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ACCSAP > HF/ Cardiomyopathy > Flashcards

HF/ Cardiomyopathy Flashcards

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1
Q

headaches/fatigue
OSA tx
Central apnea

A

sleep apnea
CPAP
optimize volume and GDMT

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2
Q

rapidly progressive HF, may be in refractory shock+ ventricular arrhythmias+ h/o autoimmune d/o in young, previously healthy person

A

endomyocardial biopsy to eval for giant cell myocarditis

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3
Q

VAD complications

A

Bleeding, stroke, driveline infection, RV dysfunction, and device failure/thrombosis

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4
Q

myocarditis presentation

long term

A 
mild dyspnea or chest pain that resolves spontaneously to arrhythmias and cardiogenic shock
dilated cardiomyopathy (DCM) with heart failure
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5
Q 
restrictive cardiomyopathy (amyloid, infiltrative, inflammatory, and endomyocardial processes)
hemochromatosis,  myocarditis, tachy CM, peripartum CM, takotsubo
A 
biventricular HF, severely elevated BNP, low voltage, biatrial enlargement
dilated CM (increased EDV, decreased EF, and increased eccentric myocardial mass)
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6
Q

myocarditis treatment

A

standard HF therapy, no immunosupression

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7
Q

Heart block/ ventricular arrhythmias + cardiomyopathy

A

lyme disease

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8
Q

chagas ECG

chagas echo

A

right bundle branch block, left anterior fascicular block, and atrioventricular block
ventricular dysfunction, segmental wall motion abnormalities, and apical aneurysms

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9
Q

hypersensitivity myocarditis

diagnosis

A

temporal association b/w onset of HF and new med

biopsy

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10
Q

chemo (anthracyclines, HER2 antagonists, and TKI therapy) induced cardiomyopathy definition

A

decrease in global EF/ more severe in septum
CHF signs and symptoms
LVEF drop of ≤5-55% with signs/symptoms
LVEF drop of ≤10-55% with signs/symptoms
MUGA is equivalent to echo

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11
Q

pulm htn in HFpEF

A

related to elevated left heart filling pressures

treat BP, diurese, control ventricular rate

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12
Q

hypotension in patients with obstructive CM

A

Avoid increasing contractility (will increase gradient and reduce output)
Choose agents that increase afterload (phenylephrine), alpha agonists)

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13
Q

excitation-contraction coupling

A

calcium enters cell-> calcium released from SR-> binds to troponin C-> displaces tropomyosin-> cross bridge formation

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14
Q

greatest risk factors for HF

A

hypertension and CAD

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15
Q

lifetime risk for development of HF at age 40

A

1 in 5

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16
Q

ICD in HCM

A

personal history of sudden cardiac death (SCD), ventricular fibrillation, or hemodynamically significant VT, first-degree relative with SCD, maximum wall thickness >30 mm, and one or more recent syncopal episodes, hypotension with exercise

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17
Q

HFpEF facts

A

50% of HF, as fatal as HFrEF
female, older, and hypertensive
prevalence increasing

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18
Q

torsemide> furosemide because

A

better oral bioavailability

switch if lasix is not working

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19
Q

Risk factors for anthracycline CM

A

lifetime dose, intravenous bolus admin, higher single doses, h/o of mediastinal radiation, use of other cardiotoxic agents such as cyclophosphamide, trastuzumab, and paclitaxel, female, underlying cardiovascular disease, extremes of age, increased time since therapy completion, prechemo EF <50%

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20
Q

most common viruses to cause myocarditis in the West

A

parvovirus B19 and HHV-6

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21
Q

spironolactone for HFpEF

A

TOPCAT, neutral

subgroup analysis in North American patients positive, but jury is still out

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22
Q

hypertensive acute heart failure

A

use vasodilators: nitroglycerin, isosorbide mononitrate, isosorbide dinitrate, and sodium nitroprusside, captopril?

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23
Q

Brockenbrough sign (HOCM)

A

post PVC increased contractility-> interventricular septum to anterior leaflet of mitral valve-> obstruction -> stroke volume and aortic pulse pressure falls

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24
Q

Post PVC

A

increased contractility and increased preload-> increased pressure gradient
in AS, subaortic membrane, and HOCM

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25
Inotropy for palliation | end stage HF
continuous, intermittent has not been studied | Cardiac transplant or VAD-> continuous inotropy if not a candidate for others
26
preservation of the base and a large segment of apical ballooning, severely elevated BNP treatment
takotsubo ACEI/ BB
27
peripartum cardiomyopathy + severely reduced EF
anticoagulation, avoid preg
28
renal dysfunction in acute HF
venous congestion (hypervolemia without shock), low renal perfusion (cardiogenic shock), and dysfunctional autoregulation of the kidney
29
ventricular arrhythmias in HF
amiodarone, search for ischemia, electrolyte disturbances, or drug-induced QT prolongation
30
high RA pressure+ blunted y descent | steep x+ y descents
tamponade | constriction
31
survival after heart transplant
90% at 1 year, 70-75% at 5 years, and 50% beyond 10 years.
32
myocarditis treatment
GDMT
33
MRA indication
NYHA class II-IV heart failure with an LVEF of 35% or less, cr <2.5 in men and <2 in women, potassium < 5
34
heart failure diagnosis
go by exam
35
isordil/hydra
``` AA, NYHA class III-IV heart failure and reduced EF on ACEI+ BB Or anyone who cannot be given ACEI/ARB ```
36
risk factor that confers worst prognosis
inability to tolerate ACE inhibitors due to either hypotension or renal failure others are hyponatremia, renal insufficiency, anemia, elevated natriuretic peptides, and elevated troponins
37
RHC indication
ADHF-> not responding as expected | in consideration for inotropes, LVADs, transplant
38
best predictors for hospital mortality in ADHF
blood urea nitrogen (≥43 mg/dl), followed by low SBP (<115 mm Hg), and high serum creatinine (≥2.75 mg/dl)
39
Fabry's disease
alpha-galactosidase A deficiency HFpEF+ chest pain, normal coronary arteries, LV hypertrophy, and renal dysfunction family history of HF in males, X linked
40
endocardial thickening and mural thrombi as well as peripheral eosinophilia
Loeffler endocarditis
41
HF+ atrioventricular block or ventricular arrhythmias
sarcoid
42
5 yr mortality rate in new HF
50%
43
ADHF in hospital diuresis loop diuretics bumex to lasix
initial IV dose should equal or exceed home dose, drip is not better lasix, bumex (more potent) 2 mg IV bumex= 80 mg IV lasix
44
beta blocker therapy complication
volume retention-> increase diuretic, do not decrease beta blocker
45
pressure volume loop change in area shift up/down shift left/right
change in stroke volume (preload/ afterload) change in LV stiffness change in contractility (decreased by BB/CCB, increased by inotropy)
46
Familial cardiomyopathy (different from Fabry) diagnosis
clinical, 3 generations affected
47
myocardial remodeling in MI Endothelin activator prevent remodeling with
activation of the sympathetic nervous system+ RAAS= endothelin-1, collagen turnover, reduced nitric oxide activity, and cellular apoptosis-> increased ventricular size and sphericity, decreased contractile performance, and eventually HF angiotension (use ACEI/ARB) NO, ANP, and BNP
48
heart failure workup
only get cath if you suspect CAD (for ex not in 25 yo), biopsy is not routine (get it for things like giant cell), do it for new-onset heart failure of 2 weeks to 3 months with a dilated LV and new ventricular arrhythmias, second- or third-degree heart block, or failure to respond to usual care within 1 to 2 weeks.
49
CM+ high grade heart block differential
lyme, chagas, giant cell, sarcoid
50
weird increase in o2 sat in swan
distal migration to pulmonary vein (RA o2 can be higher than PA depending on where it is sampled, IVC can be higher)
51
prevent anthracycline CM with
dexrazoxane, use of liposomal anthracycline preparations, and use of prolonged continuous infusions rather than boluses, ACEI/BB if indicated?
52
TIA/CVA event+ carotid artery disease
aspirin+ statin | no advantage of PFO closure
53
risk factors for peripartum CM Treatment
Advanced maternal age, multiparous status, multi-fetal gestation, African descent, history of hypertension/pre-eclampsia, and cocaine abuse If hemodynamically stable, ACEI+BB can consider advanced therapies if not recovering
54
HFpEF diagnosis (exertional dyspnea and fatigue w/o clear hypervolemia)
an exaggerated elevation in systemic blood pressure and intracardiac filling pressure response to exercise, augmentation in cardiac output is blunted, lack of chronotropic response
55
grade I DD grade II DD
normal filling pressures, E/A ratio <0.8; DT >200 msec and averaged E/e’ ratio 2, decrease of E/A ratio of >0.5 with Valsalva; DT <160 msec, and averaged E/e’ ratio >13 moderately elevated filling pressures, Left atrial volume index >34 cc/m2, E/A ratio: 0.8-1.5; change with Valsalva >0.5, (DT) (msec): 160-200, E/e’ ratio: septal >15; lateral >12 or averaged >13.
56
markers of advanced HF
recurrent hospitalization, narrow pulse pressure, resting tachycardia, intolerance to ACE inhibitor, dilated ventricle, and electrical instability
57
CI to cardiac transplant
ongoing substance abuse, pulmonary hypertension, advanced age, obesity, or poor renal function
58
treatment of central sleep apnea in HF
optimize HF treatment
59
amyloid diagnosis
endomyocardial biopsy
60
most common cause of death in first 30 days after heart transplant first year post transplant
primary graft failure (older donor age, more ischemia), then infection rejection
61
best assessment of HF prognosis
``` functional capacity (CPET) oxygen consumption <14cc/kg/min-> transplant ```
62
severe decompensated HF in patient awaiting transplant
inotropy-> LVAD
63
chemo agents that cause CM
anthracyclines, trastuzamab (herceptin), TKIs (sunitinib)
64
target BB dose
coreg 25 mg BID, metop sux 200 mg daily
65
CI to impella CI to IABP CI to TandemHeart CI to VA-ECMO
LV thrombus moderate / severe AR left atrial thrombus severe PVD
66
lower cholesterol in HF
worse prognosis, related to poor nutritional status/ cachexia
67
HF exam+ hpi kings
JVP and orthopnea are most consistent w/ congestion
68
HF epidemiology
more common in older men than women treatment of BP in people > 80 yo significantly reduces HF At 40 years, the lifetime risk of developing HF is 20%
69
low voltage despite LVH
infiltrative disease (amyloid)
70
recurrence of CM in recovered peri partum cm | persistent peripartum cm
20%, no deaths | 44%, 19% risk of mortality
71
HCM assessment with inconclusive echo
Obtain MRI, varied presentations as far as which walls are hypertrophic and clinical presentation
72
Reduce HF readmissions with
GDMT, disease education

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