary Capillary Wedge test findings?
pressure elevated >25mmHg
61
Pulmonary edema management?
"MOND" Morphine (↓ anxiety, ↓ work of breathing) O2 (goal >90%) Nitrates (↓ preload, cap wedge pressure) Diuretics (↓ fluid, congestion)
62
Decompensation is?
worsening of HF sxs due to progression beyond tx
63
Most common cause of Decompensation?
inadequate reduction of therapy
64
Decompensation evaluation?
Eval for Δ in personal life Focused cardiac exam If no finding, labs (look for K+ Δs)
65
Decompensation management?
"MOND tro" Same as pulmonary except nitro instead of nitrate Nitroglycerin (reduce preload and capillary wedge pressure)
66
Most common causes of death w/ HF?
Decompensation (pump failure) | Malignant arrythemias
67
Statins use in HF?
(lowers cholesterol) | 2º prevention of CVD
68
Most common cause of HF?
LV systolic dysfxn

Q2 Clin Med Final (Cardiology, Hyperlip) (8 decks)

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