Lec 5 Heart Failure I Flashcards Preview

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Flashcards in Lec 5 Heart Failure I Deck (58):
1

What is definition of heart failure?

cardiac disorder that impairs ability of ventricles to eject blood [fwd failure] or fill with blood [backward failure] or both

2

What is equation for CO?

CO = HR * SV

3

What 3 factors can affect stroke volume?

- preload
- afterload
- contractility

4

What are signs of systolic CHF?

- decreased CO
- decrease LVEF [left ventricular ejection fraction] < 50% normal

poor contractility
often 2ndary to ischemic heart disease

5

What are signs of diastolic HF?

- normal LVEF [left ventricular ejection fraction]
- high LV, RV, end-diastolic pressures

normal contractility, impaired relaxation, impaired compliance

6

If you see decreased ejection fraction (<50% normal) what possible causes of the heart failure?

decreased EF --> decreased contractility or increased afterload

if impaired contractility:
- MI
- chronic volume overload [aortic or mitral regurgitation]
- dilated cardiomyopathy [DCM]

if increased afterload:
- AS [aortic stenosis]
- HTN

7

What is equation for ejection fraction?

EF = SV / EDV

SV = EDV - ESV

8

If you see normal ejection fraction in heart failure what possible causes?

due to impaired diastolic filling

- LV hypertrophy
- restrictive cardiomyopathy
- myocardial fibrosis
- pericardial tamponade

9

What are 3 compensatory mech in heart failure?

- frank-starling mech
- ventricular hypertrophy
- neurohormonal activation

10

How does heart failure change starling curve?

- in heart failure:
---- shift right in curve [decreased contractility]
---- move right along new HF curve [compensatory try to increase stroke volume/pressure at cost of increasing congestion

11

What is equation for wall stress?

wall stress = pressure * radius / thickness

12

How does ventricular hypertrophy help failing ventricle?

increased thickness --> decreased wall stress of ventricle

13

What kind of ventricular hypertrophy if there is volume overload?

eccentric hypertrophy = new sarcomeres in series with old

14

What kind of ventricular hypertrophy if there is pressure overload?

concentric hypertrophy = new sarcomeres in parallel with old

15

What compensatory mech in HF?

hypertrophy --> increase ventricular mass --> increase atrial pressure

frank-starling --> increase ventricular end diastolic volume --> increase atrial pressure

16

What are the 3 neurohormonal systems that are compensatory mech in heart failure?

- adrenergic nervous system [sympathetic]
- RAAS
- ADH

17

What is equation for systemic vascular resistance?

BP [svr] = CO * TPR

18

What are clinical symptoms of left sided heart failure?

- dyspnea
- orthopnea [SOB when lie flat]
- cough
- PND [Paroxysmal nocturnal dyspnea]
- fatigue

19

What are clinical symptoms of right sided heart failure?

- edema
- right upper quadrant pain
- anorexia

20

What are clinical findings of left ventricle failure?

- tachycardia
- pleural effusion
- systolic/diastolic dysfunction [S3/S4]

21

What are clinical findings of right ventricle failure?

- JVD
- hepatomegaly
- peripheral edema

22

What is first heart sound [S1]? Where is it loudest?

mitral and tricuspid valve closure

loudest at mitral area

23

What is 2nd heart sound [S2]?

aortic and pulmonary valve closure

loudest at left sternal border

24

What is 3rd heart sound [S3]?

in early diastole during rapid ventricular filling phase

associated with increased filling pressure and more common in dilated ventricles

25

What is 4th heart sound [S4]?

atrial kick

in late diastole
high atrial pressure, associated with ventricular hypertrophy

26

What are 4 stages of chronic HF?

Stage A: high risk of HF without structural heart disease or symptoms

Stage B: heart disease with asymptomatic LV dysfunction

Stage C: prior or current symptoms of HF with structural heart disease

Stage D: advanced heart disease and severely symptomatic or refractory HF

27

Why do you check CBC lab in CHF?

to check for anemia

28

Why do you check electrolyte/creatine lab in CHF?

before you start high dose diuretic

29

Why do you check fasting glucose lab in CHF?

diabetes can contribute to CHF

30

Why do you check thyroid function lab in CHF?

thyrotoxicosis and hypothyroidism can cause CHF

31

Why do you check iron lab in CHF?

check for hereditary hemochromatosis

32

Why do you check ANA [antinuclear antibody] lab in CHF?

check for autoimmune [SLE = lupus]

33

Why do you check viral studies in CHF?

check for viral myocarditis

34

Why do you check BNP lab in CHF?

usually elevates (>400) in pt with HF

35

What should you look for in HF chest xray?

- cardiomegaly
- vascular redistribution interstitial edema
- alveolar edema
- pleural effusion

36

What should you look for in EKG in HF?

- ischemic heart disease
- 1st AV block, left anterior fascicular block
- amylodidosis
- idiopathic dilated cardiomyopathy [LVH]

37

What should you look for in echo in HF?

- get ejection fraction to help determine what type of HF
- tells you about structure/function of LV/RV and valves

38

When should you do coronary artery angiogram in HF? WHat does it tell you?

- in pt with HF and angina or significant ischemia or suspected CAD

measures CO, LV dysfunction, LV end diastolic pressure

39

How do you treat pulmonary/systemic congestion?

give diuretic = get rid of fluid

40

How do you treat low cardiac output in HF?

give vasodilator or ionotropic drugs

41

What is action/use of diuretics?

- promote elimination Na and water via kidney
- reduces venous return to heart and relieves pulmonary congestion

-- no mortality benefits just provides symptomatic relief

42

What happens if over diuresis?

fall in CO

43

What is action of nitrates?

- venous vasodilators
- increase venous pooling, decrease venous return to heart

44

What is action of hydralazine?

- arteriolar vasodilators
- decreases systemic vascular resistance [SVR]
- decreases LV afterload
- increases stroke volume

45

What is action of ACEI/ARBs?

arteriolar and venous dilators

46

What is action of ace inhibitors?

- inhibit formation angiotensin II and decreases aldosterone
- improves Na elimination --> decreased intravascular volume

47

What should you use if ace inhibitor not tolerated?

ARB

48

What is action of beta blockers?

improve overall and event free survival in class 2, 3, 4 CHF

49

What are contraindications of beta blockers?

- HR < 60/min
- symptomatic bradycardia
- peripheral hypoperfusion
- COPD/asthma
- 2nd or 3rd degree AV block

50

What is digoxin?

inhibits Na/K ATPase causing indirect inhibition Na/Ca exhanger
- increases intracellular Ca
- increased contractility
- use to control HF symptoms
- decrease hospitalizations in HF
- no benefit to mortality

51

What are possible inotropes in HF?

- digoxin
- phosphodiesterase inhibitiors
- beta agonists

52

What is action of spironolactone and eplerenone?

- aldosterone antagonists
- increase diuresis, improve survival CHF

53

What is use of implantable defibrillator in HF?

- mortality of HF due to sudden cardiac death caused by arrhythmias
- increases survival benefit esp with cardiomyopathy and LVEF

54

What is use of cardiac resyncronization?

- increases LV systolic function
- increase exercise capacity
- decrease frequency of HF exacerbation

55

What do you use to treat diastolic HF dysfunction?

- problem is not a weak pump its a stiff un-relaxing pump

- treat underlying HTN or pericardiectomy
- don't give inotrope, be careful with diuretic

56

What is acute decompensated HF?

fluid goes into lungs secondary to high LA pressure and pulm venous and capillary pressures

--> cardiogenic pulmonary edema

57

What are causes of acute decompensated HF?

- acute mechanical event: rupture chordae tendinae/acute MR
- volume overload
- valvular defect [aortic stenosis]

58

How do you treat acute decompensated HF?

LMNOP

- Loop diuretic
- Morphine
- nitroglycerine [vasodilator]
- Oxygen
- positive pressure ventilation