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CVPR Exam I > 17. Heart Failure II - Diagnosis & Treatment > Flashcards

17. Heart Failure II - Diagnosis & Treatment Flashcards

1
Q

What is S2?

A

aortic/pulmonary valve closure

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1
Q

A right heart catheterization gives what measurements?

A

pressures (CVP/RA, RV, PA, PCWP) and flow (Fick CO- O2 consumption measure, and thermodilation CO- timed flow measure)

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2
Q

Name 3 signs of low flow in HF.

A
  1. cool extremities 2. tachycardia 3. low pulse pressure
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2
Q

What is S1?

A

the mitral/tricuspid valve closure

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3
Q

What is Acute pulmonary edema?

A
  • 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
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4
Q

An S3 gallop is thought to be caused by _____.

A

rapid expansion of the ventricular walls in early diastole

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5
Q

An S4 gallop is caused by _____.

A

atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic LV

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6
Q

Decreased cardiac output causes what symptom of HF?

A

symptoms of decreased organ perfusion

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6
Q

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.

A

jugular vein (internal and external)

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7
Q

_____ = CVP = right atrial pressure

A

JVP

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8
Q

What is a right heart catheterization?

A

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.

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9
Q

EF = ?

A

(end diastolic - end systolic volume) / end diastolic volume

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10
Q

What does an echo tell?

A

 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)

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11
Q

An _____ is caused by atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic LV.

A

S4 gallop

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12
Q

What does PND stand for?

A

Paroxysmal nocturnal dyspnea

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12
Q

By definition, what is absent in A-fib?

A

S4 gallops

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12
Q

What are 2 other names for a R heart catheterization?

A

Pulmonary Artery (PA) Catheter, or a Swan-Ganz catheter

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13
Q

Decreased cardiac output (low flow) causes what symptoms of HF?

A
  1. decreased muscle perfusion 2. decreased gut perfusion 3. decreased kidney perfusion 4. exercise intolerance
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14
Q

Name 3 signs of elevated R sided pressures.

A
  1. edema 2. hepatic congestion/hepatomegaly 3. JVD, increased central venous pressure (CVP)
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15
Q

When is an S3 gallop typical?

A

HFrEF/dilated heart

16
Q

What is a normal EF? HFrEF?

A

60%; 25%

17
Q

What is the mitral/tricuspid valve closure?

A

S1

18
Q

What is an echocardiogram?

A

an ultrasound of the heart

19
Q

What is cachexia?

A

wasting

20
Q

JVP = ____ = right atrial pressure

A

CVP

21
Q

What is NT-proBNP?

A

the N-terminus breakdown product of BNP that is increased with age and esp renal failure

23
Q

Name 5 signs of elevated L-sided filling pressures.

A
  1. rales (pulmonary crackles) 2. hypoxia 3. tachypnea 4. sitting bolt upright 5. popping open of alveoli
25
Q

What are rales? What causes them?

A

pulmonary crackles- sounds like velco being pulled apart upon inspiration- due to wet alveoli opening

26
Q

When is an S3 gallop normal? Abnormal?

A

normal: young people abnormal: after age 30

27
Q

Increased pulmonary venous pressure causes what symptom of HF?

A

breathlessness

28
Q

What is immediate SOB when lying flat because of lost venous pooling of blood in the legs?

A

orthopnea

29
Q

What is the aortic/pulmonary valve closure?

A

S2

30
Q

What is the test that is a gross measure of systolic function?

A

left ventricular ejection fraction (LVEF)

32
Q

What are the 3 major pathophys causes of HF?

A
  1. decreased cardiac output 2. increased pulmonary venous pressure 3. increased central venous pressure
34
Q

An _____ is thought to be caused by rapid expansion of the ventricular walls in early diastole.

A

S3 gallop

36
Q

Increased R sided filling pressure causes?

A

• Peripheral swelling / dependent edema • Ascites • Hepatic congestion • Intestinal congestion (protein-losing enteropathy)

37
Q

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.

A

lying flat or with JVD in HF

38
Q

Normal JVP is ____.

A

< 5 cm H2O

38
Q

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.

A

pressure changes; R atrium

39
Q

JVP = CVP = _____

A

right atrial pressure

40
Q

What is Paroxysmal nocturnal dyspnea (PND)?

A

– 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

40
Q

When is an S4 gallop typical?

A

never

42
Q

What EKG findings will be seen in HF?

A

no direct diagnosis- would infer from other findings, like Q wave abnormalities (prior MIs), increased voltage (LVH), arrhythmias, diffuse conduction

43
Q

What will be found on a chest xray in HF?

A
  • enlarged cardiac silhouette in HFrEF - increased upper lobe vascular markings with acute decompression - fluffy infiltrates of PE - plural effusions
45
Q

What are two assays used to detect natriuretic peptides in HF?

A
  1. BNP 2. NT-proBNP
46
Q

What is Orthopnea?

A

Immediate SOB when lying flat because of lost venous pooling of blood in the legs

47
Q

Increased central venous pressure causes what symptom of HF?

A

edema

48
Q

What tests are used to diagnose HF?

A

Chest Xray natriuretic peptides EKG cardiac imaging

49
Q

Does a low BNP or NT-proBNP rule in or rule out HF?

A

it would rule out- high is not necessarily diagnostic

CVPR Exam I (29 decks)

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