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Cardiovascular > 04.17 - Heart Failure (Nichols) > Flashcards

04.17 - Heart Failure (Nichols) Flashcards

1
Q

___ stroke volume is often a threshold of heart failure, when pts begin to have symptoms

A

25% reduction in forward stroke volume

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2
Q

2 causes of Systolic Dysfunction

A

Ischemic heart disease, HTN

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3
Q

2 Symptoms of Right Heart Failure

A

(1) Edema of feet, then ankles, then legs; (2) Abdominal Distention

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4
Q

4 causes of Diastolic Dysfunction

A

Massive LV Hypertrophy, Myocardial Fibrosis, Amyloidosis, Constrictive Pericarditis

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5
Q

4 Left Heart Failure Signs

A

(1) Bibasilar Pulmonary Crackles; (2) Tachycardia; (3) S3; (4) Pedal, ankle, or leg edema

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6
Q

4 Right Heart Failure Signs

A

(1) Pedal, ankle, or leg edema; (2) Jugular Venous Distension; (3) Hepatomegaly; (4) Ascites

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7
Q

4 symptoms of Left Heart Failure

A

(1) Dyspnea on exertion progressing to at rest; (2) Orthopnea; (3) PND; (4) Fatigue

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8
Q

Action of BNP

A

Vasodilation, Increased Urinary Sodium Excretion (Counterregulatory)

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9
Q

Acute Heart Failure patients have what 2 major spectrums

A

Congestion and Perfusion

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10
Q

Ankle and Pretibial edema is a hallmark of

A

Right Heart Failure

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11
Q

Aortic regurgitation causes a heart murmur during

A

Diastole

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12
Q

Aortic Stenosis causes a heart murmur during

A

Systole

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13
Q

Best measure of hypertrophy in volume-overloaded hearts

A

Heart weight, rather than wall thickness

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14
Q

Biochemical sign of shock

A

Elevated Serume Lactate from anaerobic metabolism

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15
Q

Complications of A Fib in left sidede heart failure

A

Reduced stroke volume, thrombosis

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16
Q

Diastolic Dysfunction is inability to

A

Relax and Fill

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17
Q

Diastolic Dysfunction/ HF with Preserved Ejection Fraction + Decompensation =

A

Systolic Dysfunction; HF w Decreased Ejection

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18
Q

Diastolic Heart Failure is aka

A

Heart Failure with Preserved Ejection Fraction

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19
Q

Earliest and most significant symptom of left sided heart failure

A

Dyspnea

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20
Q

Gross morphologic changes in left ventricle due to left sided heart failure dilation (besides hypertrophy)

A

Papillary muscles displace outward –> Mitral regurg (systolic murmur)

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21
Q

HF in which populations may be more commonly attributable to Diastolic Dysfunction

A

Elderly, Women, Diabetics

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22
Q

In left sided heart failure, where does fluid accumulate in lungs

A

Alveoli, Interstitium, Pleura (Effusion)

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23
Q

In most cases of chronic cardiac decompensation, pts present with

A

Biventricular CHF, encompassing the clinical syndromes of both right and left HF

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24
Q

Initial symptom of heart failure is usually only with __ and is ___

A

Exertion, Dyspnea

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25
Q

Is mitral valve regurgitation a cause or effect of heart failure?

A

Can be either

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26
Q

Key morphologic finding in lungs of left sided heart failure

A

Heart Failure Cells: Hemosiderin-laden Alveolar Macrophages

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27
Q

Management of Acute HF should be directed toward a __ profile

A

Warm and Dry

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28
Q

Mitral regurgitation causes a heart murmur during

A

Systole

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29
Q

Mitral stenosis causes a heart murmur during

A

Diastole

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30
Q

Most cases of heart failure are due to ___ dysfunction

A

Systolic

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31
Q

Most common cause of isolated right sided HF

A

Severe Pulmonary HTN –> Cor Pulmonale

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32
Q

Most common causes of left sided cardiac failure

A

IHD, systemic HTN, Mitral or Aortic Valve disease, primary diseases of myocardium

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33
Q

Most common clinical scenario for Heart Failure with Preserved Ejection Fraction

A

Elderly, Long-standing HTN, Obesity, Concentric LV Hypertrophy

34
Q

Most common type of shock?

A

Distributive (Septic), then Cardiogenic and Hypovolemic

35
Q

Most heart failure patients have both ___

A

left and right heart failure

36
Q

Normal central venous pressure range (and average)

A

2-8 mmHg (6 average)

37
Q

Normal Ejection Fraction Range

A

50-75% (average 60)

38
Q

Normal LVEDP Range

A

4-12 (10 average)

39
Q

Normal LVEDV Range

A

65-240 (120-150 average)

40
Q

Normal LVESV Range

A

15-145 (average 50)

41
Q

Normal Pulmonary Capillary Pressure

42
Q

Normal Stroke Volume

A

55-100 (70 average)

43
Q

Patients with large MI’s do NOT go thru

A

a phase of diastolic dysfunction, heart failure with preserved ejection fraction

44
Q

Patients with large MI’s go straight to

A

HF w Systolic Dysfunction and Decreased Ejection Fraction

45
Q

Pattern of Hepatic Passive Congestion is referred to as

A

Nutmeg Liver

46
Q

Peptide elevated in heart failure patients

A

B-type Natriuretic Peptide

47
Q

Primary microscopic changes in Left Sided Heart Failure

A

Myocyte hypertrophy with interstitial fibrosis

48
Q

Respiratory symptoms in Right HF?

A

Very few, unlike left

49
Q

Result of Atrial Natriuretic Peptide release?

A

Diuresis and Vascular SM relaxation

50
Q

Right sided heart failure is usually the consequence of

A

Left Sided HF

51
Q

Severe acute uncompensated aortic regurgitation is a

A

surgical emergency

52
Q

Skin signs of shock

A

Mottled, Cold, Clammy, Pale, or Cyanotic

53
Q

Structural changes that occur in Pressure Overload State

A

Concentric Hypertrophy – Vent thicker w/out increase in size of chamber

54
Q

Structural changes that occur in Volume Overload State

A

Dilated ventricle; Wall thickness can decrease, stay same, or increase

55
Q

T/F: Morbid obesity can cause heart failure by itself

56
Q

Take Home Point: BNP is

A

Counterregulatory

57
Q

The dx of shock is based on __ signs

A

Clinical, Hemodynamic, and Biochemial

58
Q

The Pulmonary Capillary Wedge pressure is approx the same as

A

Left Atrial Pressure and Left Vent End-Diastolic Pressure (LVEDP)

59
Q

Three major things that lead to Diastolic Dysfunction/ HF w Preserved Ejection Fraciton

A

(1) Compensated HTN Heart Disease; (2) Compensated Hypertrophic Cardiomyopathy; (3) Compensated Restrictive Cardiomyopathy

60
Q

Three windows of clinical shock

A

Behavior, Skin, Urine

61
Q

Tx for Wet Acute HF

62
Q

Tx for Wet and Cold Acute HF

A

Vasoactive therapy (vasodilators, inotropes) with Diuresis

63
Q

Type of edema seen in bedridden right HF patients?

64
Q

Urine signs of shock

A

Decreased Output

65
Q

Ventricular dilation comes at expense of

A

Increased wall tension and amplifies oxygen requirements of myocardium

66
Q

What can cause Pulmonary Edema with normal Pulmonary Capillary Pressure?

A

Septic Shock

67
Q

What can cause Pulmonary Edeme with low pulmonary capillary pressure?

A

Hemorrhagic Shock

68
Q

What causes fine rales at lung base in left sided heart failure?

A

Opening of edematous alveoli

69
Q

What causes Systolic Murmur in left sided HF

A

Vent Dilation –> Papillary muscles displace outward –> Mitral regurg

70
Q

What increases risk of A Fib in left sided heart failure

A

Atrial Dilation

71
Q

What is anasarca?

A

Generalized massive edema

72
Q

What is backward failure?

A

Increased congestion of the venous circulation

73
Q

What is compensated heart failure?

A

Increased EDV dilate heart –> Increased stretching –> Increased contraction force –> Increased CO

74
Q

What is decompensated heart failure?

A

Ventricular dilation comes at expense of increased wall tension –> Amplifies O2 requirements fo mycocardium –> failure muscle eventually can’t meet needs of body

75
Q

What is Distributive Shock?

A

Vasodilation –> Capicitance of vascular system too big for amount of blood availabe

76
Q

What is Obstructive Shock?

A

PE, Hyperpericardium (Cardiac Tamponade)

77
Q

What type of edema is a hallmark of righ heart failure

A

Ankle and Pretibial

78
Q

Which comes first: Dyspnea or Transudation of Fluid into lungs?

A

Dyspnea in case of increaed venous pulmonary pressure

79
Q

Which comes first: Interstitial or Alveolar Pulmonary Edema?

A

Interstitial (20mmHg), then Alveolar (25mmHg)

80
Q

Why do Left Heart Failure pts have edema?

A

Decreased renal perfusion, increased sodium retention, increased osmotic pressure then ADH

81
Q

Why do left sided HF patients experience Orthopnea

A

Supine increases venous return from lower extremities and also elevates diaphragm

82
Q

Worst prognosis type of Acute HF

A

Cold and Wet (40% mortality)

Cardiovascular (18 decks)

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