17. Heart Failure II - Diagnosis & Treatment Flashcards
What is S2?
aortic/pulmonary valve closure
A right heart catheterization gives what measurements?
pressures (CVP/RA, RV, PA, PCWP) and flow (Fick CO- O2 consumption measure, and thermodilation CO- timed flow measure)
Name 3 signs of low flow in HF.
- cool extremities 2. tachycardia 3. low pulse pressure
What is S1?
the mitral/tricuspid valve closure
What is Acute pulmonary edema?
- Acute intense shortness of breath – Occurs once fluid retention / left atrial pressure overwhelms compensatory mechanisms (e.g. lymphatic fluid return) – Fluid spills from the pulmonary vasculature into the interstitial space and then into the alveoli, producing hypoxia – Increase vascular prominence on CXR first, followed by “fluffy” infiltrates
An S3 gallop is thought to be caused by _____.
rapid expansion of the ventricular walls in early diastole
An S4 gallop is caused by _____.
atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic LV
Decreased cardiac output causes what symptom of HF?
symptoms of decreased organ perfusion
With a person lying flat or with JVD in HF, the _____ fills with blood. Thus the neck veins will appear full on visual examination. More importantly, they will transmit pressure changes in the right atrium as waves.
jugular vein (internal and external)
_____ = CVP = right atrial pressure
JVP
What is a right heart catheterization?
A plastic catheter introduced into one of the major veins and then “floated” through the right heart into the pulmonary artery - Has a balloon on the end of it to help blood flow carry it into the lungs - The balloon also allows a branch of the pulmonary artery to be occluded so that the downstream pressure (post-capillary wedge pressure [PCWP]) can be measured, which is equivalent to the left atrial pressure / left-sided filling pressure.
EF = ?
(end diastolic - end systolic volume) / end diastolic volume
What does an echo tell?
LVEF (systolic function) Chamber size (dilation) LV wall thickness (hypertrophy) Measures of relaxation (diastology) Valvular anatomy and function Estimated filling pressures (LA, CVP) Estimated pulmonary pressures (pulmonary hypertension)
An _____ is caused by atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic LV.
S4 gallop
What does PND stand for?
Paroxysmal nocturnal dyspnea
By definition, what is absent in A-fib?
S4 gallops
What are 2 other names for a R heart catheterization?
Pulmonary Artery (PA) Catheter, or a Swan-Ganz catheter
Decreased cardiac output (low flow) causes what symptoms of HF?
- decreased muscle perfusion 2. decreased gut perfusion 3. decreased kidney perfusion 4. exercise intolerance
Name 3 signs of elevated R sided pressures.
- edema 2. hepatic congestion/hepatomegaly 3. JVD, increased central venous pressure (CVP)
When is an S3 gallop typical?
HFrEF/dilated heart
What is a normal EF? HFrEF?
60%; 25%
What is the mitral/tricuspid valve closure?
S1
What is an echocardiogram?
an ultrasound of the heart
What is cachexia?
wasting
JVP = ____ = right atrial pressure
CVP
What is NT-proBNP?
the N-terminus breakdown product of BNP that is increased with age and esp renal failure
Name 5 signs of elevated L-sided filling pressures.
- rales (pulmonary crackles) 2. hypoxia 3. tachypnea 4. sitting bolt upright 5. popping open of alveoli
What are rales? What causes them?
pulmonary crackles- sounds like velco being pulled apart upon inspiration- due to wet alveoli opening
When is an S3 gallop normal? Abnormal?
normal: young people abnormal: after age 30
Increased pulmonary venous pressure causes what symptom of HF?
breathlessness
What is immediate SOB when lying flat because of lost venous pooling of blood in the legs?
orthopnea
What is the aortic/pulmonary valve closure?
S2
What is the test that is a gross measure of systolic function?
left ventricular ejection fraction (LVEF)
What are the 3 major pathophys causes of HF?
- decreased cardiac output 2. increased pulmonary venous pressure 3. increased central venous pressure
An _____ is thought to be caused by rapid expansion of the ventricular walls in early diastole.
S3 gallop
Increased R sided filling pressure causes?
• Peripheral swelling / dependent edema • Ascites • Hepatic congestion • Intestinal congestion (protein-losing enteropathy)
With a person _____, the jugular vein (internal and external) fill with blood. Thus the neck veins will appear full on visual examination. More importantly, they will transmit pressure changes in the right atrium as waves.
lying flat or with JVD in HF
Normal JVP is ____.
< 5 cm H2O
With a person lying flat or with JVD in HF, the jugular vein (internal and external) fill with blood. Thus the neck veins will appear full on visual examination. More importantly, they will transmit _____ in the _____ as waves.
pressure changes; R atrium
JVP = CVP = _____
right atrial pressure
What is Paroxysmal nocturnal dyspnea (PND)?
– Delayed SOB, waking patients from sleep – Classically patient gets out of bed and ambulates to relieve symptoms – Relates to mobilization of edema from tissue through lymphatics back into blood stream
When is an S4 gallop typical?
never
What EKG findings will be seen in HF?
no direct diagnosis- would infer from other findings, like Q wave abnormalities (prior MIs), increased voltage (LVH), arrhythmias, diffuse conduction
What will be found on a chest xray in HF?
- enlarged cardiac silhouette in HFrEF - increased upper lobe vascular markings with acute decompression - fluffy infiltrates of PE - plural effusions
What are two assays used to detect natriuretic peptides in HF?
- BNP 2. NT-proBNP
What is Orthopnea?
Immediate SOB when lying flat because of lost venous pooling of blood in the legs
Increased central venous pressure causes what symptom of HF?
edema
What tests are used to diagnose HF?
Chest Xray natriuretic peptides EKG cardiac imaging
Does a low BNP or NT-proBNP rule in or rule out HF?
it would rule out- high is not necessarily diagnostic
